The influence of COVID-19 epidemic on the number of orthopaedic surgeries in Japan

Koji Yamada; Tomohiro Shinozaki; Junji Ito; Susumu Nakajima; Koichi Nakagawa; Takeo Furuya; Kanichiro Wada; Naomi Kobayashi; Naoto Shiba; Yoshitomo Kajino; Naohiro Kawamura; Daisuke Hamada; Yasunori Tome; Akira Nishimoto; Toshinori Sakai; Kazutoshi Hasegawa; Yuki Iijima; Katsushi Takeshita; Yasuharu Nakashima; Committee on Patient Safety and Infection Control, Japanese Orthopaedic Associationus

doi:10.1016/j.jos.2023.08.016

The influence of COVID-19 epidemic on the number of orthopaedic surgeries in Japan

J Orthop Sci. 2023 Oct 18:S0949-2658(23)00255-5. doi: 10.1016/j.jos.2023.08.016. Online ahead of print.

Authors

Koji Yamada¹, Tomohiro Shinozaki², Junji Ito³, Susumu Nakajima⁴, Koichi Nakagawa⁵, Takeo Furuya⁶, Kanichiro Wada⁷, Naomi Kobayashi⁸, Naoto Shiba⁹, Yoshitomo Kajino¹⁰, Naohiro Kawamura¹¹, Daisuke Hamada¹², Yasunori Tome¹³, Akira Nishimoto¹⁴, Toshinori Sakai¹², Kazutoshi Hasegawa¹⁵, Yuki Iijima¹⁶, Katsushi Takeshita¹⁶, Yasuharu Nakashima¹⁷; Committee on Patient Safety and Infection Control, Japanese Orthopaedic Associationus

Affiliations

¹ Department of Orthopaedic Surgery, Nakanoshima Orthopaedics, Kanagawa, Japan. Electronic address: kyamadaortho-tky@umin.ac.jp.
² Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan.
³ Department of Orthopaedic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan.
⁴ Department of Patient Safety, Toranomon Hospital, Tokyo, Japan.
⁵ Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Chiba, Japan.
⁶ Department of Orthopaedic Surgery, Chiba University Hospital, Chiba, Japan.
⁷ Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan.
⁸ Department of Orthopaedic Surgery, Yokohama City University Medical Center, Kanagawa, Japan.
⁹ Department of Orthopaedic Surgery, Kurume University Hospital, Fukuoka, Japan.
¹⁰ Department of Orthopedic Surgery, Kanazawa University School of Medical Sciences, Ishikawa, Japan.
¹¹ Department of Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
¹² Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan.
¹³ Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
¹⁴ Department of Orthopaedic Surgery, Nishimoto Hospital, Ehime, Japan.
¹⁵ Department of Orthopaedic Surgery, Hasegawa Hospital, Chiba, Japan.
¹⁶ Department of Orthopaedic Surgery, Jichi Medical University Hospital, Tochigi, Japan.
¹⁷ Department of Orthopaedic Surgery, Kyushu University Hospital, Fukuoka, Japan.

PMID: 37863684
DOI: 10.1016/j.jos.2023.08.016

Abstract

Background: There is limited data on the impact of COVID-19 epidemic on the number of orthopaedic surgeries in Japan.

Methods: We conducted a nationwide hospital survey asking for the monthly number of orthopaedic surgeries performed at each facility from January 2019 to June 2021. Those facilities that had performed at least 100 surgeries in 2019 were included for analyses. The facilities were further grouped by prefecture and by hospital characteristics. A brief health economic evaluation was also performed. Risk ratios were compared using univariate analyses with P < 0.05 considered statistically significant.

Results: Questionnaire was sent to 1988 hospitals with 1671 hospitals (84%) responding. The survey data indicated a total number of orthopaedic surgeries decreased in 2020 compared to 2019 (1,061,541 vs 1,119,955 P < 0.01), and also for the first six months of 2021 compared to the same period in 2019 (530,388 vs 550,378 P < 0.01). In 2020, over 50% of all facilities in nearly all of the prefectures saw a decline in surgical procedures. The risk of incurring more than a 25% decease in the number of surgeries was significantly higher in 2020 for class I designated medical institutions compared to those that were not designated for any types of infectious diseases among the institutions with a tertiary emergency medical center in 2020 (crude risk ratio 2.9: 95% CI 1.2-7.4, p = 0.02) and in 2021 (crude risk ratio 4.7: 95% CI 1 0.9-12.1, p < 0.01). The estimated total nationwide decrease of revenue were in the range of approximately ¥29.2 to ¥116.8 billion per year for orthopaedic surgeries alone.

Conclusion: There was a statistically significant decrease in the number of orthopaedic surgeries in Japan. The magnitude of the decline varied by prefectures and hospital characteristics, with the greater impact imposed on medical institutions with higher classification functions. The estimated immediate health economic impact was sizable.

Keywords: COVID-19; Health economic evaluation; Japan; Orthopaedic surgery.