Pietrzak Jurek Rafal Tomasz, Maharaj Zia, Erasmus Magdalena, Sikhauli Nkhodiseni, Cakic Josip Nenad, Mokete Lipalo
Department of Orthopaedics, University of the Witwatersrand, Johannesburg 2193, Gauteng, South Africa.
Department of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, Gauteng, South Africa.
World J Orthop. 2021 Mar 18;12(3):152-168. doi: 10.5312/wjo.v12.i3.152.
Elective total joint arthroplasty (TJA) procedures have been postponed as part of the coronavirus disease 2019 (COVID-19) response to avert healthcare system collapse. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures comprise the highest volume of elective procedures performed at health care facilities worldwide.
To determine the demand for TJA despite the pandemic and the impact of surgery postponement on physical and mental health.
We conducted a prospective cross-sectional telephonic interview-based study on patients awaiting THA and TKA at an academic institution in South Africa. The questionnaire consisted of four sections. The first section recorded baseline demographic data and medical co-morbidities, the length of time spent awaiting TJA, and the patients' desire to undergo elective surgery despite the COVID-19 pandemic. Section 2 and Section 3 assessed the patients' current physical and mental health, respectively, as a consequence of deferred surgical intervention. The last section established the patients' perception of the healthcare system's response to the COVID-19 pandemic and necessity to postpone elective surgery. Patients received counseling and education on the current state of surgery during the COVID-19 pandemic and associated risks. Thereafter, patients were once again asked about their desire to undergo TJA during the COVID-19 pandemic.
We included 185 patients (65.95% female; mean age: 50.28 years) awaiting TJA for a mean of 26.42 ± 30.1 mo. Overall, 88.65% of patients wanted TJA despite the COVID-19 pandemic. Patients awaiting TJA for 1-3 years were 3.3-fold more likely to want surgery than those waiting < 1 year ( < 0.000). Patients with comorbidities were 8.4-fold less likely to want TJA than those with no comorbidities ( = 0.013). After receiving education, the patients wanting TJA decreased to 54.05%. Patients who changed their opinion after education had less insight on the increased morbidity ( = 0.046) and mortality ( = 0.001) associated with COVID-19. Despite awaiting TJA for shorter period (24.7 ± 20.38 mo), patients who continued to demand TJA had greater pain ( < 0.000) and decreased function ( = 0.043) since TJA postponement.
There is deterioration in health for patients, who have had elective procedures postponed during the COVID-19 pandemic. Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.
作为2019冠状病毒病（COVID-19）应对措施的一部分，择期全关节置换术（TJA）已被推迟，以避免医疗系统崩溃。全髋关节置换术（THA）和全膝关节置换术（TKA）是全球医疗机构中开展数量最多的择期手术。
确定尽管存在疫情，TJA的需求情况以及手术推迟对身心健康的影响。
我们在南非一家学术机构对等待THA和TKA的患者进行了一项基于电话访谈的前瞻性横断面研究。问卷由四个部分组成。第一部分记录基线人口统计学数据和合并症、等待TJA的时间长度，以及患者在COVID-19大流行期间接受择期手术的意愿。第二部分和第三部分分别评估由于手术干预推迟导致的患者当前身心健康状况。最后一部分确定患者对医疗系统应对COVID-19大流行的看法以及推迟择期手术的必要性。在COVID-19大流行期间，患者接受了关于当前手术状态及相关风险的咨询和教育。此后，再次询问患者在COVID-19大流行期间接受TJA的意愿。
我们纳入了185例等待TJA的患者（女性占65.95%；平均年龄：50.28岁），平均等待时间为26.42±30.1个月。总体而言，88.65%的患者尽管处于COVID-19大流行期间仍希望接受TJA。等待TJA 1 - 3年的患者接受手术的意愿是等待时间<1年患者的3.3倍（<0.000）。有合并症的患者接受TJA的意愿比无合并症的患者低8.4倍（=0.013）。接受教育后，希望接受TJA手术的患者比例降至54.05%。教育后改变想法的患者对COVID-19相关发病率增加（=0.046）和死亡率增加（=0.001）的认识不足。尽管等待TJA的时间较短（24.7±20.38个月），但自TJA推迟以来，仍要求手术的患者疼痛更严重（<0.000），功能下降（=0.043）。
在COVID-19大流行期间接受择期手术推迟的患者健康状况恶化。在重新启动择期手术时，应根据紧迫性对等待名单进行优先排序。
