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COVID-19 对择期关节置换术的恢复影响有限且存在种族差异。

COVID-19 had Limited Impact on Resumption of Elective Joint Arthroplasty and Ethnic Disparities.

机构信息

Straub Medical Center, Honolulu, HI (KW, SNA, CKN).

John A Burns School of Medicine, University of Hawai'i, Honolulu, HI (KW).

出版信息

Hawaii J Health Soc Welf. 2023 Mar;82(3):59-65.

Abstract

In response to the COVID-19 pandemic, federal and state recommendations included the postponement of elective arthroplasties until adequate safety measures could be implemented. Following resumption of arthroplasties, exposure fears and financial concerns may have restricted access for some demographics. Therefore, the purpose of this study was to (1) investigate how the COVID-19 pandemic impacted the incidence of arthroplasty, both overall and by various demographics, and (2) evaluate if pre-operative patient-reported measures were different throughout the pandemic. Data were collected prospectively as part of an on-site joint registry between January 2019 and April 2021. Phase 1 (N=518) included all patients prior to the cancelation of elective procedures (average 36 cases/month), Phase 2 (N=121) was defined from restart until monthly caseload met/surpassed the average Phase 1 caseload (5 months), and Phase 3 (N=277) included all remaining cases. Multiple analysis of variance and chi-squared tests were performed to compare patient demographics and outcomes between phases. No significant differences were noted in patient demographics, with the exception of a decrease in Native Hawaiian/Pacific Islander patients and an increase in Asian patients during Phase 2 (P =.004). Length of stay decreased for unilateral arthroplasty from Phase 1 (0.9±1.1 days) to Phase 2 (0.4±0.6 days) and Phase 3 (0.6±0.7 days) (P <.001), while pre-operative patient reported outcomes remained similar across the 3 time periods. By implementing proper safety measures, the current orthopedic center achieved a timely recovery with no long-lasting inconsistencies in patient cohorts upon resumption of arthroplasties.

摘要

针对 COVID-19 大流行,联邦和州的建议包括推迟择期关节置换术,直到能够实施足够的安全措施。关节置换术恢复后,由于接触恐惧和财务问题,某些人群的手术机会可能受到限制。因此,本研究的目的是:(1) 调查 COVID-19 大流行如何影响关节置换术的发生率,包括总体发生率和各种人群的发生率;(2) 评估整个大流行期间术前患者报告的测量结果是否存在差异。数据是作为现场关节登记处的一部分,于 2019 年 1 月至 2021 年 4 月期间前瞻性收集的。第 1 阶段(N=518)包括取消择期手术前的所有患者(平均每月 36 例),第 2 阶段(N=121)从重新开始到每月病例数达到/超过第 1 阶段的平均病例数(5 个月),第 3 阶段(N=277)包括所有剩余病例。采用方差分析和卡方检验对各阶段的患者人口统计学和结果进行比较。除第 2 阶段的夏威夷原住民/太平洋岛民患者减少和亚裔患者增加(P =.004)外,患者人口统计学无显著差异。单侧关节置换术的住院时间从第 1 阶段(0.9±1.1 天)缩短到第 2 阶段(0.4±0.6 天)和第 3 阶段(0.6±0.7 天)(P <.001),而术前患者报告的结果在 3 个时间段内保持相似。通过实施适当的安全措施,目前的骨科中心在恢复关节置换术时,及时恢复且患者人群没有长期的不一致性。

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