Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, United Kingdom.
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom.
PLoS One. 2023 Nov 29;18(11):e0294304. doi: 10.1371/journal.pone.0294304. eCollection 2023.
Elective hip and knee replacement operations were suspended in April 2020 due to the COVID-19 pandemic. The impact of this suspension and continued disruption to the delivery of joint replacement surgery is still emerging. We describe the impact of the pandemic on the provision of publicly funded elective hip and knee replacement surgery at one teaching hospital in England and on which patients had surgery.
We included all elective primary and revision hip and knee replacements performed at one hospital between January 2016 and June 2021. Using data for the years 2016-2019, we estimated the expected number of operations and beds occupied per month in January 2020 to June 2021 using time series linear models (adjusting for season and trend). We compared the predictions with the real data for January 2020 to June 2021 to assess the impact of the pandemic on the provision of elective hip and knee replacements. We compared the length of stay and characteristics (age, gender, number of comorbidities, index of multiple deprivation) of patients who had surgery before the pandemic with those who had surgery during the pandemic.
We included 6,964 elective primary and revision hip and knee replacements between January 2016 and June 2021. Between January 2020 and June 2021 primary hip replacement volume was 59% of predicted, and 47% for primary knee replacements. Revision hip replacement volume was 77% of predicted, and 42% for revision knee replacement. Median length of stay was one day shorter for primary (4 vs 3 days) and revision (6 vs 5 days) operations during the pandemic compared with before. Patients operated on during the pandemic were younger and had slightly more comorbidities than those operated on before the pandemic.
The restricted provision of elective hip and knee replacements during the COVID-19 pandemic changed the patient casemix, but did not introduce new inequalities in access to these operations. Patients were younger, had more comorbidities, and stayed in hospital for less time than those treated before the pandemic. Approximately half the number of operations were performed during the pandemic than would have been expected and the effect was greatest for revision knee replacements.
由于 COVID-19 大流行，2020 年4 月暂停了择期髋关节和膝关节置换手术。这种暂停以及对关节置换手术的持续干扰的影响仍在显现。我们描述了大流行对英格兰一所教学医院提供的公共资助的择期髋关节和膝关节置换手术的影响，以及进行手术的患者情况。
我们纳入了 2016 年 1 月至 2021 年 6 月期间在一家医院进行的所有择期初次和翻修髋关节和膝关节置换手术。使用 2016-2019 年的数据，我们使用时间序列线性模型（调整季节和趋势）估计 2020 年 1 月至 2021 年 6 月期间每月的预期手术数量和占用床位数量。我们将预测值与 2020 年 1 月至 2021 年 6 月的实际数据进行比较，以评估大流行对择期髋关节和膝关节置换手术的提供情况的影响。我们比较了大流行前和大流行期间接受手术的患者的住院时间和特征（年龄、性别、共病数量、多重剥夺指数）。
我们纳入了 2016 年 1 月至 2021 年 6 月期间的 6964 例择期初次和翻修髋关节和膝关节置换手术。2020 年 1 月至 2021 年 6 月期间，初次髋关节置换手术量为预测量的 59%，初次膝关节置换手术量为预测量的 47%。翻修髋关节置换手术量为预测量的 77%，翻修膝关节置换手术量为预测量的 42%。与大流行前相比，大流行期间初次（4 天对 3 天）和翻修（6 天对 5 天）手术的中位住院时间缩短了一天。在大流行期间接受手术的患者比大流行前接受手术的患者年龄更小，共病数量略多。
COVID-19 大流行期间选择性髋关节和膝关节置换手术的供应受限改变了患者的病例组合，但在获得这些手术方面并未引入新的不平等。在大流行期间接受手术的患者比大流行前接受手术的患者更年轻，共病更多，住院时间更短。大流行期间进行的手术数量约为预期数量的一半，对翻修膝关节置换手术的影响最大。
