Department of Medical Innovation and Research, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Cadet Company One, Graduate School of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Front Public Health. 2024 Oct 15;12:1357984. doi: 10.3389/fpubh.2024.1357984. eCollection 2024.
The COVID-19 pandemic has profoundly affected the care practices of total joint arthroplasty (TJA) throughout the world. However, the impact of the pandemic on TJA care practices has not yet been studied in China.
This retrospective multicenter cohort included patients aged 18 years or older who underwent TJA between January 2019 and December 2019 (prepandemic period) and January 2020 to December 2021 (pandemic period). Data were obtained from the medical records of 17 Chinese hospitals. Interrupted time series (ITS) analysis was used to estimate differences in monthly TJA volume, hospitalization proportion of TJA, preoperative characteristics, postoperative complications, 30-day readmissions, length of stay (LOS), and costs in inpatients undergoing TJA between the prepandemic and pandemic periods. Multivariate regression and propensity score matching (PSM) analyses were used to assess the impact of the COVID-19 pandemic on hospital complications, readmissions at 30 days, LOS, and costs at the patient level.
A total of 752,477 inpatients undergoing TJA in the prepandemic period, 1,291,248 in the pandemic period, with an average 13.1% yearly decrease in the volume of TJA during the pandemic. No significant changes were observed in the proportion of hospitalizations for TJA. ITS analyses showed increases in the proportion of comorbidities (8.5%, 95% CI: 3.4-14.0%) and the number of comorbidities (15.6%, 95% CI: 7.7-24.1%) in TJA cases during the pandemic, without increasing LOS, costs, complications, and readmission rates. Multivariate and PSM analyses showed 6% and 26% reductions in costs and readmission rates during the pandemic, respectively.
The COVID-19 pandemic was associated with more severe preoperative conditions and decreased volume, costs, and readmission rates in patients undergoing TJA in China. These findings demonstrate that the COVID-19 pandemic did not have a dramatic impact on the TJA care pattern in China, which may have resulted from active and strict strategies in combating COVID-19 as well as a rapid response in hospital management.
COVID-19 大流行深刻影响了全球范围内的全关节置换术（TJA）的治疗实践。然而，大流行对 TJA 治疗实践的影响在中国尚未得到研究。
本回顾性多中心队列纳入了 2019 年 1 月至 2019 年 12 月（大流行前）和 2020 年 1 月至 2021 年 12 月（大流行期间）在中国 17 家医院接受 TJA 的年龄 18 岁及以上的患者。数据来自 17 家中国医院的病历。采用中断时间序列（ITS）分析估计大流行前和大流行期间每月 TJA 量、TJA 住院比例、术前特征、术后并发症、30 天再入院、住院时间（LOS）和住院患者费用的差异。采用多变量回归和倾向评分匹配（PSM）分析评估 COVID-19 大流行对患者层面医院并发症、30 天再入院、LOS 和费用的影响。
大流行前共纳入 752477 例 TJA 住院患者，大流行期间纳入 1291248 例，TJA 量平均每年下降 13.1%。TJA 住院比例无显著变化。ITS 分析显示，大流行期间 TJA 病例合并症比例（8.5%，95%CI：3.4-14.0%）和合并症数量（15.6%，95%CI：7.7-24.1%）增加，但 LOS、费用、并发症和再入院率没有增加。多变量和 PSM 分析显示，大流行期间费用和再入院率分别降低了 6%和 26%。
COVID-19 大流行与中国接受 TJA 治疗的患者术前病情加重、TJA 量、费用和再入院率下降有关。这些发现表明，COVID-19 大流行并未对中国的 TJA 治疗模式产生重大影响，这可能是由于中国积极、严格的 COVID-19 防控策略以及医院管理的快速反应所致。
