Effect of Institution and COVID-19 on Access to Adult Arthroplasty Surgery.

Kylen K.J Soriano,Paul Toogood

doi:10.1016/j.artd.2022.01.027

Kylen K.J Soriano, Paul Toogood

Open Access

https://doi.org/10.1016/j.artd.2022.01.027

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Journal: Arthroplasty Today	Publication Date: Jan 24, 2022
Citations: 3	License type: cc-by

Affiliation: University of California, San Francisco

Abstract

BackgroundAlthough insurance status is important to patients’ ability to access care, it varies significantly by race, age, and socioeconomic status. Novel coronavirus disease 2019 (COVID-19) negatively impacted access to care, while simultaneously widening pre-existing health-care disparities. The purpose of the present study was to document this phenomena within orthopedics.MethodsPatients undergoing hip or knee arthroplasty at two medical centers in San Francisco, California, were evaluated. One cohort came from the University of California San Francisco (UCSF), a tertiary center, and the other from Zuckerberg San Francisco General Hospital (ZSFGH), a safety-net hospital. Patients who underwent arthroplasty before the pandemic (March 2020) and those after pandemic declaration were evaluated. Patient demographics, surgical wait times, and operative volumes were compared.ResultsTwo-hundred sixty-nine (pre-COVID, 184; post-COVID, 85) cases at UCSF and 63 (pre-COVID, 47; post-COVID, 16) cases at ZSFGH met inclusion criteria. Patients at ZSFGH had a significantly higher body mass index, were more often racial minorities, and were less likely to speak English. Patients at ZSFGH were less likely to have private insurance. A comparison of case volumes showed a larger decrease at ZSFGH than at UCSF after COVID. Wait times between the two sites before and after COVID showed a larger increase in wait times at ZSFGH. Notably, wait times at ZSFGH before COVID were more than double the wait times at UCSF after COVID.ConclusionsCOVID-19 worsened access to primary hip and knee arthroplasties at two academic medical centers in San Francisco. The pandemic also worsened pre-existing disparities. Racial minorities, non-English speakers, and those with nonprivate insurance were affected the most.

Highlights

Insurance status is a well-known predictor of patients’ ability to access medical care in the United States [1]
By the time COVID-19 was declared a pandemic by the World Health Organization [13], recommendations had been made by the American College of Surgeons [14], the Centers for Disease Control [15], and the American Academy of Orthopedic Surgeons [16] to postpone all elective surgical cases
Rates of elective procedures, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA), decreased dramatically across the United States beginning in March 2020

Summary

Introduction

Insurance status is a well-known predictor of patients’ ability to access medical care in the United States [1]. Lower rates of provider reimbursement, onerous paperwork, and increasing clinical complexity and comorbidities associated with Medicaid-insured patients have all been hypothesized to contribute [6]. These disparities in access have been well documented not just in primary. Studies have focused on the novel coronavirus disease 2019 (COVID-19) pandemic and its effects on access to medical care [12]. Methods: Patients undergoing hip or knee arthroplasty at two medical centers in San Francisco, California, were evaluated. Conclusions: COVID-19 worsened access to primary hip and knee arthroplasties at two academic medical centers in San Francisco.

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