Impact of COVID-19 on inpatient anatomic, reverse and hemi shoulder arthroplasty case volume in the United States

Abstract

BackgroundDespite known surgical volume reductions in 2020 during the height of the COVID-19 pandemic, no studies have quantified the impact of the pandemic on the number of inpatient anatomic total shoulder arthroplasty (aTSA), reverse total shoulder arthroplasty (rTSA) and hemiarthroplasty cases. The purpose of this study is to analyze the impact of COVID-19 on aTSA, rTSA and hemiarthroplasty case volumes in the United States. MethodsThe Premier Health-care Database was used to identify adults undergoing primary inpatient aTSA, rTSA and hemiarthroplasty from January 2017 to December 2020. Patients undergoing revision total shoulder arthroplasty surgery were excluded. The monthly case volume variance in 2020 was calculated by subtracting the 2017-2019 monthly mean from each respective monthly mean in 2020. Differences in patient and hospital characteristics between subgroups were analyzed using analysis of variance for continuous variables and chi-squared for categorical variables. All statistical analysis was done using STATA (version 17BE; StataCorp LLC, College Station, TX, USA). ResultsA total of 127,496 cases were identified using the Premier Healthcare Database from January 2017 to December 2020. Anatomic TSA accounted for 30.67% of all cases, rTSA represented 63.55%, and hemiarthroplasty accounted for 5.78%. A precipitous decline in cases was observed in March and April of 2020, with aTSA declining by 97%, rTSA declining by 83% and hemiarthroplasty declining by 77% from their prepandemic monthly averages. Cases rebounded in May and peaked by June (rTSA and hemiarthroplasty) or July (aTSA). Cases slightly declined in August, rebounded in September, and declined again at the end of the year. The average length of stay in 2020 was slightly longer for aTSA (1.87 to 2.12 days, P < .0001) and hemiarthroplasty (2.08 to 2.49 days, P = .0021), but slightly shorter for rTSA (1.92 to 1.64 days, P < .0001). We estimated that a total of 29,951 cases were performed in 2020, representing a 7.8% decrease compared with the average from 2017 through 2019, with roughly 2564 patients either delayed or unable to undergo arthroplasty in 2020. ConclusionBased on data from the Premier database, COVID-19 had a negative impact on the case volume of inpatient shoulder replacement (aTSA, rTSA and hemiarthroplasty) surgery in the United States. By the end of 2020, rTSA cases had returned to its monthly average in the years preceding the pandemic, while aTSA and hemiarthroplasty recovered to roughly 75% of their prepandemic case volumes.