Quantifying the Impact of COVID-19 on Hand and Wrist Surgery Procedural Volume: A National Analysis of 381,046 Cases

Abstract

The purpose of this study is to quantify and describe the impact of the COVID-19 pandemic on procedural volume trends in hand and wrist surgery in 2020 through early 2022 at multiple centers. In this retrospective comparative study, a real-time, national, federated research database was utilized to identify patients of interest from 56 healthcare organizations across the United States. Patients were queried from March 1, 2018, through February 28, 2022. Current Procedural Terminology (CPT) codes were chosen using the Accreditation Council for Graduate Medical Education's Hand Fellowship procedure requirements. Common hand and wrist surgeries exhibited substantial fluctuations in procedural volume per healthcare organization during the COVID-19 pandemic. Time periods with considerable procedural volume decreases corresponded with surges of increased COVID-19 caseloads and the emergence of COVID-19 variants. Periods of procedural volume increase occurred in summer 2020 as well as immediately following distribution of the COVID-19 vaccine to the general public. Fixation of metacarpal fracture, fixation of phalangeal fracture, tendon transfer, flexor tendon repair, and extensor tendon repair consistently showed decreased volumes over the study period. In contrast, ulnar nerve decompression was the only procedure to experience a statistically significant increase in volume over an entire year (2021) as compared to before the pandemic. Major milestones of the COVID-19 pandemic correlated with fluctuations in the number of hand and wrist procedures performed across the United States. Future studies should seek to evaluate the impact of patient backlogs and individual procedure fluctuations on financial impacts, patient outcomes, and orthopaedic trainee experience.