key: cord-0808027-alowbibu
authors: Bedard, Nicholas A.; Elkins, Jacob M.; Brown, Timothy S.
title: Effect of COVID-19 on Hip and Knee Arthroplasty Surgical Volume in the United States
date: 2020-04-24
journal: J Arthroplasty
DOI: 10.1016/j.arth.2020.04.060
sha: 4b8ba7af97af7acbe612019739ce55601eddd6ac
doc_id: 808027
cord_uid: alowbibu

Abstract In an effort to help combat the COVID-19 pandemic and preserve essential healthcare resources, starting in mid-March 2020, surgeons have been instructed to only perform essential surgical procedures during this time. The vast majority of hip and knee arthroplasty surgery does not meet the definition of essential surgery. This study estimated the number of arthroplasty procedures that would be canceled due to these important restrictions. We estimated that approximately 30,000 primary and 3,000 revision hip and knee arthroplasty procedures will be canceled each week while COVID-19 restrictions regarding non-essential surgery are in place. This large number of canceled procedures will undoubtedly have a profound impact on patients and the healthcare system.

In an effort to help combat the SARS-CoV-2 (COVID-19) pandemic, minimize the 15 burden on the healthcare system and preserve essential healthcare resources needed to care for 16 patients infected with COVID-19, the American College of Surgeons (ACS) and the Centers for procedures starting mid-March 2020. The majority of states have followed with similar 19 guidelines [1] . Although definitions of "elective" or "non-essential" surgery vary across pandemic. However, this mandated reduction of non-essential surgical procedures will have a 27 profound impact on the healthcare system [2]. Furthermore, given that hip and knee arthroplasty 28 compromise a substantial share of the surgical volume in the United States (US), there is no 29 doubt these policies are hard felt by hip and knee arthroplasty patients and the providers and 30 institutions that care for them. The purpose of this study was to estimate 1) the number of 31 primary hip and knee arthroplasty procedures canceled due to COVID-19 and 2) the number of 32 revision hip and knee arthroplasty procedure canceled due to COVID-19 in order to better 33 understand the effect of COVID-19 on hip and knee arthroplasty surgical volume in the US. The availability of current national procedural data is quite limited in the US. Therefore, 

In general, the recommendations/mandates from various states, CMS, and ACS specified 53 that surgeons only perform "essential" surgical procedures and to postpone or cancel "non-54 essential" surgery [1] . Although definitions for essential and non-essential surgical procedures 55 are either not defined or vary across published guidelines [1] , for the purposes of this study the 56 following arthroplasty procedures were assumed to fall under a general definition of "essential" knee arthroplasty procedures being canceled in a given month due to COVID-19. We hope that 178 these estimates help policy makers, administrators, healthcare providers and patients better 179 understand the impact COVID-19 is having on the hip and knee arthroplasty community and our 180 patients as we all work together to combat this pandemic. 

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