key: cord-0976458-eofp7pnj authors: Silvestre, Jason; Thompson, Terry L.; Nelson, Charles L. title: The Impact of COVID-19 on Total Joint Arthroplasty Fellowship Training date: 2022-04-04 journal: J Arthroplasty DOI: 10.1016/j.arth.2022.03.083 sha: 4f266ce961093d87821ebee5c0bce2dffaefad47 doc_id: 976458 cord_uid: eofp7pnj BACKGROUND: COVID-19 created unprecedented challenges in surgical training especially in specialties with high elective case volume. We hypothesized that case volume during total joint arthroplasty fellowship training would decrease by 25% given widespread economic shutdowns encountered during the fourth quarter of the 2019-2020 academic year. METHODS: Case logs from the Accreditation Council for Graduate Medical Education were obtained for accredited during total joint arthroplasty fellowships (2017-2018 to 2020-2021). Case volumes were extracted and summarized as means ± SD. Student’s t tests were used for inter-year comparisons. RESULTS: 183 arthroplasty fellows from 24 accredited fellowships were included. There was a 14% year-over-year decrease in total case volume during the 2019-2020 academic year (390 ± 108 vs 453 ± 128, p<0.001). Case volume rebounded during the 2020-2021 academic year to 465 ± 93 (19% increase, p<0.001). Case categories with the most significant percentage declines in 2019-2020 were primary total knee arthroplasty (TKA, -23%), revision total hip arthroplasty (THA, -19%), revision TKA (rTKA, -11%), and primary THA (-10%). CONCLUSION: There was a 14% overall decrease in arthroplasty case volume during the 2019-2020 academic year, which correlated with the widespread economic shutdowns during the COVID-19 pandemic. Certain elective case categories like Primary TKA experienced the greatest negative impact. Results from this study may inform prospective trainees and faculty during future national emergencies. volume and clinical outcomes in total joint arthroplasty [16] [17] [18] [19] [20] [21] [22] [23] , the stakes are especially high for 47 total joint arthroplasty fellows who must refine operative skills for complex cases 48 encountered during autonomous practice. 49 Given the high percentage of elective cases in adult reconstructive orthopedics, we 50 hypothesized that total joint arthroplasty fellows would report significantly less cases during the The ACGME defines case categories for total joint arthroplasty fellowships 71 (Supplemental Table 1 ). For the 2017 academic year, case categories were refined from generic 72 case categories used for orthopedic residency to more granular case categories for total joint 73 arthroplasty fellowships. As such, temporal analyses were limited from 2017-2018 to 2020-2021 74 to facilitate multi-year comparisons. The independent variable was academic year and the dependent variable was reported 76 case volume. We hypothesized that the 2019-2020 academic year would experience an 77 approximate 25% reduction in reported case volume corresponding to the widespread economic 87 132 total joint arthroplasty fellows were included in this study (Table 1) Elective surgeries were widely discontinued during the initial outbreak of the COVID-19 105 pandemic, thus negatively impacting operative training for orthopedic surgery residents and 106 fellows [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] . This study demonstrated that total joint arthroplasty fellows reported an 107 approximate 14% reduction in case volume during the 2019-2020 academic year, which was less 108 than the anticipated 25% reduction. The greatest negative change was observed for primary TKA understand the impact of COVID-19 on reported case volume during total joint arthroplasty 136 fellowship training and propose methods to address these challenges. The issue of procedure volume is total joint arthroplasty is a critical one facing 138 orthopedic fellows, faculty, and the general public. In a multi-institutional study, higher surgeon 139 volume was associated with a lower risk of complications including lower readmission rates, There were several limitations to this study. First and foremost, only ACGME accredited 162 fellowships were included in this study. There are many non-accredited fellowships, but overall 163 orthopedic subspecialty fellowship training has been trending towards ACGME accreditation 164 [24]. Second, data are summarized by academic year, which typically begins the first week of 165 July. More granular weekly or monthly data are not released by the ACGME. However, we were 166 interested in understanding the impact of COVID-19 on total annual case volume during joint 167 arthroplasty fellowship training. Third, ACGME case logs are self-reported and susceptible to 168 bias and mis-reporting [30] [31] . However, given the increasing importance of accuracy for these 169 case logs in accreditation and job placement after fellowship, there is high scrutiny on this data. Fourth, while the number of ACGME accredited programs remains largely stable from year-to- year, small changes occur as programs gain and lose accreditation. In our sample, this amounted Table 1 ); red bubbles indicate decreases in reported case volume in 2019-306 Arthroscopy, shoulder, surgical; biceps tenodesis Bony Procedures for Shoulder Instability 23460 Capsulorrhaphy, anterior, any type Capsulorrhaphy, anterior, any type Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block Soft Tissue Procedures for Shoulder Instability 23455 Capsulorrhaphy, glenohumeral joint, any type multi-directional instability 29806 Arthroscopy, shoulder, surgical; capsulorrhaphy Open Acromioplasty 23130 Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release Other Upper Limb Arthroscopic Procedures 29807 Arthroscopy with repair of slap lesion 29824 Arthroscopy, shoulder, surgical; distal claviculectomy, including distal articular surface shoulder, surgical; decompression of subacromial space with partial acromioplasty Arthroscopy, shoulder, surgical Arthroscopy, elbow, diagnostic, with or without synovial biopsy (separate procedure Arthroscopy, elbow, surgical, with removal of loose body or foreign body 29835 elbow, surgical; synovectomy, partial 29836 Arthroscopy, elbow, surgical; synovectomy, complete 29837 Arthroscopy, elbow, surgical; debridement, limited 29838 Arthroscopy, elbow, surgical; debridement Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure wrist, surgical; for infection, lavage and drainage 29844 wrist, surgical; synovectomy, partial 29845 Arthroscopy, wrist, surgical; synovectomy wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridement wrist, surgical; internal fixation for fracture or instability