Original Article

Adapting hip arthroplasty practices during the COVID-19 pandemic: Assessing the impact of outpatient care sudden increase on early complications and clinical outcomes

¹ Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
² LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
³ Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
⁴ Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, 235 Euston Rd., London NW1 2BU, UK
⁵ Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK

^* Corresponding author: constant.foissey@chu-lyon.fr

Received: 26 October 2023
Accepted: 8 December 2023

Abstract

Introduction: The COVID-19 pandemic has significantly affected access to timely care for patients with hip osteoarthritis requiring total hip replacement (THR). This study aimed to assess the changes in surgical activity, outpatient treatment, length of stay (LOS), discharge destinations, readmission rates, clinical outcomes, and patient satisfaction before and after the pandemic at our institution. Materials and methods: This retrospective study encompassed patients undergoing primary THR through the direct anterior approach at a single university hospital. Data on demographic characteristics, surgical technique, perioperative management, LOS, discharge destinations, complications, and clinical outcomes were collected. Furthermore, a comparative analysis between the pre-pandemic (2019) and post-pandemic (2022) periods was conducted. Results: There was a 14% increase in surgical activity post-pandemic, with 214 patients undergoing surgery in 2019 versus 284 in 2022. The percentage of patients managed as outpatients significantly increased from 0.5% in 2019 to 29.6% in 2022 (p < 0.001). LOS decreased from 2.7 ± 1 [0–8] days to 1.4 ± 1.1 [0–12] days (p < 0.001), and the rate of discharge to rehabilitation centres declined from 21.5% to 8.8% (p < 0.001). No significant increase in the readmission rates was observed (1.4% in both periods). At two months postoperatively, the mean HHS and satisfaction rates were comparable between the two groups (p = 1 and p = 0.73, respectively). Discussion: Despite the challenges posed by the COVID-19 pandemic, surgical activity at our institution demonstrated an increase compared to the pre-pandemic levels by expanding outpatient care, reducing LOS, and increasing rates of home discharges. Importantly, these changes did not adversely affect rehospitalization rates or early clinical outcomes.

Level of evidence: IV