The impact of COVID-19 lockdown restrictions on emergency and elective hip surgeries

Abstract

Purpose: The coronavirus disease 2019 (COVID-19) emerged late 2019 and rapidly spread in a global pandemic causing over 1 million deaths by October 2020 National lockdown measures are believed to dramatically have limited the spread of the virus globally, but on the other side, may have had several unknown negative side effects on the planned and acute care for vulnerable groups In this study, we aimed to assess the effects of COVID-19 pandemic lockdown restrictions on the number of emergency and elective hip joint surgeries due to fractures and osteoarthritis (OA), respectively, and explore whether these procedures are more/less affected by lockdown restrictions than other hospital care Methods: In 1 344 355 persons aged ≥35 years in the Norwegian emergency preparedness (BEREDT C19) register, we studied the daily number of persons having 1) electively planned surgeries due to hip OA, and 2) emergency surgeries due to hip fractures before and after COVID-19 lockdown restrictions were implemented nationally on March 13th 2020, for different age and sex groups We also studied the daily number of all-cause elective- and all-cause emergency hospitalizations (>24 hours) For all our outcomes, we categorized dates in five 2-weeks periods before lockdown (March 13th 2020), and five 2-weeks periods after lockdown, covering a total time period from January 3rd 2020 to May 21st 2020 To observe trends in number of events over time, we compared the incidence rate ratios (IRR) for all the 2-week periods with the base level, which was defined as the two first weeks of January We also compared IRR in the 10 weeks before and after lockdown restrictions were implemented, using the entire period of 10 weeks before lockdown as base level (Jan 3rd-March 12th) The IRRs reflect the after-lockdown number of events divided by the before-lockdown number events Results: The IRRs for all the 2-weeks periods, for elective and emergency hip surgeries are presented in the Figure, indicating a large and consistent decrease in hip OA surgeries and a smaller but more age- and sex-dependent decrease in hip fracture surgeries More specifically, for the two 10-weeks periods before and after lockdown, we observed that the number of after-lockdown elective hip surgeries due to OA were one third of the number of before-lockdown elective hip surgeries due to OA, and the drop was similar for men and women above and below 70 years (IRR ∼0 3) This drop for hip OA surgeries was greater than the drop seen for all-cause elective hospital care (IRR ∼0 6, 95% CI=0 6-0 6) In contrast, the number of emergency hip fracture surgeries had a drop of a similar magnitude as that observed for all-cause emergency care (IRR=0 8, 95% CI=0 8-0 8) However, there were age and sex differences in the magnitude of the drop Men aged 35-69 had close to half the number of surgeries (IRR ∼0 6, 95% CI=0 6-0 6), whereas women aged ≥70 had the same number of emergency hip fracture surgeries after lockdown (IRR ∼1, 95% CI = 1-1) Only women aged 35-69 and men aged ≥70 had emergency hip fracture surgery rates after lockdown comparable to what may be expected based on analyses of all-cause acute care (IRR ∼0 8, 95% CI=0 8-0 8) Conclusions: We report a sudden and steep decrease in the daily number of planned hip joint surgeries due to OA, beginning on the day after lockdown restrictions were implemented in Norway on March 13th 2020 This decrease was greater than the decrease in other (all-cause) elective inpatient care for all age and sex groups Interestingly, we also report a consistent decrease of all-cause emergency inpatient care that only partly was found in age- and sex-specific analyses of emergency hip joint fracture surgeries We believe these findings are important to report for an improved knowledge foundation allowing for an optimal management of future pandemics of a similar or larger scale [Formula presented]