Comparison of total joint arthroplasty care patterns prior to the Covid-19 pandemic and after resumption of elective surgery during the Covid-19 Outbreak: A retrospective, large urban academic center study

Background: After the suspension of elective surgeries was lifted in June 2020 in New York State, challenges remained regarding coordination of total joint arthroplasty (TJA) cases. Using the experience from a high-volume health system in New York City, we aimed to describe patterns of care after resumption of elective TJA. Methods: We retrospectively assessed 7,699 TJAs performed before and during the COVID-19 pandemic. Perioperative characteristics and clinical outcomes were compared between TJAs based on time period of performance: 1) pre-pandemic (PP, June 8th–December 8th, 2019), 2) initial period post-resumption of elective surgeries (IR, June 8th–September 8th, 2020), and 3) later period post-resumption (LR, September 9th–December 8th, 2020). Results: LOS > 2 days (83%, 67%, 70% for PP, IR, LR periods respectively) and discharge rates to post-acute care (PAC) facilities were lower during the pandemic periods (OR_{IR vs. PP}: 0.48, 95% CI: 0.40–0.59, p < 0.001; OR_{LR vs. PP}: 0.63, 95% CI: 0.53–0.75, p < 0.001). Compared to the pre-pandemic period, the risk for 30-day readmission was lower during the IR period (OR: 0.62, 95% CI: 0.40–0.98, p = 0.041) and similar during the LR period (OR: 0.96, 95% CI: 0.65–1.41, p = 0.832). Conclusions: Despite decreased LOS and discharge to PAC for TJAs performed during the pandemic, 30-day readmissions did not increase. Given the increased costs and lack of superior functional outcomes associated with discharge to PAC, these findings suggest that discharge to PAC facilities need not return to pre-pandemic levels.