How have the Volume and Backlog of Total Shoulder Arthroplasty Cases Changed during the COVID-19 Pandemic?

Abstract

BACKGROUND As COVID-19 rapidly propagated, many institutions were forced to respond with suspension in all elective surgical procedures, including primary and revision Total Shoulder Arthroplasty (TSA). In 2021, the Centers of Medicare & Medicaid Services (CMS) removed primary and revision TSA from the Inpatient-Only-List (IPO). These rapid changes created uncertainty surrounding the potential backlog of patients that healthcare systems could face. The purpose of this study is to observe the change in volume as well as proportion of TSA performed in the outpatient setting. METHODS Patients who underwent primary and revision elective TSA from January 2018 to April 2021 were identified using the Pearldiver database. Descriptive analysis was utilized to report the monthly changes in elective TSA volume and the proportion of the volume performed in the outpatient setting. A linear forecast analysis using historical data was utilized to determine the expected volume and proportion of TSA cases performed on an outpatient basis during the pandemic period. This was compared to the observed case volume and setting. RESULTS Within 3 months following suspension, the total volume had returned to expected for both primary and revision TSA. Those performed in the outpatient setting significantly increased throughout the pandemic, with the largest peak following January 2020. By April 2021, four months after the CMS removal of TSA from the IPO list, the backlog of primary TSA volume had decreased by 30.8% with respect that in December 2020. For revision TSA, the backlog was entirely overcome by April 2021 as there was an observed decrease of 131% with respect that in December 2020. CONCLUSION The backlog for both primary and revision TSA from the beginning of the pandemic has decreased. The observed decrease did not seem to start until January 2021 following CMS’ removal of TSA from the IPO list. Therefore, the reduction in the backlog may be associated with the increased utilization of outpatient primary and revision TSA.