This Survey of Orthopaedic Clinical Directors conducted 11th November 2020 attempted to project the required levels of practice – as a percentage of ‘normal’ 2019 practice – necessary to clear the additional arthroplasty caseload generated by the pandemic. 1
Several scenarios were modelled:
Scenario 1: Routine caseload possible from 1st December 2020, with no further COVID-19 related reduction in activity. Intended to understand the pending workload of elective joint replacements currently, which is 107,400 cases. UK surgeons working at ‘normal’ capacity between 1st December 2020 and March 2021 would have to operate at 154% of their pre-COVID practice to clear all cases in 12 months. 1
Scenario 2: Assumes that the second lockdown will reduce the operative caseload to 50% from December to March 2021. In this scenario, an additional 140,806 cases will require arthroplasty surgery by the time normal practice is resumed in April 2021. This means that surgeons would have to operate at 170% of their pre-COVID practice from April 2021 to clear all the cases in 12 months. 1
Scenario 3: Same recovery assumed as scenario 2, but with increased theatre utilisation by introducing three-session lists (12 hours instead of 9) Monday to Friday across all facilities, and two-session lists (9 hours) Saturdays & Sundays. Assuming that 20% of cases had been performed on extra session lists previously, the total operative capacity could be increased by a further 27.7% from 54 to 69 hours/week. If possible, surgeons would have to operate at 133% of ‘normal’ pre-COVID levels from April 2021 in order to clear the additional caseload generated by the pandemic within 12 months. 1
Conclusions & Recommendations
The authors concluded that “additional resources are required to facilitate recovery. Recommendations include an increase in ring-fenced ‘green’ pathway elective orthopaedic facilities, regional or network collaborative models of care to facilitate maximal efficiency, and continued utilisation of independent sector facilities. Additionally, the use of cloud-based technology to facilitate care pathways and workflows across geographical boundaries will ensure, care continues to be delivered safely and independent of individual Trust-restricted systems. Realistic target-setting is essential as is honest communication with patients to set realistic expectations.”1
Can more orthopaedic day surgery help clear the additional patient caseload generated by the COVID-19 pandemic? Leave a comment in the forum!