Orthopaedic Surgery During the First Year of the COVID-19 Pandemic: Global Insights from a Systematic Review and Meta-Analysis
Description
Introduction/Background: Prior studies have quantified aspects of COVID-19's early impact on orthopaedic services, focusing on a single domain or reporting geographically restricted data. This review synthesizes global evidence by (i) integrating studies with heterogeneous 2019–2020 comparison windows and (ii) mapping changes across the care continuum.
Methods: Study inclusion was limited to sources with matched 2019–2020 periods reporting raw changes in surgical volume, clinic visits, discharge status, or length of stay (LOS). Analyses included (i) standardization by service-area population (per 100k) and comparison window (months), (ii) paired t-tests, and (iii) country-level semi-log OLS regression.
Results: Of 3,428 sources screened, 106 original reports met inclusion criteria, representing >60 million data points. Unweighted totals showed global trends: surgical volume −29.3%; clinic visits −31.5%; same-day discharge +65.2%; LOS −15.6%. Paired showed significant decreases in total (p < 0.001), elective (p < 0.05), trauma (p < 0.05), arthroplasty (p < 0.05), and pediatric surgeries (p < 0.05); and a significant rise in same-day discharge (p < 0.05). No significant differences in clinic visits (p = 0.116) or LOS (p = 0.066). In a 32-country analysis, surgical losses increased nonlinearly with national mortality: incremental harms were larger at higher mortality levels (β = –1.88 surgeries/month/100k per 1-unit increase in ln(1 + deaths/million); p < 0.05; R² = 0.13).
Discussion: Orthopaedic access declined worldwide in 2020. This review summarizes fragmented reporting and establishes a unified benchmark of early orthopaedic disruptions during one of modern history's deadliest pandemics. These findings can guide preparedness for future disruptions.
Citation Information
Hart, Jeremy; Zelenski, Kyle N.; Christensen, Gavin; Harris, Zachary; Zelenski, Kiefer J.; and Ogunleye, Temi D., "Orthopaedic Surgery During the First Year of the COVID-19 Pandemic: Global Insights from a Systematic Review and Meta-Analysis" (2026). Office of Research DMU Research Symposium. 2.
https://digitalcommons.dmu.edu/researchsymposium/2025rs/2025abstracts/2
Orthopaedic Surgery During the First Year of the COVID-19 Pandemic: Global Insights from a Systematic Review and Meta-Analysis
Introduction/Background: Prior studies have quantified aspects of COVID-19's early impact on orthopaedic services, focusing on a single domain or reporting geographically restricted data. This review synthesizes global evidence by (i) integrating studies with heterogeneous 2019–2020 comparison windows and (ii) mapping changes across the care continuum.
Methods: Study inclusion was limited to sources with matched 2019–2020 periods reporting raw changes in surgical volume, clinic visits, discharge status, or length of stay (LOS). Analyses included (i) standardization by service-area population (per 100k) and comparison window (months), (ii) paired t-tests, and (iii) country-level semi-log OLS regression.
Results: Of 3,428 sources screened, 106 original reports met inclusion criteria, representing >60 million data points. Unweighted totals showed global trends: surgical volume −29.3%; clinic visits −31.5%; same-day discharge +65.2%; LOS −15.6%. Paired showed significant decreases in total (p < 0.001), elective (p < 0.05), trauma (p < 0.05), arthroplasty (p < 0.05), and pediatric surgeries (p < 0.05); and a significant rise in same-day discharge (p < 0.05). No significant differences in clinic visits (p = 0.116) or LOS (p = 0.066). In a 32-country analysis, surgical losses increased nonlinearly with national mortality: incremental harms were larger at higher mortality levels (β = –1.88 surgeries/month/100k per 1-unit increase in ln(1 + deaths/million); p < 0.05; R² = 0.13).
Discussion: Orthopaedic access declined worldwide in 2020. This review summarizes fragmented reporting and establishes a unified benchmark of early orthopaedic disruptions during one of modern history's deadliest pandemics. These findings can guide preparedness for future disruptions.
