Transitioning to Outpatient Arthroplasty during the COVID-19 Pandemic: It’s Time to Pivot

To The Editor,

The paper by Wang et al. highlights the significant surgical backlog in Ontario resulting from the first wave of the COVID-19 pandemic.(1) We are currently in the midst of the second wave and, as predicted, its impact on inpatient resources has exacerbated the surgical backlog even further. The total joint arthroplasty (TJA) program at Sinai Health recently introduced an enhanced recovery after surgery (ERAS) bundle,(2) which has enabled us to pivot quickly to an outpatient TJA program in response restrictions on inpatient surgery.

After careful review of epidemiological forecasts and resources available early during the pandemic,(3) our surgical services team anticipated that to continue to be able to perform TJA procedures throughout future waves of the COVID-19 pandemic, we would need to quickly establish a hybrid outpatient/inpatient arthroplasty program.(4) An internal needs assessment was performed. Results highlighted the need to develop an evidence-based patient-centred outpatient pathway.(5) New interventions included: 1) well-defined outpatient selection criteria; 2) modification of anesthetic to facilitate early ambulation; 3) outpatient recovery education materials; and 4) virtual postoperative care follow-up. By January 2021 our program evolved into a hybrid TJA program with over 25% of primary TJA patients being outpatient. This outpatient pathway was well-appreciated by patients and hospital leadership alike.

With an output of over 125,000 TJA procedures per year, Canadian arthroplasty centres are faced with the challenge of how to continue providing care during the COVID-19 pandemic. To minimize inpatient health resource utilization, hospitals need to “pivot” towards outpatient TJA by rapidly implementing pathways, protocols, and resources to ensure TJA patients continue to receive the surgical care they need.