The impact of COVID-19 on the demand of arthroplasty

BACKGROUND: Nowadays healthcare systems are affected both by a growing demand for prosthetic surgery, and by an increase of patients’ migration who are seeking a place of care more suited to their needs. This study aims to evaluate the impact of COVID-19 on patients’ migration for lower limb arthroplasty in Italy's regional healthcare systems. METHODS: We conducted a cross sectional study on Hospital Discharge Cards provided by the Italian Ministry of Health from 2015 to 2020. We considered hospitalizations for lower limb arthroplasty (Diagnosis Related Groups 544; 545 and 471). We analyzed the interregional patients’ migration, comparing the average number of admissions in the years 2015-2019 with that of 2020. Regional data of Residents, Attractions and Escapes, were graphically represented through Gandy's Nomogram (GN). RESULTS: In years 2015-2019, the GN shows that all regions satisfied care needs of their Residents, except for Basilicata, for which the number of Escapes is greater than the number of residents hospitalized in their own region. However, only Piedmont, Lombardy, Veneto, E.Romagna, Tuscany, Abruzzo, and the Autonomous Province (A.P.) of Bolzano showed an Attractions minus Escapes positive balance. However, A.P. of Bolzano had a negative balance in 2020, while in Liguria and Molise, the number of Escapes exceeded the admission of residents to regional hospitals. During studied period, Attractions increased for Piedmont, A.P. of Trento, Veneto, Friuli V.G., E.Romagna, Marche, Apulia, and Calabria, while Escapes decreased for Piedmont, A.P. of Trento, E. Romagna, Tuscany, Marche, Lazio, Abruzzo, Campania, Apulia, Calabria, Sicily, and Sardinia. CONCLUSIONS: Hospitalization for lower limb arthroplasty decreased in most of the regions during the COVID-19 pandemic. Piedmont, A.P. of Trento, E.Romagna, Marche, Apulia, and Calabria showed to be the most “resilient” regions, increasing the Attractions, and decreasing the Escapes at the same time. KEY MESSAGES: • Mapping flows by type of healthcare service is essential to identify the lack of supply so as to strengthen it in critical areas. • Italian Regions have responded to the impact of COVID-19 pandemic on hospital activity in different ways.