Background:

Although insurance status is important to patients’ ability to access care, it varies significantly by race, age, and socioeconomic status. COVID-19 negatively impacted access to care, while simultaneously widening pre-existing health care disparities. The purpose of the current study was to document this phenomena within orthopedics.

Methods:

Patients undergoing hip or knee arthroplasty at two medical centers in San Francisco, California were evaluated. One cohort came from the University of California San Francisco (UCSF), a tertiary center and the other from Zuckerberg San Francisco General Hospital (ZSFGH), a safety-net hospital. Patients undergoing arthroplasty prior to the pandemic (March 2020) and after pandemic declaration were evaluated. Patient demographics, surgical wait times, and operative volumes were compared.

Results:

269 (pre-COVID, 184; post-COVID, 85) cases at UCSF and 63 (pre-COVID, 47; post-COVID, 16) cases at ZSFGH met inclusion criteria. Patients at ZSFGH had a significantly higher BMI, were more often racial minorities, and were less likely to speak English. Patients at ZSFGH were less likely to have private insurance. Comparing case volumes showed a larger decrease at ZSFGH compared to UCSF post-COVID. Wait times between the two sites pre- and post-COVID showed a larger increase in wait times at ZSFGH. Notably, wait times at ZSFGH pre-COVID were more than double the wait times at UCSF post-COVID.

Conclusions:

COVID-19 worsened access to primary hip and knee arthroplasty at two academic medical centers in San Francisco. The pandemic also worsened pre-existing disparities. Racial minorities, non-English speakers, and those with non-private insurance were affected most.