Disparities in Pediatric Orthopedic Surgery Care During the COVID-19 Pandemic Pre-vaccine and Post-Vaccine Availability
Authors: Culbert August A. , Ren Bryan O. , Maheshwer Bhargavi , Curtis Andrew , Ajayakumar Jayakrishnan , Gilmore Allison , Hardesty Christina , Mistovich R. Justin , Son-Hing Jochen , Liu Raymond W. , Glotzbecker Michael P. 
Published: July 2023

Background:

The COVID-19 pandemic has led to significant disruptions in medical care, resulting in an estimated 40% of US adults avoiding care. However, the return to baseline health care utilization following COVID-19 restrictions within the pediatric orthopedic population remains unexplored. We sought to analyze the visit volume and demographics of pediatric orthopedic patients at 3 timepoints: prepandemic (2019), pandemic (2020), and pandemic post-vaccine availability (2021), to determine the impact of COVID-19 restrictions on our single-center, multisite institution.

Methods:

We performed a retrospective cohort study of 6318 patients seeking treatment at our institution from May through August in 2019, 2020, and 2021. Patient age, sex, address, encounter date, and ICD-10 codes were obtained. Diagnoses were classified into fractures and dislocations, non–fracture-related trauma, sports, elective, and other categories. Geospatial analysis comparing incidence and geospatial distribution of diagnoses across the time periods was performed and compared with the Centers for Disease Control (CDC) social vulnerability index (SVI).

Results:

The total number of pediatric orthopedic visits decreased by 22.2% during the pandemic (P<0.001) and remained 11.6% lower post-vaccine availability compared with prepandemic numbers (P<0.001). There was no significant difference in age (P=0.097) or sex (P=0.248) of the patients across all 3 timepoints; however, patients seen during the pandemic were more often White race (67.7% vs. 59.3%,P<0.001). Post-vaccine availability, trauma visits increased by 18.2% (P<0.001) and total fractures remained 13.4% lower than prepandemic volume (P<0.001). Sports volume decreased during the pandemic but returned to prepandemic volume in the post-vaccine availability period (P=0.298). Elective visits did not recover to prepandemic volume and remained 13.0% lower compared with baseline (P<0.001). Geospatial analysis of patient distribution illustrated neighborhood trends in access to care during the COVID-19 pandemic, with fewer patients from high SVI and low socioeconomic status neighborhoods seeking fracture care during the pandemic than prepandemic. Post-vaccine availability, fracture population distribution resembled prepandemic levels, suggesting a return to baseline health care utilization.

Conclusion:

Pediatric orthopedic surgery visit volume broadly decreased during the COVID-19 pandemic and did not return to prepandemic levels. All categories increased in the post-vaccine availability time point except elective visits. Geospatial analysis revealed that neighborhoods with a high social vulnerability index (SVI) were associated with decreased fracture visits during the pandemic, whereas low SVI neighborhoods did not experience as much of a decline. Future research is needed to study these neighborhood trends and more completely characterize factors preventing equitable access to care in the pediatric orthopedic population.

Level of Evidence:

Retrospective Study, Level III.