O2078: Trends in Pediatric Orthopedic Surgery Care During the COVID-19 Pandemic Pre- and Post-vaccine Availability

Background: The COVID-19 pandemic has led to significant disruptions in medical care, with an estimated 40% of U.S. adults avoiding care during this time. Currently, the return to baseline health care utilization following COVID-19 restrictions within the pediatric orthopedic population remains unexplored. The purpose of our study was to analyze the case volume and demographics of pediatric orthopedic patients in three time points: pre-pandemic (2019), pandemic (2020), and pandemic post-vaccine availability (2021) to determine the impact of COVID-19 restrictions on our single-center, multi-site institution.

Methods: This was a retrospective cohort study of 6,318 patients seeking treatment at our institution from May through August in 2019, 2020, and 2021. Patient age, sex, zip code, encounter date, and ICD-10 codes were obtained. Diagnoses were classified into fractures and dislocations, non-fracture related trauma, sports, elective, and other categories. Analysis comparing incidence and geospatial distribution of diagnoses across the time periods was performed.

Results: The total number of pediatric orthopedic visits decreased by 23.2% during the pandemic (p < 0.001) and remained 13.3% lower post-vaccine availability compared to pre-pandemic numbers (p < 0.001). Post-vaccine availability, total fractures remained 20.1% lower than pre-pandemic volume; however, lower extremity fractures rates returned to pre-pandemic levels (p=0.55). The proportion of fractures occurring in patients greater than 12 years old decreased by 58.5% during the pandemic (p < 0.001) and remained at 50% of original volume post-vaccine availability (p < 0.001). Trauma visits increased by 39.7% post-vaccine availability compared to the pandemic (p < 0.001). Sports volume decreased during the pandemic but returned to pre-pandemic volume in the post-vaccine availability period (p=0.575), while elective visits decreased throughout the pandemic and remained 12.9% below pre-pandemic volume (p < 0.001). Geospatial maps of patient distribution illustrate neighborhood trends in access to care during the COVID-19 pandemic, with east Cuyahoga County zip codes demonstrating proportionally decreased volume in both 2021 and 2020 compared to west Cuyahoga County and surrounding Geauga, Lake and Medina Counties.

Conclusion: Pediatric orthopedic surgery case volume broadly decreased during the COVID-19 pandemic and did not return to pre-pandemic levels. All categories increased in the post-vaccine availability time point except elective cases. Geospatial analysis of patient distribution revealed disparities in neighborhood access to care during the COVID-19 pandemic. Case volume in east Cuyahoga County zip codes did not return to pre-pandemic levels, despite increases in surrounding suburbs and west Cuyahoga County. Future research is needed to study these neighborhood trends and more completely characterize factors preventing equitable access to care in the pediatric orthopedic population.