Impact of COVID-19 outbreak in knee arthroplasty in Chile: a cross-sectional, national registry-based analysis

Introduction The need for beds and health personnel to treat coronavirus (COVID- 19) patients has led to the suspension of many elective sur-geries in Chile, including knee arthroplasties. This study aims to determine the incidence of knee arthroplasty in 2020, reflecting the effect of the COVID- 19 pandemic, and estimate the cost and time it would take to recover the waiting list prior to March 2020. Methods A cross- sectional study was designed. We analyzed databases from The Department of Statistics and Health Information databases from Chile for 2019 and 2020, identifying patients with surgical discharges associated with knee arthroplasty codes. We estimated the time it would take to recover the surgeries unperformed in 2020 by simulating a monthly workload increase from the 2019 baseline. The costs of knee arthroplasty paid by the National Health Fund to institutions were estimated by diagnosis-related groups. Results We found that the incidence rate of knee arthroplasty in 2020 decreased by 64% compared with 2019. The impact was higher in the public system (68%) and the National Health Found (63%). A simulated increase in knee arthroplasty productivity by 30% would allow recovering the postponed knee arthroplasty surgeries in 27 months, at a monthly cost to the public system of 318 million Chilean pesos (378 thousand US dollars). Conclusions The incidence rate of knee arthroplasty during 2020 decreased by 64%, revealing the extensive waiting line for people with knee osteoarthritis. An increase between 20- 40% in productivity compared with 2019 would allow recovering the unperformed surgeries in 20 to 41 months, at a monthly cost to the public network between 210 and 425 million Chilean pesos (250 to 506 thousand US dollars). 10.5867/medwave.2022.04.002511 https://www.medwave.cl/link.cgi/English/Reviews/Analysis/8732.act Reflections on death in the time of Covid-19 Donovan Casas Patiño The pandemic of COVID- 19 filled the world with sorrow as death was an ever- present menace everywhere. This document aims to rescue some reflective facts about death marked by a socio- historical context that revealed breaking points. These points work around three specific aspects: the agony of the dying, funeral and religious rituals, and the pilgrimage between doubt and guilt. Death in times of pandemic revealed the need to humanize and guarantee a dignified death. Likewise, the pandemic reinvented funeral rituals by globalizing them using technology and social net