LAUSR

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.