Reduction in Surgical Volume for Metastatic Disease to the Femur and Humerus during the COVID-19 Pandemic with an Associated Backlog of Surgeries

Amil Agarwal; Christa LiBrizzi; Zachary Pearson; Megan Hsu; Uzoma Ahiarakwe; Savyasachi Thakkar; Adam Levin

doi:10.3113/JSOA.2026.0022

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Journal article

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Reduction in Surgical Volume for Metastatic Disease to the Femur and Humerus during the COVID-19 Pandemic with an Associated Backlog of Surgeries

Amil Agarwal, Christa LiBrizzi, Zachary Pearson, Megan Hsu, Uzoma Ahiarakwe, Savyasachi Thakkar and Adam Levin

Journal of surgical orthopaedic advances, Vol.35(1), p.22

04/01/2026

DOI: 10.3113/JSOA.2026.0022

PMID: 41811257

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Abstract

The purpose of this study was to observe how the COVID-19 pandemic impacted surgical volume for metastatic bone disease to the femur and humerus and whether the proportion of surgeries performed prophylactically significantly changed during the pandemic (March 2020 to April 2021). Patients who underwent surgical management for metastatic disease of the humerus and femur from January 2018 to April 2021 were identified in the PearlDiver Database. These patients were further stratified to surgeries performed prophylactically or not. The monthly changes in surgical volume and percentage of surgeries performed prophylactically were recorded. A linear forecast analysis using historical data from January 2018 to February 2020 was utilized to determine the expected volume and percentage of surgeries performed prophylactically during the pandemic period. From March to May 2020, there was a significant decrease in the volume of surgical procedures for metastatic bone disease to the humerus and femur. The surgical volume returned to pre-pandemic projections by June 2020. From March 2020, the backlog of surgical cases increased by 245%. The proportion of surgeries performed prophylactically did not significantly change during the COVID-19 pandemic. This study demonstrates a reduction in surgical management for metastatic lesions in the humerus and femur with an associated increase in backlog of cases during the COVID-19 pandemic in the United States. (Journal of Surgical Orthopaedic Advances 35(1):022 - 026, 2026).

Bone Neoplasms - epidemiology

Bone Neoplasms - secondary

Bone Neoplasms - surgery

COVID-19 - epidemiology

COVID-19 - prevention & control

Femoral Neoplasms - secondary

Femoral Neoplasms - surgery

Femur - surgery

Humans

Humerus - surgery

Male

Orthopedic Procedures - statistics & numerical data

Orthopedic Procedures - trends

Pandemics

United States - epidemiology

Details

Title: Subtitle: Reduction in Surgical Volume for Metastatic Disease to the Femur and Humerus during the COVID-19 Pandemic with an Associated Backlog of Surgeries
Creators: Amil Agarwal - Johns Hopkins University
Christa LiBrizzi - Johns Hopkins University
Zachary Pearson - Johns Hopkins University
Megan Hsu - University of Iowa, Orthopedics and Rehabilitation
Uzoma Ahiarakwe - Johns Hopkins University
Savyasachi Thakkar - Johns Hopkins University
Adam Levin - Johns Hopkins University
Resource Type: Journal article
Publication Details: Journal of surgical orthopaedic advances, Vol.35(1), p.22
DOI: 10.3113/JSOA.2026.0022
PMID: 41811257
NLM abbreviation: J Surg Orthop Adv
ISSN: 1548-825X
Language: English
Date published: 04/01/2026
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9985147194902771

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