Impact of COVID-19 on hand surgery transfers at a level-1 trauma center

Background: The COVID-19 pandemic significantly impacted elective surgical volume across the country; however, its effect on urgent transfers is unclear. This study sought to understand the impact of COVID-19 on transfers for hand surgery evaluation at a single quaternary referral center during the initial 3 mo of state mandated restrictions. Methods: A retrospective analysis was performed comparing the rate and character of transfers for hand surgery evaluation from March to June of 2020 to a temporally matched cohort averaged across 2018 and 2019. The primary outcome of this study was transfer frequency, with secondary outcomes of treatment rendered and type of disposition. Results: The rate of transfer between emergency departments for hand surgery evaluation was not statistically different from before to during COVID (ED-to-ED transfer rate: 4.3% and 5.1% respectively, P=0.68). Patient demographics were similar, with no difference in age (pre-COVID-19 mean 48.6 yr vs. intra-COVID-19 mean 53.2 yr, P=0.31) or type of insurance (P=0.99). Regarding reason for transfer, both cohorts were similar in the number of transfers for trauma versus infection (pre-COVID-19 infection: 11 trauma: 20.5 vs. intra-COVID-19 infection: 4 trauma: 17 P=0.99). We observed similar rates of transfers requiring procedural intervention (pre-COVID-19 69.8% vs. intra-COVID-19 57.1% P=0.19). Lastly, there was no difference in admission patterns, with pre-COVID-19 rates (71.4%) similar to those during COVID-19 (52%) P=0.15. Conclusions: Despite the many changes to healthcare in the US during the COVID-19 pandemic, the practice of transferring for evaluation to a Level 1 hand surgery center was similar to pre-pandemic years. Level VI Evidence: Presenting a single descriptive study.