Background and Aims The COVID-19 pandemic has profoundly impacted daily clinical practice and numerous clinical recommendations were published focusing on guidance to maximize patient and healthcare worker safety.^1–3 It is unclear to what extent these recommendations impacted anesthesia practice in the early stage of the pandemic. We therefore utilized a large national dataset to elucidate potential changes in practice in the United States, with a specific focus on anesthesia practice in orthopedic surgery.

Methods This study is approved by Hospital for Special Surgery Institutional Review Board (IRB#2016–436).Using the Premier database, we identified who patients underwent elective total knee/hip arthroplasty (TKA/THA) in the US during the initial surge of COVID-19 from March 1st to June 30th in 2020. In order to compare this cohort to controls, we selected patients admitted during the same time frame the year prior.We compared anesthesia practice before and during the first wave of the COVID-19 pandemic using standardized differences.

Results There was no clinically meaningful, observable change of overall practice of anaesthesia between 2019 and 2020 in either the TKA or THA cohort. Benzodiazepine use was slightly lower during the COVID-19 period among TKA patients (from 77.7% to 72.3%,Table 1)

Conclusions In conclusion, despite the recommendations from worldwide airway experts to avoid airway instrumentation during the period of the pandemic our data showed that anesthetic practice in the US did not change with regards to the conduct of general and regional anesthesia. Further research is needed to investigate if these recommendations had lasting consequences beyond the initial pandemic period.