Dataset Information

Impact of COVID-19 on Orthopaedic and Trauma Service: An Epidemiological Study.

ABSTRACT: BACKGROUND:Coronavirus disease 2019 (COVID-19) has caused substantial disruptions to orthopaedic and trauma services. The purpose of the present study was to quantify its impact on surgical volume, hospitalizations, clinic appointments, and accident and emergency attendances to guide staffing and resource deployment for the sustenance of emergency services. METHODS:Data were retrieved from all 43 Hong Kong public hospitals and 122 outpatient clinics from a population of 7.5 million residents. The "COVID-19 cohort" of patients who received treatment from January 25 to March 27, 2020, was compared with the "control cohort" of patients who received treatment during the same time of year over the past 4 years. Primary outcomes consisted of changes in patient diagnoses, number of operations performed, and hospitalizations during the COVID-19 pandemic. Secondary outcomes included differences in patient age and comorbidity, the nature of operations performed, types of anesthesia for orthopaedic procedures, difference in anesthetic times, wait times, and personal protective equipment (PPE) reserves. RESULTS:A total of 928,278 patient-episodes (32,613 operations, 97,648 hospital admissions, 302,717 accident and emergency attendances, and 495,300 outpatient clinic attendances) were analyzed. Orthopaedic operations were reduced by 44.2%, from a mean (and standard deviation) of 795 ± 115.1 to 443.6 ± 25.8 per week (p < 0.001), with the ratio of emergency to elective operations increasing from 1.27:1 to 3.78:1. Operations for the treatment of upper and lower-limb fractures decreased by 23% (from 98.5 ± 14 to 75.9 ± 15.2 per week; p < 0.001) and 20% (from 210.6 ± 29.5 to 168.4 ± 16.9 per week; p < 0.001), respectively, whereas elective joint replacement and ligamentous reconstruction procedures decreased by 74% to 84% (p < 0.001). Operations for orthopaedic infections such as necrotizing fasciitis and septic arthritis remained similar (p > 0.05). The number of hospitalizations decreased by 41.2% (from 2,365 ± 243 to 1,391 ± 53 per week; p < 0.001), whereas clinical outpatient visits decreased by 29.4% (from 11,693 ± 2,240 to 8,261 ± 1,104 per week; p < 0.001). Patients did not endure longer wait times for emergency operations and accident and emergency consultations (p > 0.05). PPE consumption did not exceed procurement, with net increases in PPE reserves. CONCLUSIONS:Demand for orthopaedic care remains, despite weekly reductions of 351 orthopaedic operations, 974 hospital admissions, and 3,432 clinic attendances. Orthopaedic surgeons and health-care professionals should factor this into consideration during staffing and resource deployment. LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

SUBMITTER: Wong JSH

PROVIDER: S-EPMC7431143 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Impact of COVID-19 on Orthopaedic and Trauma Service: An Epidemiological Study.

Wong Janus Siu Him JSH Cheung Kenneth Man Chee KMC

The Journal of bone and joint surgery. American volume 20200701 14

<h4>Background</h4>Coronavirus disease 2019 (COVID-19) has caused substantial disruptions to orthopaedic and trauma services. The purpose of the present study was to quantify its impact on surgical volume, hospitalizations, clinic appointments, and accident and emergency attendances to guide staffing and resource deployment for the sustenance of emergency services.<h4>Methods</h4>Data were retrieved from all 43 Hong Kong public hospitals and 122 outpatient clinics from a population of 7.5 millio ...[more]

PMID: 32675668

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Project description:BackgroundThe Coronavirus disease-2019 (COVID-19) placed unprecedented pressure on the healthcare system. Many institutions implemented a government-mandated restructured set of safety and administrative protocols to treat urgent orthopaedic trauma patients. The objective of this study was to compare two cohorts of patients, a COVID group and non-COVID control group, and to evaluate the effectiveness of safety measures outlined in the Rutgers Orthopaedic Trauma Patient Safety Protocol (ROTPSP). Secondary outcomes were to elucidate risk factors for complications associated with fractures and COVID-19.MethodsPatients treated for orthopaedic traumatic injuries were retrospectively identified between March and May 2020, and compared to a series of patients from the same time period in 2018. Main outcome measures included surgical site infections (SSI), length of stay (LOS), post-operative LOS (poLOS), presentation to OR time (PORT), and length of surgery.ResultsAfter review, 349 patients (201 non-COVID, 148 COVID) undergoing 426 surgeries were included. Average LOS (11.91 days vs. 9.27 days, p = 0.04), poLOS (9.68 days vs. 7.39 days, p = 0.03), and PORT (30.56 vs. 25.59 h, p < 0.01) was significantly shorter in the COVID cohort. There were less SSI in the COVID group (5) compared to the non-COVID group (14) (p = 0.03). Overall complications were significantly lower in the COVID group. Patients receiving Cepheid tests had significantly shorter LOS and poLOS compared to patients receiving the RNA and DiaSorin tests (p < 0.01 and p < 0.01, respectively). The Cepheid test carried the best benefit-to-cost ratio, 0.10, p < 0.05.ConclusionThe restructuring of care protocols caused by COVID-19 did not negatively impact perioperative complication rates, PORT or LOS. Cepheid COVID test type administered upon admission plays an integral role in a patient's hospital course by reducing both length of stay and hospital costs. This information demonstrates we can continue to treat orthopaedic trauma patients safely during the COVID-19 pandemic by utilizing strict safety protocols.

Project description:BackgroundThe purpose of the present study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery departments in university hospitals in Germany in order to clarify current challenges.MethodsIn this cross-sectional study, an online-based anonymous survey was conducted within the Convention of University Professors of Orthopaedic and Trauma Surgery in Germany from April 3 to April 11, 2020. A bipolar 5-point Likert scale (with possible responses of "totally disagree," "rather disagree," "neutral," "rather agree," and "totally agree") was applied. Fifty-two (69.3%) of 75 clinic directors participated.ResultsCommunication and cooperation with the government, hospital administration, and other departments during the COVID-19 pandemic were mainly perceived as appropriate. However, only 7 respondents (13.7%) totally agreed or rather agreed with the statement that the authorities are supporters of orthopaedic and trauma surgery departments. Substantial financial and personnel changes in orthopaedic and trauma surgery departments of university hospitals were reported, resulting in an average reduction of 49.4% in operating room capacity and an expected 29.3% loss of revenue. In addition, 14.7% of physicians were reallocated from orthopaedic and trauma surgery to other care-delivery environments.ConclusionsOur study demonstrated that the COVID-19 pandemic has had a substantial impact on orthopaedic and trauma surgery departments in German university hospitals. Distinct structural and financial effects were noted. Nevertheless, the present study demonstrates the commitment of our specialty to overcome the pandemic by providing competent personnel as well as close cooperation with the hospital administration and other departments.Clinical relevanceTo our knowledge, this is the first Germany-wide survey among the heads of orthopaedic and trauma surgery departments in university hospitals on the impact of the COVID-19 pandemic. The survey results may help to inform system-wide decision-making in Germany, in Europe, and beyond.

Project description:INTRODUCTION:The COVID -19 outbreak has had a profound effect on the management of healthcare service provision in the UK. Orthopaedic departments have been no exception to this and have needed to adapt to the changing circumstances by releasing resources and focusing on 'essential' activity. The aim of this study is to quantify the reduction in trauma and, in addition, describe any changes in the type of referrals to the trust which may have been affected by the pandemic itself and the social distancing measures employed by the UK government. METHODS:The study was performed in a UK District Hospital which is also a Trauma Unit providing trauma and orthopaedic care to a population of 625,000 people. The trust based electronic database of trauma referrals was used to compare the numbers of, and types of referral to our trauma service during the COVID-19 pandemic and the corresponding time periods in the previous 3 years. RESULTS:The mean number of referrals per week to the service reduced by 33% in the time period following the confirmation of the outbreak as a pandemic (p<0.0001). Number of operations performed per week reduced by 26% (p = 0.001). There was no change in the number of referrals relating to domestic abuse or non-accidental injury. In addition, numbers of hip fractures, periprosthetic fractures and prosthetic joint dislocations were unchanged. There was a significant reduction in the number of referrals for simple fractures, native joint dislocations, wounds and soft tissue injuries. Within the paediatric population, similarly, a reduction in simple fracture referrals was demonstrated. DISCUSSION:An association between the outbreak of the pandemic and a reduction in referral numbers to our department has been demonstrated. The direct cause of this may be multifactorial but proposing that it is, in part, due to the social distancing measures introduced by the government is certainly conceivable. The patterns of injury would reflect this also with low energy and fragility trauma persisting whilst injuries associated with younger people have reduced. We would suggest that information such as this could be useful in healthcare planning and resource allocation in future pandemic situations.

Project description:ObjectiveThis is the first British multicentre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak.DesignA longitudinal, multicentre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from 17 March 2020 compared with the same period in 2019.SettingHospitals from six major urban cities were recruited around the UK, including London.ParticipantsA total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion.Primary and secondary outcome measuresPrimary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia used.ResultsDuring the COVID-19 period, there was a 34% reduction in acute orthopaedic trauma referrals compared with 2019 (1792 down to 1183 referrals), and a 29.5% reduction in surgical interventions (993 down to 700 operations). The mortality rate was more than doubled for both risk and odds ratios during the COVID-19 period for all referrals (1.3% vs 3.8%, p=0.0005) and for those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-19-related complications (vs non-COVID-19 causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID-19, there was an increase in odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters, as well as doubled odds of a consultant acting as the primary surgeon.ConclusionAlthough there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared with the same time interval 1 year ago.

Project description:Background:Surgical specialties face unique challenges caused by SARS-COV-2 (COVID-19). These disruptions will call on clinicians to have greater consideration for non-operative treatment options to help manage patient symptoms and provide therapeutic care in lieu of the traditional surgical management course of action. This study aimed to summarize the current guidance on elective surgery during the COVID-19 pandemic, assess how this guidance may impact orthopaedic care, and review any recommendations for non-operative management in light of elective surgery disruptions. Methods:A systematic search was conducted, and included guidance were categorized as either "Selective Postponement" or "Complete Postponement" of elective surgery. Selective postponement was considered as guidance that suggested elective cases should be evaluated on a case-by-case basis, whereas complete postponement suggested that all elective procedures be postponed until after the pandemic, with no case-by-case consideration. In addition, any statements regarding conservative/non-operative management were summarized when provided by included reports. Results:A total of 11 reports from nine different health organizations were included in this review. There were seven (63.6%) guidance reports that suggested a complete postponement of non-elective surgical procedures, whereas four (36.4%) reports suggested the use of selective postponement of these procedures. The guidance trends shifted from selective to complete elective surgery postponement occurred throughout the month of March. The general guidance provided by these reports was to have an increased consideration for non-operative treatment options whenever possible and safe. As elective surgery begins to re-open, non-operative management will play a key role in managing the surgical backlog caused by the elective surgery shutdown. Conclusion:Global guidance from major medical associations are in agreement that elective surgical procedures require postponement in order to minimize the risk of COVID-19 spread, as well as increase available hospital resources for managing the influx of COVID-19 patients. It is imperative that clinicians and patients consider non-operative, conservative treatment options in order to manage conditions and symptoms until surgical management options become available again, and to manage the increased surgical waitlists caused by the elective surgery shutdowns.

Dataset Information

Impact of COVID-19 on Orthopaedic and Trauma Service: An Epidemiological Study.

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Impact of COVID-19 on Orthopaedic and Trauma Service: An Epidemiological Study.

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