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Pattnaik S, Algharibeh M, Zarifian A, Sidhu GAS, Chahal J, Punwar S. Navigating ACL Injuries Amid the COVID-19 Pandemic: A Retrospective Analysis. Cureus 2023; 15:e47857. [PMID: 38022222 PMCID: PMC10680049 DOI: 10.7759/cureus.47857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction In the United Kingdom, musculoskeletal injuries represent a substantial proportion of primary care appointments, and within this category, acute knee injuries are prominent in accident and emergency department cases. Notably, diagnosing anterior cruciate ligament (ACL) injuries is a recognized challenge, often leading to extended diagnostic delays. The COVID-19 pandemic has significantly affected the management of musculoskeletal disorders, driven by reduced surgical capacities, creating a backlog of patients awaiting necessary surgical interventions. Delayed ACL reconstruction poses risks of prolonged knee instability and secondary injuries. To address these concerns, this study evaluates the impact of COVID-19 on the timeline from ACL injury diagnosis to MRI and surgical intervention, with a specific focus on an internal acute knee clinic pathway designed to expedite the evaluation, diagnosis, and management of soft tissue knee injuries. Methods In this cross-sectional study, we retrospectively reviewed all the patients who underwent primary ACL reconstruction from January 2019 to November 2022 in a district general teaching hospital (DGH). Besides demographic data of the patients, we recorded the dates of injury, primary presentation, first knee specialist review, knee MRI, and ACL reconstruction surgery, as well as the injury-to-surgery, injury-to-MRI, and MRI-to-surgery periods. Patients were divided based on the date of operation to pre- and post-COVID, and outcomes were compared to see the possible effects of COVID-19. Data were analyzed using a quantitative and qualitative test with a P < 0.05 significance level. Results Our cohort included 97 patients, and the mean age of patients was 30.6 years (17-53 years). The median time of injury-to-MRI was 46.5 days during the pre-COVID period, which decreased to 44 days in the post-COVID period (P = 0.596). The median time of injury-to-surgery was 287.5 days during the pre-COVID period, which increased to 289 days in the post-COVID period (P = 0.019). The median MRI-to-surgery duration was 200 days during the pre-COVID period, which increased to 225 days in the post-COVID period (P = 0.006). Around 35% of patients had an MRI prior to getting evaluated by a specialist. Conclusion The COVID-19 pandemic had a significant impact on the management of ACL injuries, with delays in elective knee clinics and surgery potentially leading to delays in the diagnosis and management of such injuries. However, our study showed that the delay from ACL injury to subsequent surgery actually reduced post-pandemic due to hospital-based acute knee pathway, which is particularly important in the context of associated meniscal injury that can worsen while patients wait for surgery.
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Affiliation(s)
| | - Majd Algharibeh
- Trauma and Orthopaedics, University Hospital Lewisham, London, GBR
| | | | - Gur Aziz Singh Sidhu
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Jacinder Chahal
- Trauma and Orthopaedics, Queen Elizabeth Hospital, London, GBR
| | - Shahid Punwar
- Trauma and Orthopaedics, University Hospital Lewisham, London, GBR
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2
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Morri M, Ruisi R, Peccerillo V, Franchini N, Magli AO, Forni C. The impact of the pandemic on functional outcomes for joint replacement patients: An observational study. Medicine (Baltimore) 2022; 101:e30395. [PMID: 36086684 PMCID: PMC10980505 DOI: 10.1097/md.0000000000030395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Elective surgeries, as joint replacement, were resumed after the first COVID-19 pandemic wave in 2020 and a phase of coexistence with the virus began. Surgery was organized in a new way that incorporated procedures aimed at reducing the risk of spreading the virus. The aim of this study is to describe the early functional results for patients undergoing hip and knee replacements at the time healthcare services were being reopened and to compare them with the same outcomes recorded in the prepandemic period. This is a controlled retrospective study. All patients consecutively admitted during 2020 and who underwent hip and knee replacement were enrolled in the study. Patient records from January to March 2020 constituted the prepandemic control group, while patient records from May to December 2020 constituted the study group. Functional recovery was described through the patient's ability to walk using antebrachial devices and to climb up and down 3 steps. The day after surgery on which these activities were first performed was also recorded. The prepandemic group consisted of 183 patients and the pandemic group of 280 patients. The mean age of patients was 66 years (±13.1), female was 44.9% and hip replacement was 66.5%. The number of patients who climbed stairs and the timing thereof was comparable for the 2 groups (68.5% vs 72.2%, respectively; P = .403). There was no significant difference in the incidence of patients able to walk with antebrachial device and incidence of pressure ulcers and major complications. Multivariate analysis confirmed that the incidence of stair climbing was not associated with the prepandemic or pandemic inclusion. During the reopening of orthopedic surgery activity, the reorganization and treatment pathway did not affect the functional outcome achieved by patients underwent joint replacement. Constant monitoring of the functional outcomes will be required so as to further increase the number of joint replacement surgeries.
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Affiliation(s)
- Mattia Morri
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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3
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Fowler Davis S, Humphreys H, Maden-Wilkinson T, Withers S, Lowe A, Copeland RJ. Understanding the Needs and Priorities of People Living with Persistent Pain and Long-Term Musculoskeletal Conditions during the COVID-19 Pandemic—A Public Involvement Project. Healthcare (Basel) 2022; 10:healthcare10061130. [PMID: 35742180 PMCID: PMC9222303 DOI: 10.3390/healthcare10061130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Critiques of public involvement (PI) are associated with failing to be inclusive of under-represented groups, and this leads to research that fails to include a diversity of perspectives. Aim: The aim of this PI project was to understand the experiences and priorities of people from three seldom-heard groups whose musculoskeletal pain may have been exacerbated or treatment delayed due to COVID-19. Engaging representatives to report diverse experiences was important, given the goal of developing further research into personalised and integrated care and addressing population health concerns about access and self-management for people with musculoskeletal pain. Methods: The project was approved via Sheffield Hallam University Ethics but was exempt from further HRA approval. A literature review was conducted, followed by informal individual and group discussions involving professionals and people with lived experience of (a) fibromyalgia pain, (b) those waiting for elective surgery and (c) experts associated with the care home sector. Findings from the literature review were combined with the insights from the public involvement. Resulting narratives were developed to highlight the challenges associated with persistent pain and informed the creation of consensus statements on the priorities for service improvement and future research. The consensus statements were shared and refined with input from an expert steering group. Results: The narratives describe pain as a uniformly difficult experience to share with professionals; it is described as exhausting, frustrating and socially limiting. Pain leads to exclusion from routine daily activities and often resigns people to feeling and being unwell. In all cases, there are concerns about accessing and improving services and critical issues associated with optimising physical activity, functional wellbeing and managing polypharmacy. Exercise and/or mobilisation are important and commonly used self-management strategies, but opportunity and advice about safe methods are variable. Services should focus on personalised care, including self-management support and medication management, so that people’s views and needs are heard and validated by health professionals. Conclusions: More research is needed to explore the most effective pain management strategies, and public involvement is important to shape the most relevant research questions. Health and care systems evaluation is also needed to address the scale of the population health need. The pandemic appears to have highlighted pre-existing shortcomings in holistic pain management.
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Affiliation(s)
- Sally Fowler Davis
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
- Correspondence:
| | - Helen Humphreys
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Tom Maden-Wilkinson
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Sarah Withers
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Broomhall, Sheffield S10 2JF, UK;
| | - Anna Lowe
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Robert J. Copeland
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
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Bunch CM, Moore EE, Moore HB, Neal MD, Thomas AV, Zackariya N, Zhao J, Zackariya S, Brenner TJ, Berquist M, Buckner H, Wiarda G, Fulkerson D, Huff W, Kwaan HC, Lankowicz G, Laubscher GJ, Lourens PJ, Pretorius E, Kotze MJ, Moolla MS, Sithole S, Maponga TG, Kell DB, Fox MD, Gillespie L, Khan RZ, Mamczak CN, March R, Macias R, Bull BS, Walsh MM. Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation. Front Surg 2022; 9:889999. [PMID: 35599794 PMCID: PMC9119324 DOI: 10.3389/fsurg.2022.889999] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 12/12/2022] Open
Abstract
Early in the coronavirus disease 2019 (COVID-19) pandemic, global governing bodies prioritized transmissibility-based precautions and hospital capacity as the foundation for delay of elective procedures. As elective surgical volumes increased, convalescent COVID-19 patients faced increased postoperative morbidity and mortality and clinicians had limited evidence for stratifying individual risk in this population. Clear evidence now demonstrates that those recovering from COVID-19 have increased postoperative morbidity and mortality. These data-in conjunction with the recent American Society of Anesthesiologists guidelines-offer the evidence necessary to expand the early pandemic guidelines and guide the surgeon's preoperative risk assessment. Here, we argue elective surgeries should still be delayed on a personalized basis to maximize postoperative outcomes. We outline a framework for stratifying the individual COVID-19 patient's fitness for surgery based on the symptoms and severity of acute or convalescent COVID-19 illness, coagulopathy assessment, and acuity of the surgical procedure. Although the most common manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is COVID-19 pneumonitis, every system in the body is potentially afflicted by an endotheliitis. This endothelial derangement most often manifests as a hypercoagulable state on admission with associated occult and symptomatic venous and arterial thromboembolisms. The delicate balance between hyper and hypocoagulable states is defined by the local immune-thrombotic crosstalk that results commonly in a hemostatic derangement known as fibrinolytic shutdown. In tandem, the hemostatic derangements that occur during acute COVID-19 infection affect not only the timing of surgical procedures, but also the incidence of postoperative hemostatic complications related to COVID-19-associated coagulopathy (CAC). Traditional methods of thromboprophylaxis and treatment of thromboses after surgery require a tailored approach guided by an understanding of the pathophysiologic underpinnings of the COVID-19 patient. Likewise, a prolonged period of risk for developing hemostatic complications following hospitalization due to COVID-19 has resulted in guidelines from differing societies that recommend varying periods of delay following SARS-CoV-2 infection. In conclusion, we propose the perioperative, personalized assessment of COVID-19 patients' CAC using viscoelastic hemostatic assays and fluorescent microclot analysis.
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Affiliation(s)
- Connor M. Bunch
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Ernest E. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, United States
| | - Hunter B. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, United States
| | - Matthew D. Neal
- Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Anthony V. Thomas
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Nuha Zackariya
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Jonathan Zhao
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Sufyan Zackariya
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Toby J. Brenner
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Margaret Berquist
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Hallie Buckner
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Grant Wiarda
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Daniel Fulkerson
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Neurosurgery, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Wei Huff
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Neurosurgery, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Hau C. Kwaan
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Genevieve Lankowicz
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | | | | | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Maritha J. Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Muhammad S. Moolla
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sithembiso Sithole
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Tongai G. Maponga
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Douglas B. Kell
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mark D. Fox
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Laura Gillespie
- Department of Quality Assurance and Performance Improvement, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Rashid Z. Khan
- Department of Hematology, Michiana Hematology Oncology, Mishawaka, IN, United States
| | - Christiaan N. Mamczak
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Orthopaedic Trauma, Memorial Hospital South Bend, South Bend, IN, United States
| | - Robert March
- Department of Cardiothoracic Surgery, St. Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Rachel Macias
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Plastic and Reconstructive Surgery, St. Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Brian S. Bull
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Mark M. Walsh
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
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Diekmann PR, O’Neill OR, Floyd ER, Meinke LC, Lehman-Lane J, Uzlik RM, Stone McGaver R. Orthopedic Surgery in Ambulatory Surgery Centers During the COVID-19 Pandemic: Low Incidence of Infection Among Patients, Surgeons, and Staff. Cureus 2022; 14:e24247. [PMID: 35602796 PMCID: PMC9116689 DOI: 10.7759/cureus.24247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective The coronavirus disease 2019 (COVID-19) pandemic has presented tremendous challenges to the healthcare systems worldwide. Consequently, ambulatory surgery centers (ASCs) have been forced to find new and innovative ways to function safely and maintain operations. We conducted a study at a large United States (US) private orthopedic surgery practice, where a universal screening policy and testing protocol for COVID-19 was implemented for patients and ASC personnel including surgeons, in order to examine the incidence of COVID-19 in patients scheduled for orthopedic surgery in ASC settings as well as the incidence among the surgeons and ASC personnel. Methods The universal screening protocol was implemented in the ASCs of the facility during the early stage of the pandemic for an eight-month period from April 28, 2020, to December 31, 2020. All ASC personnel including surgeons had their symptoms tracked daily and were rapid-tested every two weeks. All patients were screened and tested before they entered the ASC. Results A total of 70 out of 12,115 patients and 41 out of 642 ASC personnel tested positive for COVID-19, resulting in infection rates of 0.6% and 6.4%, respectively. Individual symptoms, age, the American Society of Anesthesiologists (ASA) scores, and comorbidities were documented, and no single factor was found to be common among positive (+) tests. Conclusions The implementation of universal screening and symptom-reporting procedures was associated with a very low rate of infections among ASC patients, staff, and surgeons, and it offers a reproducible framework for other facilities to continue to provide orthopedic outpatient operations in ASC settings during the ongoing iterations of the COVID-19 pandemic.
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Altinok K, Erdsiek F, Yilmaz-Aslan Y, Brzoska P. Expectations, concerns and experiences of rehabilitation patients during the COVID-19 pandemic in Germany: a qualitative analysis of online forum posts. BMC Health Serv Res 2021; 21:1344. [PMID: 34915890 PMCID: PMC8674409 DOI: 10.1186/s12913-021-07354-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/29/2021] [Indexed: 01/25/2023] Open
Abstract
Background The COVID-19 pandemic, as well as efforts to prevent its spread, have had a strong impact on the delivery of rehabilitative services in Germany. While several studies have addressed the impact of these developments on health service providers and COVID-19 patients, little is known about its impact on patients in need of rehabilitative treatment because of other conditions. This study aims to identify expectations, concerns and experiences of rehabilitation patients related to service delivery in this situation. Methods Using a qualitative study design, user posts from six German online forums between March and Mid-November 2020 were systematically searched with respect to experiences, concerns and expectations of health care users toward receiving rehabilitative treatment. We used qualitative content analysis with inductive coding as our methodological approach. Results Users fearing physical or psychological impairment were concerned about not receiving timely or effective treatment due to closed hospitals, reduced treatments and limited admissions. In contrast, patients more concerned about getting infected with COVID-19 worried about the effectiveness of protective measures and being denied postponement of treatment by the funding bodies. During their stay, some patients reported feeling isolated due to contact restrictions and did not feel their treatment was effective, while others reported being satisfied and praised hospitals for their efforts to ensure the safety of the patients. Many patients reported communication problems before and during their treatment, including concerns about the safety and effectiveness of their treatment, as well as financial concerns and worries about future treatments. Several users felt that their concerns were disregarded by the hospitals and the funding bodies, leaving them feeling distressed, insecure and dissatisfied. Conclusions While some users report only minor concerns related to the pandemic and its impact on rehabilitation, others report strong concerns relating not only to their own health and safety, but also to financial aspects and their ability to work. Many users feel ignored and disregarded, showing a strong need for more coordinated strategies and improved communication specifically with funding bodies like health insurance companies and the German pension funds.
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Affiliation(s)
- Kübra Altinok
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research Unit, Witten, Germany
| | - Fabian Erdsiek
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research Unit, Witten, Germany.
| | - Yüce Yilmaz-Aslan
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research Unit, Witten, Germany.,Bielefeld University, Faculty of Health Sciences, AG3 Epidemiology and International Public Health, Bielefeld, Germany.,Bielefeld University, Faculty of Health Sciences, AG6 Health Services Research and Nursing Science, Bielefeld, Germany
| | - Patrick Brzoska
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research Unit, Witten, Germany
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Kazubski K, Tomczyk Ł, Morasiewicz P. Effects of the COVID-19 Pandemic on the Epidemiology of Knee and Shoulder Arthroscopy. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211056037. [PMID: 34775868 PMCID: PMC8645303 DOI: 10.1177/00469580211056037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of our study was to comprehensively assess the effect of the COVID-19 pandemic on knee and shoulder arthroscopy performed in an orthopedic department of a university hospital in Poland. This study compared the data on all shoulder and knee arthroscopy procedures performed in two different periods: The period of the COVID-19 pandemic in Poland (from March 4, 2020, to October 15, 2020) and the corresponding period prior to the pandemic (March 4, 2019, to October 15, 2019). The study evaluated epidemiological data, demographic data, and hospital stay duration. The total number of arthroscopy procedures conducted in the evaluated period in 2020 was approximately 8.6% higher than that in the corresponding 2019 period. The mean duration of hospital stay for orthopedic patients after their knee or shoulder arthroscopy was 3.1 days in 2020 and 2.8 days in 2019. Our study revealed the mean age of arthroscopy patients during the pandemic to be lower at 48.4 years than the 51.2 years recorded in 2019. The male-to-female ratio was shown to be lower at .85 during the pandemic, having decreased from 1.5 in 2019. The COVID-19 pandemic did not reduce the number of arthroscopy performed at our center, and the mean age of the patients did not change. However, the pandemic had a marked effect on the mean duration of hospital stay and male-to-female ratio.
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Affiliation(s)
- Krystian Kazubski
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, 49576University of Opole, Opole, Poland
| | - Łukasz Tomczyk
- Department of Food Safety and Quality Management, 49645Poznan University of Life Sciences, Poznan, Poland
| | - Piotr Morasiewicz
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, 49576University of Opole, Opole, Poland
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Comfort SM, Murata Y, Pierpoint LA, Philippon MJ. Management of Outpatient Elective Surgery for Arthroplasty and Sports Medicine During the COVID-19 Pandemic: A Scoping Review. Orthop J Sports Med 2021; 9:23259671211053335. [PMID: 34778487 PMCID: PMC8579361 DOI: 10.1177/23259671211053335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The onset of the coronavirus disease 2019 (COVID-19) pandemic has presented unforeseeable challenges to the orthopaedic community, especially arthroplasty and sports medicine subspecialities, as many surgeries were deemed nonessential and delayed. Although there is a glimpse of hope with the approval and distribution of vaccines, daily case numbers and death tolls continue to rise at the time of this review. Purpose: To summarize the available literature on the management of elective sports medicine and arthroplasty procedures in the outpatient setting to gather a consolidated source of information. Study Design: Scoping review; Level of evidence, 5. Methods: A scoping review of 3 databases (PubMed, Embase, and OVID Medline) was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. All retrospective and prospective analyses, systematic reviews and meta-analyses, expert opinions, and societal guidelines were included for review, with 29 articles meeting the inclusion criteria. Results: Guidance for resumption of elective arthroplasty and sports medicine surgery and patient selection during the COVID-19 pandemic focuses on resource availability, patient fitness, and time sensitivity of the procedure, with patient and surgical team safety as the highest priority. Telemedicine and other innovative technology can be used to continue patient care during periods of delayed surgery through monitoring disease progression and offering nonoperative management options. Conclusion: While the current societal recommendations provide guidance on safety protocols and patient prioritization, each orthopaedic practice must consider its unique situation and use evidence-based medicine when determining surgical timing and patient selection.
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Affiliation(s)
| | - Yoichi Murata
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Marc J. Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, USA
- Marc J. Philippon, MD, Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Drive, Suite 400, Vail, CO 81657, USA ()
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Taha-Mehlitz S, Hendie A, Taha A. The Development of Electronic Health and Artificial Intelligence in Surgery after the SARS-CoV-2 Pandemic-A Scoping Review. J Clin Med 2021; 10:jcm10204789. [PMID: 34682912 PMCID: PMC8537136 DOI: 10.3390/jcm10204789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND SARS-CoV-2 has significantly transformed the healthcare environment, and it has triggered the development of electronic health and artificial intelligence mechanisms, for instance. In this overview, we concentrated on enhancing the two concepts in surgery after the pandemic, and we examined the factors on a global scale. OBJECTIVE The primary goal of this scoping review is to elaborate on how surgeons have used eHealth and AI before; during; and after the current global pandemic. More specifically, this review focuses on the empowerment of the concepts of electronic health and artificial intelligence after the pandemic; which mainly depend on the efforts of countries to advance the notions of surgery. DESIGN The use of an online search engine was the most applied method. The publication years of all the studies included in the study ranged from 2013 to 2021. Out of the reviewed studies; forty-four qualified for inclusion in the review. DISCUSSION We evaluated the prevalence of the concepts in different continents such as the United States; Europe; Asia; the Middle East; and Africa. Our research reveals that the success of eHealth and artificial intelligence adoption primarily depends on the efforts of countries to advance the notions in surgery. CONCLUSIONS The study's primary limitation is insufficient information on eHealth and artificial intelligence concepts; particularly in developing nations. Future research should focus on establishing methods of handling eHealth and AI challenges around confidentiality and data security.
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Affiliation(s)
- Stephanie Taha-Mehlitz
- Clarunis, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4002 Basel, Switzerland;
| | - Ahmad Hendie
- Department of Computer Engineering, McGill University, Montreal, QC H3A 0C6, Canada;
| | - Anas Taha
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, 4321 Allschwil, Switzerland
- Correspondence: ; Tel.: +41-61-207-54-02
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Paediatric orthopaedic surgery during the SARS-CoV-2 pandemic. A safe and pragmatic approach to service provision. Surgeon 2021; 20:e338-e343. [PMID: 34600829 PMCID: PMC8418910 DOI: 10.1016/j.surge.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/11/2020] [Accepted: 08/19/2021] [Indexed: 11/23/2022]
Abstract
The SARS-COV-2 pandemic has brought unparalleled challenges to healthcare provision. Being a newly discovered virus, there is a lack of previous experience and published evidence to guide healthcare providers on how to deliver services. We would like to share our approach to service delivery in a newly open children's hospital in the United Arab Emirates with a particular focus on paediatric orthopaedic services.
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Zagra L, Faraldi M, Andreata M, Ottaiano I, Basile G, Lombardi G. A seven week observational analysis of clinical activities in a North Italian orthopaedic hospital during the second wave of SARS-CoV-2 pandemic: far from usual volumes, but different from the first wave. INTERNATIONAL ORTHOPAEDICS 2021; 45:2473-2482. [PMID: 33983467 PMCID: PMC8116436 DOI: 10.1007/s00264-021-05064-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
Purpose We previously described the radical changes occurred in an orthopaedic hospital in Milan (Italy) during the first SARS-CoV-2 pandemic outbreak. Currently, during the second wave, the situation is still far from normality. Here we describe the changes that took place, and are still ongoing, in the clinical practice. Methods Number and type of admissions, outpatients activity, ER and urgent procedures in SARS-CoV-2 negative and positive patients have been analyzed over seven weeks (October 26th–December 13th, 2020) and compared with the correspondent period in 2019 and the same timeframe during the first wave (February 24th–April 10th). Results 2019 vs. 2020: Overall admissions decreased by 39.8%; however, while admissions for elective surgery dropped by 42.0%, urgent surgeries increased by 117.0%. Rehabilitation admissions declined by 85.2%. White and green priority ER consultations declined by 41.6% and 52.0%, respectively; yellow and red increased by 766.7% and 400.0%, respectively. Second vs. first wave: Overall admissions increased by 58.6% with a smoother decrement in weekly admissions than during the first wave. Disparity of acute admissions vs. rehabilitation expanded: Acute cases increased by 63.6% while rehabilitation cases decreased by 8.7%. Admissions to triage procedures increased by 72.3%. Conclusions Activity levels are far from normality during the second COVID-19 wave. Elective surgery and outpatients-related activities are still strongly limited compared to 2019 while the number of urgent cases treated increased consistently. SARS-CoV-2 positive emergencies are slightly higher than during the first wave. These important changes are expected to impact on health service and hospital budget for long.
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Affiliation(s)
- Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Martina Faraldi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Mauro Andreata
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Giuseppe Basile
- ER Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, Poznań, Poland
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12
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Assadian O, Golling M, Krüger CM, Leaper D, Mutters NT, Roth B, Kramer A. Surgical site infections: guidance for elective surgery during the SARS-CoV-2 pandemic - international recommendations and clinical experience. J Hosp Infect 2021; 111:189-199. [PMID: 33600892 PMCID: PMC7883712 DOI: 10.1016/j.jhin.2021.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The COVID-19 pandemic not only had an impact on public life and healthcare facilities in general, but also affected established surgical workflows for elective procedures. The strategy to protect patients and healthcare workers from infection by SARS-CoV-2 in surgical departments has needed step-by-step development. Based on the evaluation of international recommendations and guidelines, as well as personal experiences in a clinical 'hot spot' and in a 450-bed surgical clinic, an adapted surgical site infection (SSI) prevention checklist was needed to develop concise instructions, which described roles and responsibilities of healthcare professionals that could be used for wider guidance in pandemic conditions. METHOD Publications of COVID-19-related recommendations and guidelines, produced by health authorities and organizations, such as WHO, US-CDC, ECDC, the American College of Surgery and the Robert Koch Institute, were retrieved, assessed and referenced up to 31st January 2020. Additionally, clinical personal experiences in Germany were evaluated and considered. RESULTS Part 1 of this guidance summarizes the experience of a tertiary care, surgical centre which utilized redundant hospital buildings for immediate spatial separation in a 'hot spot' COVID-19 area. Part 2 outlines the successful screening and isolation strategy in a surgical clinic in a region of Germany with outbreaks in surrounding medical centres. Part 3 provides the synopsis of personal experiences and international recommendations suggested for implementation during the COVID-19 pandemic. CONCLUSION Understanding of COVID-19, and SARS-CoV-2-related epidemiology, is constantly and rapidly changing, requiring continuous adaptation and re-evaluation of recommendations. Established national and local guidelines for continuation of surgical services and prevention of SSI require ongoing scrutiny and focused implementation. This manuscript presents a core facility checklist to support medical institutions to continue their clinical and surgical work during the COVID-19 pandemic.
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Affiliation(s)
- O Assadian
- Regional Hospital Wiener Neustadt, Austria; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - M Golling
- Surgical Clinic I, Diakonie-Klinikum Schwäbisch Hall gGmbH, Germany
| | - C M Krüger
- Immanuel Klinikum Rüdersdorf, Department of Surgery, Center for Robotics, Rüdersdorf b. Berlin, Germany
| | - D Leaper
- Department of Surgery, University of Newcastle upon Tyne, UK; Department of Clinical Sciences, ISIaIP, University of Huddersfield, Huddersfield, UK
| | - N T Mutters
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany; CEOsys Network of the National University Medicine Research Network on Covid-19 (NUM)
| | - B Roth
- Surgical Clinic, District Hospital Belp/Switzerland, FMH for General and Trauma Surgery, Wattenwil, Switzerland
| | - A Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany; CEOsys Network of the National University Medicine Research Network on Covid-19 (NUM).
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13
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Kazubski K, Tomczyk Ł, Kopczyński B, Morasiewicz P. The Epidemiology of Hip and Knee Primary and Revision Arthroplasties during the COVID-19 Pandemic. Healthcare (Basel) 2021; 9:healthcare9050519. [PMID: 33946724 PMCID: PMC8145961 DOI: 10.3390/healthcare9050519] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The purpose of this study was to provide a comprehensive assessment of the impact of the COVID-19 pandemic on the epidemiology of primary and revision arthroplasties of the hip and knee joint. METHODS This study compared the data on knee and hip arthroplasty procedures from 2 hospitals (primary and revision) conducted in two periods: the period of the COVID-19 pandemic in Poland (from 4 March 2020 to 15 October 2020) and the corresponding period prior to the pandemic (from 4 March 2019 to 15 October 2019). We compared the epidemiological data, demographic data, and hospital stay duration data from these two periods. RESULTS Our analysis demonstrated that the total number of hip arthroplasties conducted in 2020 decreased by 26% in comparison with 2019. In the case of knee arthroplasties, the total number of procedures in the evaluated period in 2020 decreased by 44%. Our study also showed that the mean time of hospital stay for orthopedic patients following hip or knee arthroplasty was 22.87% shorter. The female-to-male patient ratio decreased between the analyzed periods, and this was 22.96% lower during the pandemic. CONCLUSION The COVID-19 pandemic in these two hospitals in Poland led to reduced numbers of hip and knee replacement procedures, shorter hospital stays, and a decreased female-to-male patient ratio. The mean age of patients undergoing hip or knee arthroplasty remained unchanged during the national lockdown with respect to the pre-pandemic figure.
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Affiliation(s)
- Krystian Kazubski
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, al. Witosa 26, 45-401 Opole, Poland; (K.K.); (B.K.)
| | - Łukasz Tomczyk
- Department of Food Safety and Quality Management, Poznan University of Life Sciences, Wojska Polskiego 28, 60-637 Poznan, Poland;
| | - Bartosz Kopczyński
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, al. Witosa 26, 45-401 Opole, Poland; (K.K.); (B.K.)
| | - Piotr Morasiewicz
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, al. Witosa 26, 45-401 Opole, Poland; (K.K.); (B.K.)
- Correspondence:
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14
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van der Zwaard BC, Liu WY, Sprengers J, Verschoor N, van Hove RP, Donell S. Preparation for the next COVID-19 wave: The European Hip Society and European Knee Associates recommendations. Acta Orthop 2021; 92:247-248. [PMID: 33615974 PMCID: PMC8158179 DOI: 10.1080/17453674.2021.1872169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
| | - Wai-Yan Liu
- Máxima Medical Center, Department of Orthopaedic Surgery, Eindhoven, the Netherlands,Catharina Hospital, Department of Orthopaedic Surgery, Eindhoven, the Netherlands
| | - Judith Sprengers
- Jeroen Bosch Ziekenhuis, Department of Orthopaedic Surgery, ’s-Hertogenbosch, the Netherlands
| | - Nico Verschoor
- Jeroen Bosch Ziekenhuis, Department of Orthopaedic Surgery, ’s-Hertogenbosch, the Netherlands
| | - Ruud P van Hove
- Jeroen Bosch Ziekenhuis, Department of Orthopaedic Surgery, ’s-Hertogenbosch, the Netherlands
| | - Simon Donell
- Norwich Medical School, University of East Anglia, Norwich, UK,
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15
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Hotchen AJ, Khan SA, Khan MA, Seah M, Charface ZH, Khan Z, Khan W, Kang N, Melton JTK, McCaskie AW, McDonnell SM. Insights into patient preferences for elective surgery during the COVID-19 pandemic. Bone Jt Open 2021; 2:261-270. [PMID: 33882713 PMCID: PMC8085616 DOI: 10.1302/2633-1462.24.bjo-2020-0201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS To investigate factors that contribute to patient decisions regarding attendance for arthroplasty during the COVID-19 pandemic. METHODS A postal questionnaire was distributed to patients on the waiting list for hip or knee arthroplasty in a single tertiary centre within the UK. Patient factors that may have influenced the decision to attend for arthroplasty, global quality of life (QoL) (EuroQol five-dimension three-level (EQ-5D-3L)), and joint-specific QoL (Oxford Hip or Knee Score) were assessed. Patients were asked at which 'COVID-alert' level they would be willing to attend an NHS and a "COVID-light" hospital for arthroplasty. Independent predictors were assessed using multivariate logistic regression. RESULTS Of 540 distributed questionnaires, 400 (74.1%; 236 awaiting hip arthroplasty, 164 awaiting knee arthroplasty) complete responses were received and included. Less than half (48.2%) were willing to attend for hip or knee arthroplasty while a UK COVID-19 epidemic was in circulation (COVID-alert levels 3 to 5). Patients with worse joint-specific QoL had a preference to proceed with surgery at COVID-alert levels 3 to 5 compared to levels 1 and 2 (hip arthroplasty odds ratio (OR) 1.54 (95% confidence interval (CI) 1.45 to 1.63); knee arthroplasty OR 1.16 (1.07 to 1.26)). The odds of patients with worse joint-specific QoL being willing to attend for surgery at COVID-alert levels 3 to 5 increased further if surgery in a private, "COVID-light" hospital was available (hip arthroplasty OR 3.50 (95% CI 3.26 to 3.71); knee arthroplasty OR 1.41 (95% CI 1.29 to 1.53). CONCLUSION Patient decisions surrounding elective surgery have been influenced by the global COVID-19 pandemic, highlighting the importance of patient involvement in ensuring optimized provision of elective surgery during these challenging times. Cite this article: Bone Jt Open 2021;2(4):261-270.
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Affiliation(s)
- Andrew James Hotchen
- Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Saad A Khan
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Maaz A Khan
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Matthew Seah
- Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Zain H Charface
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Zarif Khan
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Niel Kang
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
| | | | - Andrew W McCaskie
- Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Stephen M McDonnell
- Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
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16
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COVID-19-related cancellation of elective orthopaedic surgery caused increased pain and psychosocial distress levels. Knee Surg Sports Traumatol Arthrosc 2021; 29:2379-2385. [PMID: 33710414 PMCID: PMC7952835 DOI: 10.1007/s00167-021-06529-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/02/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Health care systems in most European countries were temporarily restructured to provide as much capacity as possible for the treatment of coronavirus disease 2019 (COVID-19) patients. Subsequently, all elective surgeries had to be cancelled and postponed for months. The aim of the present study was to assess the pretreatment health status before and after COVID-19-related cancellation and the psychosocial distress caused by the cancellation. METHODS For this study, a questionnaire was developed collecting sociodemographic data and information on health status before and after the cancellation. To assess psychosocial distress, the validated depression module of the Patient Health Questionnaire (PHQ-9), was implemented. PHQ-9-Scores of 10 and above were considered to indicate moderate or severe depressive symptoms. In total, 119 patients whose elective orthopaedic surgery was postponed due to the COVID-19 pandemic were surveyed once at least 8 weeks after the cancellation. RESULTS Seventy-seven patients (65%; 34 female, 43 male) completed the questionnaire and were included. The predominant procedures were total knee arthroplasty (TKA), hip arthroscopy and foot and ankle surgery. The mean pain level significantly increased from 5.5 ± 2.2 at the time of the initially scheduled surgery to 6.2 ± 2.5 at the time of the survey (p < 0.0001). The pain level before cancellation of the surgery was significantly higher in female patients (p = 0.029). An increased analgetic consumption was identified in 46% of all patients. A mean PHQ-9 score of 6.1 ± 4.9 was found after cancellation. PHQ-9 scores of 10 or above were found in 14% of patients, and 8% exhibited scores of 15 points or above. Significantly higher PHQ-9 scores were seen in female patients (p = 0.046). No significant differences in PHQ-9 scores were found among age groups, procedures or reasons for cancellation. CONCLUSION Cancellation of elective orthopaedic surgery resulted in pain levels that were significantly higher than when the surgery was scheduled, leading to increased analgesic use. Additionally, significant psychosocial distress due to the cancellation was identified in some patients, particularly middle-aged women. Despite these results, confidence in the national health care system and in the treating orthopaedic surgeons was not affected. LEVEL OF EVIDENCE Level III.
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17
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Prioritising of hip and knee arthroplasty procedures during the COVID-19 pandemic: the European Hip Society and the European Knee Associates Survey of Members. Knee Surg Sports Traumatol Arthrosc 2021; 29:3159-3163. [PMID: 33433635 PMCID: PMC7802426 DOI: 10.1007/s00167-020-06379-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE During the COVID-19 pandemic there has been a massive reduction of arthroplasty services due to reallocation of hospital resources. The unique challenge for clinicians has been to define which arthroplasty patients most urgently require surgery. The present study aimed to investigate priority arthroplasty procedures during the pandemic and in the reinstatement period from the surgeon's perspective. MATERIAL AND METHODS An online survey was conducted among members of the European Hip Society (EHS), European Knee Associates (EKA) and other invited orthopaedic arthroplasty surgeons (experts) from across the world. The survey consisted of 17 different arthroplasty procedures/indications of which participants were asked to choose and rank the most important 10. RESULTS Four hundred and thirty-nine arthroplasty surgeons from 44 countries responded. The EHS and EKA had a 43% response rate of members. In weighted average points, the majority of respondents (67.5 points) ranked 'acute fractures requiring arthroplasty (Periprosthetic fractures, THA/hemi-arthroplasty for femoral neck fractures)' as priority indication number one, followed by 'first-stage explantations for acute PJI (periprosthetic joint infection)' in second place and priority indication (45.9 points) three as 'one-stage revision for acute PJI' (39.7 points). CONCLUSIONS There was agreement that femoral neck fractures, periprosthetic fractures, and acute infections should be prioritised and cannot be postponed in the setting of the COVID-19 pandemic. As arthroplasty procedures are being resumed in most countries now, there has also been a relaxation of lockdown rules in most countries, which might cause a so-called second wave of the pandemic. Therefore, the results of the current study present a proposal by experts as to which operations should be prioritised in the setting of a second wave of the pandemic.
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18
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Tan YN, Vandekerckhove PJ, Verdonk P. The long road to recovery: at six months since the first COVID-19 wave, elective orthopedic care has still not fully recovered in Belgium. J Exp Orthop 2020; 7:99. [PMID: 33349907 PMCID: PMC7752098 DOI: 10.1186/s40634-020-00316-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The primary aim of our study was to investigate elective orthopaedic care during the first wave government-imposed COVID-19 lockdown and at four weeks and 21 weeks after resuming elective care. The secondary aim of our study was to evaluate the implementation of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) COVID-19 Guidelines and Recommendations for Resuming Elective Surgery in the clinical practice of Belgian knee surgeons. METHODS We sent three anonymous online surveys to 102 Belgian Knee Society members (BKS) at times mentioned above. Addressed topics were: (1) participant demographics, (2) elective surgeries, (3) outpatient visits, (4) ESSKA Guidelines, (5) patient and surgeon safety. RESULTS During the COVID-19 lockdown, there was a decrease of 97% in elective knee surgeries and 91% in outpatient visits. At four and 21 weeks after resuming elective care, volumes were respectively 67% and 89% for elective surgeries and 81% and 91% for outpatient visits. Regarding ESSKA guidelines, 91% of surgeons had no COVID-19 testing prior to resuming elective care. Ninety-two per cent reported preoperative (< 72 h) patient PCR testing, and 45% gave preference to young patients without comorbidities. Seventy-two per cent did not use additional personal protective equipment (PPE) if a patient PCR test was negative. Forty-nine per cent continued to give preference to general anaesthesia. CONCLUSION Our study shows that elective surgeries and outpatient visits were almost completely interrupted during the COVID-19 lockdown and were still below normal at four and 21 weeks after resuming elective care. Regarding ESSKA COVID-19 guidelines, our study observes good compliance in preoperative patient COVID-19 testing, but lower compliance for preoperative health care personnel testing, patient selection, use of PPE, and locoregional anaesthesia. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Y N Tan
- Department of Orthopedics and Traumatology, University Hospital Brussels, Laarbeeklaan 101, 1090, Jette, Belgium.
| | - P J Vandekerckhove
- Department of Orthopedics and Traumatology, Sint-Jan Hospital, Ruddershove 10, 8000, Orthoclinic, AZ, Belgium
| | - P Verdonk
- ORTHOCA, AZ Monica, Stevenslei 20, 2100, Deurne, Belgium.,Department of Orthopedics and Traumatology, University Hospital Antwerp, Antwerp, Belgium
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