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Ross SW, McCartt JC, Cunningham KW, Reinke CE, Thompson KJ, Green JM, Thomas BW, Jacobs DG, May AK, Christmas AB, Sing RF. Emergencies do not shut down during a pandemic: COVID pandemic impact on Acute Care Surgery volume and mortality at a level I trauma center. Am J Surg 2022; 224:1409-1416. [PMID: 36372581 PMCID: PMC9575313 DOI: 10.1016/j.amjsurg.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/23/2022] [Accepted: 10/13/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of the COVID-19 pandemic on volume and outcomes of Acute Care Surgery patients, and we hypothesized that inpatient mortality would increase due to COVID+ and resource constraints. METHODS An American College of Surgeons verified Level I Trauma Center's trauma and operative emergency general surgery (EGS) registries were queried for all patients from Jan. 2019 to Dec. 2020. April 1st, 2020, was the demarcation date for pre- and during COVID pandemic. Primary outcome was inpatient mortality. RESULTS There were 14,460 trauma and 3091 EGS patients, and month-over-month volumes of both remained similar (p > 0.05). Blunt trauma decreased by 7.4% and penetrating increased by 31%, with a concomitant 25% increase in initial operative management (p < 0.001). Despite this, trauma (3.7%) and EGS (2.9-3.0%) mortality rates remained stable which was confirmed on multivariate analysis; p > 0.05. COVID + mortality was 8.8% and 3.7% in trauma and EGS patients, respectively. CONCLUSION Acute Care Surgeons provided high quality care to trauma and EGS patients during the pandemic without allowing excess mortality despite many hardships and resource constraints.
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Affiliation(s)
- Samuel W. Ross
- Corresponding author. Atrium Health Carolinas Medical Center, Charlotte NC, 1000 Blythe Blvd, Suite 601 MEB, Charlotte, NC, 28203, USA
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Mehta A, Awuah WA, Ng JC, Kundu M, Yarlagadda R, Sen M, Nansubuga EP, Abdul-Rahman T, Hasan MM. Elective surgeries during and after the COVID-19 pandemic: Case burden and physician shortage concerns. Ann Med Surg (Lond) 2022; 81:104395. [PMID: 35999832 PMCID: PMC9388274 DOI: 10.1016/j.amsu.2022.104395] [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: 06/16/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
The COVID-19 pandemic had a significant impact on several aspects of global healthcare systems, particularly surgical services. New guidelines, resource scarcity, and an ever-increasing demand for care have posed challenges to healthcare professionals, resulting in the cancellation of many surgeries, with short and long-term consequences for surgical care and patient outcomes. As the pandemic subsides and the healthcare system attempts to reestablish a sense of normalcy, surgical recommendations and advisories will shift. These changes, combined with a growing case backlog (postponed surgeries + regularly scheduled surgeries) and a physician shortage, can have serious consequences for physician health and, as a result, surgical care. Several initiatives are already being implemented by governments to ensure a smooth transition as surgeries resume. Newer and more efficient steps aimed at providing adequate surgical care while preventing physician burnout, on the other hand, necessitate a collaborative effort from governments, national medical boards, institutions, and healthcare professionals. This perspective aims to highlight alterations in surgical recommendations over the course of the pandemic and how these changes continue to influence surgical care and patient outcomes as the pandemic begins to soften its grip. The COVID-19 pandemic had a significant impact on several aspects of surgical care. New surgical recommendations amidst an ever-increasing demand for care pose, short and long-term consequences for surgical care and patient outcomes. As the pandemic subsides, these changes, combined with a growing case backlog and a physician shortage, can have serious consequences for physician health and, as a result, surgical care.
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Yoon JS, Khoo KH, Akhavan AA, Lagziel T, Ha M, Cox CA, Blanding R, Werthman EH, Caffrey J, Hultman CS. Changes in Burn Surgery Operative Volume and Metrics due to COVID-19. J Burn Care Res 2022; 43:1233-1240. [PMID: 35986489 PMCID: PMC9384663 DOI: 10.1093/jbcr/irac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to COVID-19, hospitals underwent drastic changes to operating room policy to mitigate the spread of the disease. Given these unprecedented measures, we aimed to look at the changes in operative volume and metrics of the burn surgery service at our institution. A retrospective review was conducted for operative cases and metrics for the months of March to May for 2019, 2020, and 2021, which correspond with pre-COVID, early COVID (period without elective cases), and late COVID (period with resumed elective cases). Inclusion criteria were cases related to burns. Case types and operative metrics were compared amongst the three time periods. Compared to the hospital, the burn service had a smaller decrease in volume during early COVID (28.7% vs. 50.1%) and exceeded pre-pandemic volumes during late COVID (+21.8% vs. -4.6%). There was a significant increase in excision and grafting cases in early and late COVID periods (p < .0001 and p < .002). There was a significant decrease in laser scar procedures that persisted even during late COVID (p < .0001). The projected and actual lengths of cases significantly increased and persisted into late COVID (p < .01). COVID-19 related operating room closures led to an expected decrease in the number of operative cases. However, there was no significant decline in the number of burn specific cases. The elective cases were largely replaced with excision and grafting cases and this shift has persisted even after elective cases have resumed. This change is also reflected in increased operative times.
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Affiliation(s)
- Joshua S Yoon
- Division of Plastic, Reconstructive & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center , Baltimore, MD USA
- Department of Surgery, George Washington University Hospital , Washington, DC USA
| | - Kimberly H Khoo
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Arya A Akhavan
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Michael Ha
- Division of Plastic Surgery, University of Maryland School of Medicine , Baltimore, MD USA
| | - Carrie A Cox
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Renee Blanding
- Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Emily H Werthman
- Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing , Baltimore, MD USA
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
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Cuerpo G, Pedraz A, Pinto A. Impacto de la pandemia COVID-19 en la cirugía cardíaca en España. CIRUGIA CARDIOVASCULAR 2021. [PMCID: PMC8246706 DOI: 10.1016/j.circv.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Chong SMY, Hung RKY, Gwozdz A, Irwin S, Eastbury J, Cross T, Ahmed K, Taylor C, Goldenberg SD, Sanderson J, Olsburgh J. 30-Day postoperative COVID-19 outcomes in 398 patients from regional hospitals utilising a designated COVID-19 minimal surgical site pathway. Ann R Coll Surg Engl 2021; 103:395-403. [PMID: 33956529 PMCID: PMC10335038 DOI: 10.1308/rcsann.2020.7072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Postoperative pulmonary complications and mortality rates during the COVID-19 pandemic have been higher than expected, leading to mass cancellation of elective operating in the UK. To minimise this, the Guy's and St Thomas' Hospital NHS Foundation Trust elective surgery hub and the executive team at London Bridge Hospital (LBH) created an elective operating framework at LBH, a COVID-19 minimal site, in which patients self-isolated for two weeks and proceeded with surgery only following a negative preoperative SARS-CoV-2 polymerase chain reaction swab. The aim was to determine the rates of rates of postoperative COVID-19 infection. METHODS The collaboration involved three large hospital trusts, covering the geographic area of south-east London. All patients were referred to LBH for elective surgery. Patients were followed up by telephone interview at four weeks postoperatively. RESULTS Three hundred and ninety-eight patients from 13 surgical specialties were included in the analysis. The median age was 60 (IQR 29-71) years. Sixty-three per cent (252/398) were female. In total, 78.4% of patients had an American Society of Anesthesiologists grade of 1-2 and the average BMI was 27.2 (IQR 23.7-31.8) kg/m2. Some 83.6% (336/402) were 'major' operations. The rate of COVID-19-related death in our cohort was 0.25% (1/398). Overall, there was a 1.26% (5/398) 30-day postoperative all-cause mortality rate. Seven patients (1.76%) reported COVID-19 symptoms, but none attended the emergency department or were readmitted to hospital as a result. CONCLUSION The risk of contracting COVID-19 in our elective operating framework was very low. We demonstrate that high-volume major surgery is safe, even at the peak of the pandemic, if patients are screened appropriately preoperatively.
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Affiliation(s)
| | | | | | - S Irwin
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK
| | | | | | | | - C Taylor
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK
| | - SD Goldenberg
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK
| | - J Sanderson
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK
| | - J Olsburgh
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK
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Kirkley K, Benedetto U, Caputo M, Angelini GD, Vohra HA. The ongoing impact of COVID-19 on adult cardiac surgery and suggestions for safe continuation throughout the pandemic: a review of expert opinions. Perfusion 2021; 37:340-349. [PMID: 33985387 PMCID: PMC9069655 DOI: 10.1177/02676591211013730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To establish the impact of the COVID-19 pandemic on adult cardiac surgery by reviewing current data and use this to establish methods for safely continuing to carry out surgery. Methods: Conduction of a literature search via PubMed using the search terms: ‘(adult cardiac OR cardiothoracic OR surgery OR minimally invasive OR sternotomy OR hemi-sternotomy OR aortic valve OR mitral valve OR elective OR emergency) AND (COVID-19 or coronavirus OR SARS-CoV-2 OR 2019-nCoV OR 2019 novel coronavirus OR pandemic)’. Thirty-two articles were selected. Results: Cardiac surgery patients have an increased risk of complications from COVID-19 and require vital finite resources such as intensive care beds, also required by COVID-19 patients. Thus reducing their admission and potential hospital-acquired infection with COVID-19 is paramount. During the peak, only emergencies such as acute aortic dissections were treated, triaging patients according to surgical priority and cancelling all elective procedures. Screening and 2-week quarantine prior to admission were essential changes, alongside additional levels of PPE. Focus was on reducing length of stay and switching to day-cases to reduce post-operative transmission risk, whilst several hospitals adopted ‘hot’ and ‘cold’ operating theatres for covid-confirmed and covid-negative patients. Conclusions: This paper suggests a ‘CARDIO’ approach for reintroducing elective procedures: ‘Care, Assess, Re-Evaluate, Develop, Implement, Overcome’; prioritising the mental and physical health of the workforce, learning from and sharing experiences and objectively prioritising patients to improve case load.
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Affiliation(s)
- Kirstie Kirkley
- Department of Cardiac Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiac Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
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Oussedik S, MacIntyre S, Gray J, McMeekin P, Clement ND, Deehan DJ. Elective orthopaedic cancellations due to the COVID-19 pandemic: where are we now, and where are we heading? Bone Jt Open 2021; 2:103-110. [PMID: 33573397 PMCID: PMC7925214 DOI: 10.1302/2633-1462.22.bjo-2020-0161.r1] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS The primary aim is to estimate the current and potential number of patients on NHS England orthopaedic elective waiting lists by November 2020. The secondary aims are to model recovery strategies; review the deficit of hip and knee arthroplasty from National Joint Registry (NJR) data; and assess the cost of returning to pre-COVID-19 waiting list numbers. METHODS A model of referral, waiting list, and eventual surgery was created and calibrated using historical data from NHS England (April 2017 to March 2020) and was used to investigate the possible consequences of unmet demand resulting from fewer patients entering the treatment pathway and recovery strategies. NJR data were used to estimate the deficit of hip and knee arthroplasty by August 2020 and NHS tariff costs were used to calculate the financial burden. RESULTS By November 2020, the elective waiting list in England is predicted to be between 885,286 and 1,028,733. If reduced hospital capacity is factored into the model, returning to full capacity by November, the waiting list could be as large as 1.4 million. With a 30% increase in productivity, it would take 20 months if there was no hidden burden of unreferred patients, and 48 months if there was a hidden burden, to return to pre-COVID-19 waiting list numbers. By August 2020, the estimated deficits of hip and knee arthroplasties from NJR data were 18,298 (44.8%) and 16,567 (38.6%), respectively, compared to the same time period in 2019. The cost to clear this black log would be £198,811,335. CONCLUSION There will be up to 1.4 million patients on elective orthopaedic waiting lists in England by November 2020, approximate three-times the pre-COVID-19 average. There are various strategies for recovery to return to pre-COVID-19 waiting list numbers reliant on increasing capacity, but these have substantial cost implications. Cite this article: Bone Jt Open 2021;2(2):103-110.
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Affiliation(s)
- Sam Oussedik
- Department of Orthopaedics, University College London Hospitals, London, UK
| | - Sam MacIntyre
- Barcelona Graduate School of Economics, Barcelona, Spain
| | - Joanne Gray
- Department of Nursing, Midwifery and Health, Northumbria University, Northumbria, UK
| | - Peter McMeekin
- Department of Nursing, Midwifery and Health, Northumbria University, Northumbria, UK
| | - Nick D. Clement
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Ralhan S, Arya RC, Gupta R, Wander GS, Gupta RK, Gupta VK, Bagga S, Mohan B. Cardiothoracic surgery during COVID-19: Our experience with different strategies. Ann Card Anaesth 2020; 23:485-492. [PMID: 33109808 PMCID: PMC7879916 DOI: 10.4103/aca.aca_166_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: An acute respiratory disease (COVID-19), caused by a novel coronavirus (SARS-CoV-2,), has been declared a pandemic by WHO. A surgery on COVID-19 patients not only involves a risk of spread of the disease but also there is a serious concern for the patient's surgical outcomes and resources requirement. Aim: The retrospective study is aimed to provide a protocol for pre-operative testing of SARS CoV-2 using RT-PCR in the patient undergoing cardio-thoracic surgeries. Material and Methods: To analyze the impact of pre-operative testing of SARS- CoV-2 using RT-PCR in the patient undergoing elective cardio-thoracic surgeries. The patient who underwent surgical interventions during the COVID-19 lockdown period was divided into two phases. Phase I (without COVID-19 RT-PCR testing) and Phase II (with pre-operative COVID-19 RT-PCR testing). The retrospective comparison between the two study groups was done using Student t-test, Mann–Whitney U, and Chi square (χ2) test depending upon the clinical variable to be analyzed. Results: During the early phase (phase I), 26 patients underwent cardio-thoracic surgery without COVID-19 RT-PCR test. Whereas, during phase II, all patients were tested for COVID-19 using RT-PCR, preoperatively and a total of 64 surgeries were performed during this phase. One patient planned for CABG was positive on RT-PCR for COVID-19 and was sent to the quarantine ward. The difference in the pre-operative hospital stay between two groups was found to be statistically significant and a significant decrease in the number of PPE kits used, during the phase I. Conclusion: All asymptomatic patients should be tested for COVID-19 using RT-PCR prior to cardio-thoracic surgeries not only to contain the disease but to avoid potential implications of COVID-19 on the perioperative course, without added financial implications.
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Affiliation(s)
- Sarju Ralhan
- Department of CTVS, Chief Cardiac Surgeon, Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - Rajesh C Arya
- Department of Cardiac Anaesthesia and Intensive Care, Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - Rama Gupta
- Department of Microbiology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Gurpreet S Wander
- Department of Cardiology, Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - Rajiv K Gupta
- Department of CTVS, Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - Vivek K Gupta
- Department of Cardiac Anaesthesia and Intensive Care, Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - Suhani Bagga
- Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Bishav Mohan
- Department of Cardiology, Hero DMC Heart Institute, Ludhiana, Punjab, India
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Timeline and Procedures on Restarting Non-Emergent Arthroplasty Care in the US Epicenter of the COVID-19 Pandemic. HSS J 2020; 16:146-152. [PMID: 33013245 PMCID: PMC7524030 DOI: 10.1007/s11420-020-09801-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
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Getting back to work: A framework and pivot plan to resume elective surgery and procedures after COVID-19. Surg Open Sci 2020; 4:12-18. [PMID: 33106786 PMCID: PMC7578777 DOI: 10.1016/j.sopen.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/06/2020] [Accepted: 09/18/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The COVID-19 pandemic has compelled a majority of hospital systems to reduce surgical and procedural volumes in an attempt to preserve resources. Elective surgery and procedures resumption has proven to be a calculated risk between COVID-19 exposure and resource depletion and patient morbidity and mortality from surgical deferral. Methods Within a few days of halting elective surgery and procedures, our 7-hospital (2427 in-patient beds, 26,647 inpatient surgeries) healthcare system developed a multidisciplinary Pivot Plan with the primary outcome of a phased resumption of elective surgery and procedures. The plan entailed the integration of our electronic medical record, order entry automatization, perioperative staff utilization, partnering with primary care providers, and a stepwise COVID-19 testing algorithm based on a predetermined hierarchy of case acuity and timeliness of patient care. Results The Pivot Plan was instituted on May 10, 2020. Since then, 22,624 patients have been tested for COVID-19 in anticipation of an elective surgery and procedures; 140 (0.62%) tested positive for COVID-19 and had their procedure deferred. As our testing capability has increased, we have been able to increase our added elective surgery and procedures capacity from 13 cases per day to 531 cases per day. In turn, we have seen the case volume increase by 52%. Conclusion Our academic healthcare system located in one of the initial COVID-19 hotspots in the United States has successfully resumed elective surgery and procedures in part due to a receptive and supportive culture based upon nimbleness, agility, and rapid integration of multiple resources from a cohort of diverse disciplines applied to the perioperative services workflow.
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Clement ND, Hall AJ, Makaram NS, Robinson PG, Patton RFL, Moran M, Macpherson GJ, Duckworth AD, Jenkins PJ. IMPACT-Restart: the influence of COVID-19 on postoperative mortality and risk factors associated with SARS-CoV-2 infection after orthopaedic and trauma surgery. Bone Joint J 2020; 102-B:1774-1781. [PMID: 33249904 DOI: 10.1302/0301-620x.102b12.bjj-2020-1395.r2] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS The primary aim of this study was to assess the independent association of the coronavirus disease 2019 (COVID-19) on postoperative mortality for patients undergoing orthopaedic and trauma surgery. The secondary aim was to identify factors that were associated with developing COVID-19 during the postoperative period. METHODS A multicentre retrospective study was conducted of all patients presenting to nine centres over a 50-day period during the COVID-19 pandemic (1 March 2020 to 19 April 2020) with a minimum of 50 days follow-up. Patient demographics, American Society of Anesthesiologists (ASA) grade, priority (urgent or elective), procedure type, COVID-19 status, and postoperative mortality were recorded. RESULTS During the study period, 1,659 procedures were performed in 1,569 patients. There were 68 (4.3%) patients who were diagnosed with COVID-19. There were 85 (5.4%) deaths postoperatively. Patients who had COVID-19 had a significantly lower survival rate when compared with those without a proven SARS-CoV-2 infection (67.6% vs 95.8%, p < 0.001). When adjusting for confounding variables (older age (p < 0.001), female sex (p = 0.004), hip fracture (p = 0.003), and increasing ASA grade (p < 0.001)) a diagnosis of COVID-19 was associated with an increased mortality risk (hazard ratio 1.89, 95% confidence interval (CI) 1.14 to 3.12; p = 0.014). A total of 62 patients developed COVID-19 postoperatively, of which two were in the elective and 60 were in the urgent group. Patients aged > 77 years (odds ratio (OR) 3.16; p = 0.001), with increasing ASA grade (OR 2.74; p < 0.001), sustaining a hip (OR 4.56; p = 0.008) or periprosthetic fracture (OR 14.70; p < 0.001) were more likely to develop COVID-19 postoperatively. CONCLUSION Perioperative COVID-19 nearly doubled the background postoperative mortality risk following surgery. Patients at risk of developing COVID-19 postoperatively (patients > 77 years, increasing morbidity, sustaining a hip or periprosthetic fracture) may benefit from perioperative shielding. Cite this article: Bone Joint J 2020;102-B(12):1774-1781.
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Affiliation(s)
| | - Andrew James Hall
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Navnit S Makaram
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Robyn F L Patton
- Biomedical Sciences, Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Matthew Moran
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Andrew D Duckworth
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Paul J Jenkins
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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Abstract
Background and purpose - The ongoing Coronavirus Disease-19 (COVID-19) pandemic has taken a toll on healthcare systems around the world. This has led to guidelines advising against elective procedures, which includes elective arthroplasty. Despite arthroplasty being an elective procedure, some arthroplasties are arguably essential, as pain or functional impairment maybe devastating for patients, especially during this difficult period. We describe our experience as the Division of Arthroplasty in the hospital at the epicenter of the COVID-19 pandemic in Singapore.Patients and methods - The number of COVID-19 cases reported both nationwide and at our institution from February 2020 to date were reviewed. We then collated the number of arthroplasties that we were able to cope with on a weekly basis and charted it against the number of new COVID-19 cases admitted to our institution and the prevalence of COVID-19 within the Singapore population.Results - During the COVID-19 pandemic period, a significant decrease in the volume of arthroplasties was seen. 47 arthroplasties were performed during the pandemic period from February to April, with a weekly average of 5 cases. This was a 74% reduction compared with our institutional baseline. The least number of surgeries were performed during early periods of the pandemic. This eventually rose to a maximum of 47% of our baseline numbers. Throughout this period, no cases of COVID-19 infection were reported amongst the orthopedic inpatients at our institution.Interpretation - During the early periods of the pandemic, careful planning was required to evaluate the pandemic situation and gauge our resources and manpower. Our study illustrates the number of arthroplasties that can potentially be done relative to the disease curve. This could serve as a guide to reinstating arthroplasty as the pandemic dies down. However, it is prudent to note that these situations are widely dynamic and frequent re-evaluation is required to secure patient and healthcare personnel safety, while ensuring appropriate care is delivered.
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Affiliation(s)
- Joshua Decruz
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Sumanth Prabhakar
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Jensen RD, Bie M, Gundsø AP, Schmid JM, Juelsgaard J, Gamborg ML, Mainz H, Rölfing JD. Preparing an orthopedic department for COVID-19. Acta Orthop 2020; 91:644-649. [PMID: 32907437 PMCID: PMC8023962 DOI: 10.1080/17453674.2020.1817305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The COVID-19 pandemic has disrupted healthcare services around the world. We (1) describe the organizational changes at a level 1 trauma center, (2) investigate how orthopedic healthcare professionals perceived the immense amount of information and educational activities, and (3) make recommendations on how an organization can prepare for disruptive situations such as the COVID-19 pandemic in the future. Methods - We conducted a retrospective survey on the organizational restructuring of the orthopedic department and the learning outcomes of a needs-driven educational program. The educational activities were evaluated by a non-validated, 7-item questionnaire. Results - The hospital established 5 COVID-19 clusters, which were planned to be activated in sequential order. The orthopedic ward comprised cluster 4, where orthopedic nursing staff were teamed up with internal medicine physicians, while the orthopedic team were redistributed to manage minor and major injuries in the emergency department (ED). The mean learning outcome of the educational activities was high-very high, i.e., 5.4 (SD 0.7; 7-point Likert scale). Consequently, the staff felt more confident to protect themselves and to treat COVID-19 patients. Interpretation - Using core clinical competencies of the staff, i.e., redistribution of the orthopedic team to the ED, while ED physicians could use their competencies treating COVID-19 patients, may be applicable in other centers. In-situ simulation is an efficient tool to enhance non-technical and technical skills and to facilitate organizational learning in regard to complying with unforeseen changes.
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Affiliation(s)
- Rune Dall Jensen
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
- Department of Clinical Medicine, Aarhus University, Aarhus
| | - Magnus Bie
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
| | | | | | - Joachim Juelsgaard
- Department of Respiratory Disease and Allergy, Aarhus University Hospital
| | - Maria Louise Gamborg
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
- Centre for Health Sciences Education, Aarhus University, Denmark
| | - Hanne Mainz
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
| | - Jan Duedal Rölfing
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
- Department of Clinical Medicine, Aarhus University, Aarhus
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
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