Experience of clinical screening for COVID-19 among patients undergoing elective orthopedic surgeries: an alternative proposal

COVID-19 infection rate after urgent versus elective total hip replacement among unvaccinated individuals: A multicenter prospective cohort amid the COVID-19 pandemic

Background

Due to the COVID-19 pandemic, hospitals have become unsafe for patients as potential sources of virus transmission. This study aims to determine the COVID-19 infection rate after primary total hip arthroplasty (THA) among unvaccinated patients. THA patients undergoing elective or traumatic (urgent) THA were compared regarding COVID-19 contraction.

Methods

Primary THA patients were prospectively followed from three hospitals in *two great cities* of the country between April 2020 to August 2021. If the patient had suspected COVID-19 symptoms, had a SARS-CoV-2 PCR test from nasopharyngeal and oropharyngeal swabs and/or chest CT scan.

Results

Finally, information was received from 436 patients, including 345 (79.1%) elective and 91 (20.9%) traumatic THAs. Eight patients (1.8%) contracted COVID-19 within a month after THA discharge, and two died due to COVID-19. There was no statistical difference between COVID-19 disease and type of surgery (elective 1.4% versus traumatic 3.3%, P = 0.24). Women (Odds ratio (95% CI) = 8.5 (2.1–35.2), P = 0.01) and those who have heart disease (Odds ratio with Haldane-Anscombe correction ≈ 14.0, P = 0.01) were more likely to contract COVID-19 postoperatively.

Conclusion

In both elective and urgent cases of THA, researchers found that there is not a high risk of contracting the virus during the peri-surgery period. Urgent THA surgeries are comparable to elective THA-with those strict pre-elective surgery protocols-in terms of COVID-19 risk of infection from the hospital stay if appropriate health protocols are followed.

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The COVID-19 pandemic has made hospitals unsafe for elective surgeries.

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Eight patients (from 491, 1.8%) were infected with COVID-19 within a month of THA.

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Four were hospitalized due to severe symptoms.

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Three of 91 traumatic (3.3%) and five among 345 elective cases (1.4%) were infected.

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COVID-19 incidence is two-fold higher in urgent THA patients, but insignificant.

The effect of care transition pathway implementation on patients undergoing joint replacement during the COVID-19 pandemic: a quasi-experimental study from a tertiary care hospital orthopedic department in Beijing, China

Background

The coronavirus disease (COVID-19) pandemic has had a massive impact on individuals globally. The Chinese government has formulated effective response measures, and medical personnel have been actively responding to challenges associated with the epidemic prevention and control strategies. This study aimed to evaluate the effect of the implementation of a care transition pathway on patients that underwent joint replacement during the COVID-19 pandemic.

Methods

A quasi-experimental study was designed to evaluate the effect of implementing a care transition pathway for patients who underwent joint replacement during the COVID-19 pandemic in the orthopedic department of a tertiary care hospital in Beijing, China. Using a convenient sampling method, a total of 96 patients were selected. Of these, 51 patients who had undergone joint replacement in 2019 and received treatment via the routine nursing path were included in the control group. The remaining 45 patients who underwent joint replacement during the COVID-19 epidemic in 2020 and received therapy via the care transition pathway due to the implementation of epidemic prevention and control measures were included in the observation group. The quality of care transition was assessed by the Care Transition Measure (CTM), and patients were followed up 1 week after discharge.

Results

The observation group was determined to have better general self-care preparation, written planning materials, doctor-patient communication, health monitoring, and quality of care transition than the control group.

Conclusions

A care transition pathway was developed to provide patients with care while transitioning through periods of treatment. It improved the patient perceptions of nursing quality. The COVID-19 pandemic is a huge challenge for health professionals, but we have the ability to improve features of workflows to provide the best possible patient care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-021-02511-5.

The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients

Background

On the 11th March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. Multiple new guidelines were proposed and existing models of social, domestic and hospital care altered. Most healthcare systems were largely unprepared for this, and the pandemic has tested their adaptability. This study aimed to assess the impact of COVID-19 on the demographics, presentation, clinical management and outcomes of patients with proximal femoral (hip) fractures comparing them to a similar cohort of patients admitted a year earlier.

Methods

This retrospective multi-centre cohort study compared all patients admitted with hip fractures between 1st March and 30th May 2019 (group PC: pre-COVID-19) with hip fracture patients admitted over the same time period during the pandemic in 2020 (group C: COVID-19). The data was obtained from the hospitals’ local and National Hip Fracture Databases. Mortality data was checked with the Office for National Statistics (ONS). Primary outcomes were time to theatre, in-patient length of stay and 30-day mortality.

Results

A total of 580 patients were included (304 group PC, 276 group C). Patient demographics including Charlson Comorbidity Index and Nottingham Hip Fracture Scores were broadly similar across the two cohorts. There was a significant reduction in the percentage of total hip replacements (11 to 5%, p = 0.006) in group C. There was an increase in conservative management (1 to 5%, p = 0.002) in group C. Time to theatre was significantly delayed in group C (43.7 h) vs group PC (34.6 h) (p ≤ 0.001). The overall length of hospital stay was significantly longer in group PC (16.6 days) vs group C (15 days) (p = 0.025). The 30-day mortality rate in group C was 9.8% compared to 8.2% in group PC (p = 0.746), but for COVID-19 (+) patients, it was significantly higher at 38.2% vs 5.8% in COVID-19 (−) patients (p < 0.001).

Conclusion

This is one of the largest multi-centre comparative cohort study in the literature to date examining the impact of the COVID-19 pandemic on the management of hip fracture patients. Whilst mortality rates were similar in both groups, COVID-19-positive patients were almost seven times more likely to die, reflecting the seriousness of the COVID-19 infection and its sequelae in such elderly, vulnerable patients.