690 Orthopaedic Trauma Surgery: Has the COVID Pandemic Affected Surgical Outcomes?

Aim

To compare the surgical outcomes following orthopaedic trauma surgery before and during the COVID pandemic in an adult Major Trauma Centre.

Method

A retrospective chart review was conducted for all patients undergoing orthopaedic trauma surgery before (01/12/2019 to 29/02/2020) and during (01/03/2020 to 10/06/2020) the COVID pandemic. A Chi-square test was used to compare frequencies of type of anaesthetic used, postoperative ITU admission, any surgical complications and mortality. Data was collected 90 days after surgery.

Results

During the pre-COVID period, 501 patients (mean age at surgery 64y 4m; 222 male (44%)) underwent orthopaedic trauma surgery (395 lower limb (79%); 86 upper limb (17%); 28 pelvis (6%)) compared to 474 patients (mean age at surgery 61y 8m; 219 male (48%)) during the COVID period (388 lower limb (82%); 58 upper limb (12%); 23 pelvis (5%)). There was a significant increase in the use of a spinal as the main anaesthetic during the pandemic (9 (2%) vs 115 (24%), p < 0.001) and fewer trauma patients were admitted to ITU postoperatively (42 (8%) vs 16 (3%), p0.001). There was no difference in the rate of postoperative complications (103 (21%) vs 95 (20%), p0.841) or mortality at 90 days (42 (8%) vs 43 (9%), p0.703). Of the 244 COVID swabs done during the COVID period, 8 (3%) were positive.

Conclusions

Despite widespread operational disruption and a change in anaesthetic practice, there was no change in the rate of postoperative complications or mortality following orthopaedic trauma surgery.

198 Orthopaedic Trauma Services During A National Lockdown and Pandemic: Workload and Outcomes from A UK Major Trauma Centre. The Need for Continuing the Provision of Services

Aim

To review the trauma operating workload, theatre time and outcomes at a time of national lockdown and the beginning of the COVID-19 pandemic, comparing it with 2019.

Method

A retrospective analysis at a single UK MTC. We included all patients undergoing emergency/urgent T&O surgery. Data collected included anatomical injury site, mechanism of injury, operative procedure, anaesthesia, theatre time, complications, and 30-day mortality.

Results

159 operations were performed on 142 patients in April 2019, and 110 operations on 106 patients in April 2020 (national lockdown). This led to a decrease of 30% due to reduced numbers from RTAs and sport-related injuries. Volumes of hip fractures and injuries from low-energy falls remained the same. Operative total theatre time increased by a mean of 14 minutes, and complications and mortality were not significantly changed. The incidence of COVID-19 in the patients tested was 8.5%, which matched the population incidence at the time.

Conclusion

Orthopaedic trauma services must be maintained during a national lockdown. There is no decrease in the volume of patients sustaining falls, including hip fractures. Mean operating time only increases by 14 minutes with the wearing of PPE. This should be part of future planning of any pandemics or national lockdowns.