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Messler V, Leschinger T, Ott N, Rausch V, Burst V, Eysel P, Müller LP, Hackl M. The impact of the SARS-CoV-2 pandemic-related lockdowns on orthopedic trauma emergencies at a level-one trauma center. Arch Orthop Trauma Surg 2023; 143:6201-6208. [PMID: 37341804 PMCID: PMC10491551 DOI: 10.1007/s00402-023-04947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION The SARS-CoV-2 pandemic and its associated lockdowns had a profound effect on orthopedic trauma emergencies. This study aimed to investigate the patient volume and injury patterns at a level-one trauma center during the SARS-CoV-2 pandemic and compare them to the pre-pandemic conditions. MATERIALS AND METHODS A retrospective chart review of all patients who presented to the orthopedic trauma emergency department of a level-one trauma center in Cologne, Germany within a 2 year period from March 16th, 2019 to March 15th, 2020 (pre-pandemic control) and from March 16th, 2020 and March 15th, 2021 (pandemic) was performed. The pandemic year was separated into three periods: (1) first lockdown, (2) between lockdowns and (3) second lockdown. The absolute numbers of patient presentations, the Manchester triage score (MTS) and the relative proportion of patients with structural organ injuries, fractures and dislocations, of polytraumatized patients, of hospital admissions, of subsequent emergency or semi-elective surgeries and of work-related accidents were evaluated in comparison to the pre-pandemic control. RESULTS A total of 21,642 patient presentations were included in this study. Significantly less weekly orthopedic trauma emergency patient presentations were recorded during the pandemic (p < 0.01). The MTS was significantly lower during the first lockdown and between lockdowns (p < 0.01). The proportional incidence of overall structural organ injuries, fractures and dislocations, of upper limb fractures/dislocations, of hospital admissions and of patients requiring surgery was significantly increased during the pandemic (p ≤ 0.03). The proportional incidence of work-related injuries was significantly decreased during the pandemic (p < 0.01). CONCLUSIONS Orthopedic trauma emergency presentations were reduced during the SARS-CoV-2 pandemic. Due to the reluctancy of patients to visit the emergency department during the pandemic, the proportions of relevant injuries in general and of upper limb injuries in particular as well as of patients requiring hospital admission and trauma-related surgery were significantly increased.
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Affiliation(s)
- Valentin Messler
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Tim Leschinger
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Nadine Ott
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Valentin Rausch
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Volker Burst
- Emergency Department, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Peer Eysel
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Lars Peter Müller
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Michael Hackl
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany.
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Candela V, Proietti R, Polizzotti G, Rionero M, Gumina S. Three Years of COVID-19 on Orthopaedic Trauma; Are We Going Back to Normality? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1464. [PMID: 37629754 PMCID: PMC10456244 DOI: 10.3390/medicina59081464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
Background and Objective: On March 2020, our country became a protected area due to the COVID-19 pandemic. The consequences of COVID-19 on trauma surgery were great. We aimed to evaluate the activity of the Trauma Centre of a highly populated suburban area over 30 days starting from the first day of restrictions, to compare it with the same period of 2019 and 2022 and to evaluate whether a progressive return to normality has taken place. Materials and Methods: All patients older than 18 years managed in our Trauma Unit between 8 March 2020 and 8 April 2020 (the first COVID-19 period) were compared to the same period of 2019 (a COVID-19 free period) and 2022 (the second COVID-19 period). Clinical records were examined. Five categories of diagnoses and six mechanisms of injury were distinguished. Results: There were 1351 patients [M:719-F:632; mean age (SD):49.9 (18.7)], 451 [M:228-F:223; mean age (SD):55.9 (18.4)] and 894 [M:423-F:471;mean age (SD):54.1 (16.7)] in the COVID-19 free and in the first and second COVID-19 periods, respectively (p < 0.05). In 2020, the most significant decrease was registered for sprains/subluxations (80%); contusions decrease by 77% while fractures decrease only by 37%. The lowest reduction was found for dislocations (26%). In 2022, dislocations decreased by only 16% and both fractures and sprains decreased by about 30% with respect to the pre-pandemic period. Patients with minor trauma (contusions) were half compared to 2019. Accidental falls remain the most frequent mechanism of injury. The incidence of proximal femur, proximal humerus and distal radius fractures remained almost unchanged during both pre-pandemic and pandemic periods. Conclusions: COVID-19 has markedly altered orthopaedic trauma. Injuries related to sports and high energy trauma/traffic accidents drastically reduced in 2020; however, we are slowly going back to normality: the same injuries increased in 2022 due to the progressive easing of restrictions. Elderly fractures related to accidental falls remained unchanged.
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Affiliation(s)
- Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
| | - Riccardo Proietti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
| | - Giuseppe Polizzotti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
| | - Marco Rionero
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
| | - Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
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Kumar S, Jain AK, Maroof KA, Aggarwal AN, Arora R, Dhammi IK, Gupta H. Effect of COVID-19 on the Burden and Profile of Orthopaedic Patients Admitted Post-Resumption of Routine Services in a Tertiary Care Hospital in Delhi. Cureus 2023; 15:e44074. [PMID: 37750118 PMCID: PMC10518043 DOI: 10.7759/cureus.44074] [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: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
Purpose On resumption of routine services post-lockdown during coronavirus disease 2019 (COVID-19), we expected a backlog of orthopaedic patients who could not get appropriate and timely care and would now present with complications due to missed or delayed treatment. This study aimed to quantify the effect of COVID-19 on the burden and profile of orthopaedic patients admitted post-resumption of routine services. Materials and methods Data on all the patients admitted to the orthopaedic department were collected using an interviewer-administered schedule for a complete one-year period after the resumption of routine orthopaedic services in a tertiary care hospital in Delhi. For comparison of the burden of trauma patients with that during the pre-COVID-19 period, data were obtained from a similar study done on trauma patients in 2017 at the same institution. For patients with non-traumatic conditions, previous hospital records were used. Results A total of 1585 patients were admitted during the one-year period post-resumption of routine services following COVID-19 restrictions, which was 41% less than that compared to the corresponding pre-COVID-19 data. The proportion of patients from other neighbouring states showed a decline from 52% in the pre-COVID-19 period to 41.55% when healthcare services resumed during the COVID-19 period. Out of all admitted trauma patients in 2021, 12.7% presented with a missed or complication of treatment as compared to 3.1% in the pre-COVID period. Around half of them (52.5%) attributed their complications to a COVID-19-related lockdown. Conclusion There was a significant decline in the number of patients post-resumption of routine orthopaedic care services. Converting whole tertiary care teaching hospitals to COVID-19-dedicated hospitals must not be done as it leads to an increase in missed or complication of orthopaedic treatment.
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Affiliation(s)
- Sunil Kumar
- Orthopaedics, University College of Medical Sciences, New Delhi, IND
| | - Anil K Jain
- Orthopaedics, University College of Medical Sciences, New Delhi, IND
| | - Khan A Maroof
- Community Medicine, University College of Medical Sciences, New Delhi, IND
| | - Aditya N Aggarwal
- Orthopaedics, University College of Medical Sciences, New Delhi, IND
| | - Rajesh Arora
- Orthopaedics, University College of Medical Sciences, New Delhi, IND
| | - Ish K Dhammi
- Orthopaedics, University College of Medical Sciences, New Delhi, IND
| | - Himanshu Gupta
- Orthopaedics, University College of Medical Sciences, New Delhi, IND
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Moretti L, Bizzoca D, Farì G, Caricato A, Angiulli F, Cassano GD, Solarino G, Moretti B. Bari Shoulder Telemedicine Examination Protocol (B-STEP): A Standard Protocol for Personalized Remote Shoulder Examination. J Pers Med 2023; 13:1159. [PMID: 37511772 PMCID: PMC10381873 DOI: 10.3390/jpm13071159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/25/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic drastically changed many aspects of the traditional functioning of health systems all around the world. In Italy, as reported by the CIO, compared to the previous year, there was a significant reduction in 2020 in overall outpatient activities by up to 75%. These data support the need for telemedicine, which represents a current challenge and can no longer be postponed in the future. This study aims to elaborate on a possible model for remote shoulder examination based on traditional tests to improve the quality of telemedicine in orthopedic and rehabilitation. Between May 2020 and November 2020, ten orthopedic surgeons individually examined six patients with a known shoulder disorder, both in hospital and via webcam according to the previously shared protocol (B-STEP). According to the 10 observers, completing 100% of the ASES score and at least 87.5% of the Constant score is possible. Shoulder ROM and many specific tests are also reproducible via webcam, but with less sensitivity, according to the subjective opinion of observers. The B-STEP is a useful protocol for the standardization of the objective examination of the shoulder via webcam. Further studies are necessary to determine if the B-STEP protocol is useful for diagnosing pathology in unknown patients and evaluating its sensitivity and specificity for each pathology.
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Affiliation(s)
- Lorenzo Moretti
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Davide Bizzoca
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giacomo Farì
- Physical Medicine and Rehabilitation Unit, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Alessandro Caricato
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesco Angiulli
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppe Danilo Cassano
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppe Solarino
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Biagio Moretti
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
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Konda SR, Esper GW, Meltzer-Bruhn AT, Ganta A, Egol KA. Hip Fracture Care during COVID-19: Evolution through the Pandemic. Cureus 2023; 15:e42696. [PMID: 37654921 PMCID: PMC10465306 DOI: 10.7759/cureus.42696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION The purpose of this epidemiologic study was to analyze the care provided by our institution to middle-aged and geriatric hip fracture patients throughout the pandemic to examine for any differences compared to pre-pandemic care and across the pandemic stages. METHODS Consecutive patients >55 years old treated for hip fractures at our institution between October 2014 and January 2022 were analyzed for demographics, coronavirus disease 2019 (COVID-19) and vaccination status at admission, injury characteristics, hospital quality measures, and outcomes. Patients were divided into three separate cohorts: Pre-COVID-19 (PRECOV), COVID-19 Pre-Vaccine (PREVAX), and COVID-19 Post-Vaccine (POSTVAX). A sub-analysis removed COVID-19-positive patients across the study period. Comparative analyses were conducted. RESULTS A total of 2,633 hip fracture patients were included. For the overall cohort, there was no difference in the rate of inpatient deaths between the PRECOV, PREVAX, and POSTVAX cohorts (p=0.278). PRECOV had a significantly lower 30-day mortality rate compared to PREVAX or POSTVAX (p=0.012). Differences in complication rates for surgical site infection, urinary tract infection, and anemia (p<0.01 for all) were seen between cohorts. PRECOV had the longest length of hospital stay (p<0.01). PREVAX patients required more ICU level of care (p<0.01). When removing COVID-19-positive patients, all three cohorts had similar inpatient (p=0.872) and 30-day mortality rates (p=0.130). CONCLUSION The care of patients treated for hip fractures did not change throughout the pandemic at our institution. The elevated mortality rate due to the effects of COVID-19 seen in the pre-vaccine cohort decreased over time as the understanding of COVID-19 improved and the vaccine was introduced. We recommend continuation of the same hip fracture care protocols as used pre-pandemic.
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Affiliation(s)
- Sanjit R Konda
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Garrett W Esper
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Ariana T Meltzer-Bruhn
- Medical School, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Abhishek Ganta
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Kenneth A Egol
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
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Miranda I, Ferrás-Tarragó J, Colado J, Sangüesa-Nebot MJ, Doménech J. [Impact of the COVID-19 pandemic and the strict population confinement on hip fracture incidence in Spain: A systematic review]. Rev Esp Geriatr Gerontol 2023; 58:101380. [PMID: 37453250 PMCID: PMC10284461 DOI: 10.1016/j.regg.2023.101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/08/2023] [Accepted: 05/23/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND OBJECTIVE During the COVID-19 pandemic, a strict population confinement was decreed in Spain. In a situation of health crisis and health system saturation, knowledge of pathologies whose treatment cannot be delayed is of great importance for the correct management of resources and processes. The objective was to determine the influence of the COVID-19 pandemic and the strict population confinement on hip fracture incidence in Spain. MATERIAL AND METHOD Systematic review following the PRISMA guidelines. Search in Pubmed and Chocrane Library on 11/11/2022: hip fracture and COVID-19 and Spain. RESULTS Six studies met the inclusion criteria, 50% showed a decrease in the hip fractures incidence during strict population confinement (all in Comunidad de Madrid hospitals), and in the other 50% there were no differences (all in other region hospitals). It was constant that hip fractures, either did not decrease, or decreased much less than the rest of fractures during the period of strict population confinement, increasing their relative number with respect to the total admissions in orthopedic surgery and traumatology. CONCLUSIONS The behavior of the hip fractures number during the strict population confinement decreed by the COVID-19 pandemic has not been symmetrical in all regions. To design and implement contingency plans in the event of a pandemic situation, these data must be taken into account in order to properly plan material and human resources.
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Affiliation(s)
- Ignacio Miranda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, España.
| | - Joan Ferrás-Tarragó
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, España
| | - Javier Colado
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, España
| | | | - Julio Doménech
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, España
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Ishizu H, Shimizu T, Yamazaki S, Ohashi Y, Sato K, Shimodan S, Iwasaki N. Secondary fracture rates and risk factors 1 year after a proximal femoral fracture under FLS. J Bone Miner Metab 2023:10.1007/s00774-023-01426-x. [PMID: 37037921 PMCID: PMC10088666 DOI: 10.1007/s00774-023-01426-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/24/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION We aimed to investigate the secondary fracture rates and risk factors in patients with proximal femoral fractures using fracture liaison service (FLS) during the coronavirus disease (COVID)-19 pandemic. MATERIALS AND METHODS In this multi-center prospective cohort study, patients with proximal femoral fractures who were treated surgically at three hospitals from April 2020 to March 2021 were included. Follow-up examinations at 6 and 12 months postoperatively were conducted to investigate the clinical data and ascertain whether osteoporosis treatment could be continued. RESULTS A total of 316 patients with proximal femoral fractures were registered. During the follow-up period, 17 patients died and 67 patients could not visit the hospitals owing to the COVID-19 pandemic. In total, 172 patients who could be followed-up 12 months postoperatively were examined using dual-energy X-ray absorptiometry during hospitalization; underwent postoperative osteoporosis treatment, mainly with bisphosphonates (89.5%); and were administered medications continuously. Secondary fractures occurred within 1 year in 14 patients (8.1%). Multivariate analysis showed that patients who used sleeping pills and had a lower functional independence measure had an increased risk for developing secondary fractures. CONCLUSION During the COVID-19 pandemic, secondary fractures can be prevented if the patients can be followed and osteoporosis treatment can be continued. Conversely, despite adequate osteoporosis drug examination and treatment, a certain number of secondary fractures still occurred. The finding that postoperative osteoporosis therapy using routine medications and rehabilitation is associated with secondary fractures may support the importance of establishing clinical standards consisting of a multidisciplinary collaboration for FLS.
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Affiliation(s)
- Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Central Hospital, Hakodate, Hokkaido, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Shu Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopedic Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Yusuke Ohashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Central Hospital, Hakodate, Hokkaido, Japan
| | - Komei Sato
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopedic Surgery, Iwamizawa City Hospital, Iwamizawa, Hokkaido, Japan
| | - Shun Shimodan
- Department of Orthopedic Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
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Velek P, de Schepper E, Schiphof D, Evert van Spil W, Englund M, Magnusson K, Kiadaliri A, Dell'Isola A, Licher S, Bierma-Zeinstra S, Runhaar J. Changes to consultations and diagnosis of osteoarthritis in primary care during the COVID-19 pandemic. Osteoarthritis Cartilage 2023; 31:829-838. [PMID: 36878380 PMCID: PMC9985915 DOI: 10.1016/j.joca.2023.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE General practitioners (GP) are often the first medical professionals to treat musculoskeletal complaints. Yet the impact of COVID-19 on primary care utilisation for musculoskeletal complaints is largely unknown. This study quantifies the impact of the pandemic on primary care utilisation for musculoskeletal complaints and specifically osteoarthritis (OA) in the Netherlands. DESIGN We extracted data on GP consultations in 2015-2020 from 118,756 patients over 45 years of age and estimated reductions in consultations in 2020 as compared to 5-year average. Outcomes were GP consultations for: any musculoskeletal complaints, knee and hip OA and complaints, newly diagnosed knee and hip OA/complaints. RESULTS The relative reductions in consultations ranged from 46.7% (95% CI: 43.9-49.3%) (all musculoskeletal consultations) to 61.6% (95% CI: 44.7-73.3%) (hip complaints) at the peak of the first wave, and from 9.3% (95% CI: 5.7-12.7%) (all musculoskeletal consultations) to 26.6% (95% CI: 11.5-39.1%) (knee OA) at the peak of the second wave. The reductions for new diagnoses were 87.0% (95% CI: 71.5-94.1%) for knee OA/complaints, and 70.5% (95% CI: 37.7-86.0%) for hip OA/complaints at the peak of the first wave, and not statistically significant at the peak of the second wave. CONCLUSION We observed 47% reduction in GP consultations for musculoskeletal disorders during the first wave and 9.3% during the second wave. For hip and knee OA/complaints, the reductions were over 50% during the first, and 10% during the second wave. This disruption may lead to accumulation of patients with severe OA symptoms and more requests for arthroplasty surgery.
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Affiliation(s)
- P Velek
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - E de Schepper
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - D Schiphof
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W Evert van Spil
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, the Netherlands; Department of Rheumatology, Dijklander Hospital, Hoorn, the Netherlands
| | - M Englund
- Clinical Epidemiology Unit, Orthopaedics, Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - K Magnusson
- Clinical Epidemiology Unit, Orthopaedics, Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden; Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway
| | - A Kiadaliri
- Clinical Epidemiology Unit, Orthopaedics, Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden; Centre for Economic Demography, Lund University, Lund, Sweden
| | - A Dell'Isola
- Clinical Epidemiology Unit, Orthopaedics, Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - S Licher
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Orthopedics & Sport Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Troiano E, De Sensi AG, Zanasi F, Facchini A, De Marco G, Colasanti GB, Mondanelli N, Giannotti S. Impact of COVID-19 Pandemic on Treatment and Outcome of Fragility Hip Fractures In Non-COVID Patients: Comparison Between the Lockdown Period, a Historical Series and the "Pandemic Normality" in a Single Institution. Geriatr Orthop Surg Rehabil 2023; 14:21514593231152420. [PMID: 36950185 PMCID: PMC10026085 DOI: 10.1177/21514593231152420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Introduction The COVID-19 pandemic has affected and is still deeply affecting all aspects of public life. World governments have been forced to enact restrictive measures to stem the contagion which have led to a decrease in the movement of people within national territory and to a redirection of health care resources with a suspension of non-urgent procedures. In Italy, a lockdown was imposed from March 9th to May 3rd, 2020. As a result, a significant reduction in the overall operative volume of orthopedic trauma was expected, but it was not possible to predict a similar trend regarding fragility fractures of the proximal femur in the elderly. Methods The aim of this paper was to examine the impact of COVID-19 on the operating volume for trauma surgeries and to determine how the pandemic affected the management of fragility hip fractures (FHFs) in non-COVID patients at a single Institution. Results The first result was a statistically significant reduction in the overall operative volume of orthopedic trauma during the period of the first lockdown and an increase in the mean age of patients undergoing surgery, as expected. As regard to the second aim, the incidence of FHFs remained almost unchanged during the periods analysed. The population examined were superimposable in terms of demographics, comorbidities, type of fracture, peri-operative complications, percentage of operations performed within 48 hours from hospitalization and 1-year outcome. Discussion Our results are in line with those already present in the Literature. Conclusions Our study revealed a significant impact of the restrictive anti-contagion measures on the overall orthopedic surgical volume, but, at the same time, we could affirm that the pandemic did not affect the management of FHFs in non-COVID patients, and their results.
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Affiliation(s)
- Elisa Troiano
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Siena, Italy
| | - Alice Giulia De Sensi
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Siena, Italy
| | - Francesco Zanasi
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
| | - Andrea Facchini
- Azienda USL di Reggio Emilia, Arcispedale Santa Maria
Nuova, Reggio Emilia, Italy
| | - Giulia De Marco
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
| | - Giovanni Battista Colasanti
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Siena, Italy
| | - Nicola Mondanelli
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Siena, Italy
- Nicola Mondanelli, Department of Medicine
Surgery and Neurosciences, University of Siena; and Section of Orthopedics,
Azienda Ospedaliero-Universitaria Senese, Viale Mario Bracci 16, Siena 53100,
Italy.
| | - Stefano Giannotti
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Siena, Italy
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Lopez Gavilanez E, Navarro Chávez M, Gavilanes AWD, Cedeño German R, Chedraui P. Decreasing incidence rates of osteoporotic hip fractures in Ecuador during the COVID-19 pandemic. Arch Osteoporos 2022; 18:15. [PMID: 36574063 PMCID: PMC9793355 DOI: 10.1007/s11657-022-01202-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022]
Abstract
We aimed at comparing the incidence of hip fractures in older adults from Ecuador before and during the COVID-19 pandemic. There was a significant reduction in the number of hip fractures, with no change in the length of hospital stay, mortality, and case-fatality rate, during the period of social isolation. INTRODUCTION The impact that the COVID-19 pandemic has had on fragility fractures is being recently evaluated in the literature. Despite this, data from Latin America in this regard is scarce. PURPOSE This study aims to compare the incidence rate of hip fractures before and during the COVID-19 pandemic in older adults who received care in the public and private health system of Ecuador. METHODS This was a descriptive and retrospective study that analyzed data of individuals aged 60 years and older who had hip fractures before and during the COVID-19 pandemic. The information was obtained from the National Hospital Discharge Yearbook. We calculated the incidence, average length of hospital stay, mortality, and case-fatality rate associated with hip fractures. RESULTS There was a significant reduction in the incidence of hip fractures in adults 60 or older during the period of social isolation due to COVID-19. Between March and December 2019, there was an incidence of 152 hip fractures per 100,000 inhabitants, whereas during the same period but in 2020 in the incidence was 110 per 100,000 inhabitants (p < 0.0001). The main decrease was observed in women aged 80 or more. The average length of hospital stay did not show significant changes. Mortality displayed a non-significant decrease (p = 0.14), although this decrease was significant among women (p = 0.02). Case-fatality rate showed a non-significant increase for the whole group (p = 0.68) and for men (p = 0.09). CONCLUSION Hip fracture rates decreased significantly in adults aged 60 and older in 2020 compared to 2019. This decrease of hip fracture incidence rates was mainly due to the reductions observed in older people and women. The average length of hospital stay, mortality, and case-fatality rate associated with hip fractures did not show significant changes during the pandemic.
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Affiliation(s)
- Enrique Lopez Gavilanez
- AECE Research Group, The Association of Clinical Endocrinologists of Ecuador, Avenida de Las Américas, S/N Y E. Noboa, EC090150, Guayaquil, Ecuador.
- Servicio de Endocrinología, Hospital Docente Policía Nacional Guayaquil 2, Guayaquil, Ecuador.
| | - Manuel Navarro Chávez
- AECE Research Group, The Association of Clinical Endocrinologists of Ecuador, Avenida de Las Américas, S/N Y E. Noboa, EC090150, Guayaquil, Ecuador
| | - Antonio W D Gavilanes
- School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Instituto de Investigación E Innovación en Salud Integral, Laboratorio de Biomedicina, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Roberto Cedeño German
- AECE Research Group, The Association of Clinical Endocrinologists of Ecuador, Avenida de Las Américas, S/N Y E. Noboa, EC090150, Guayaquil, Ecuador
- Servicio de Endocrinología, Hospital de Especialidades "Abel Gilbert Pontón, Guayaquil, Ecuador
| | - Peter Chedraui
- Facultad de Ciencias de La Salud, Universidad Católica "Nuestra Señora de La Asunción", Asunción, Paraguay
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Changes to the Major Trauma Pre-Hospital Emergency Medical System Network before and during the 2019 COVID-19 Pandemic. J Clin Med 2022; 11:jcm11226748. [PMID: 36431225 PMCID: PMC9692576 DOI: 10.3390/jcm11226748] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: During the coronavirus disease 2019 pandemic, emergency medical services (EMSs) were among the most affected; in fact, there were delays in rescue and changes in time-dependent disease networks. The aim of the study is to understand the impact of COVID-19 on the time-dependent trauma network in the Lombardy region. Methods: A retrospective analysis on major trauma was performed by analysing all records saved in the EmMa database from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020. Age, gender, time to first emergency vehicle on scene and mission duration were collected. Results: In 2020, compared to 2019, there was a reduction in major trauma diagnoses in March and April, during the first lockdown, OR 0.59 (95% CI 0.49−0.70; p < 0.0001), and a reduction in road accidents and accidents at work, while injuries related to falls from height and violent events increased. There was no significant increase in the number of deaths in the prehospital setting, OR 1.09 (95% CI 0.73−1.30; p = 0.325). Conclusions: The COVID-19 pandemic has changed the epidemiology of major trauma, but in the Lombardy region there was no significant change in mortality in the out-of-hospital setting.
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Ower C, Stock K, Kaiser P, Ulmer H, Arora R, Haselbacher M. Variation in patterns and volumes of injuries admitted to a level one trauma center during lockdown for COVID-19. J Orthop Surg Res 2022; 17:306. [PMID: 35690778 PMCID: PMC9188017 DOI: 10.1186/s13018-022-03151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 05/03/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Due to the global COVID-19 pandemic, a ban on sports outside one’s home and a prohibition on travel between communities were imposed in spring 2020 in Tyrol, Austria. The aim of this study was to evaluate the impact of these restrictions on a level one trauma center. The objective was to identify the most common injury patterns to ensure targeted prevention in times of an ongoing pandemic. Material and methods Patients who presented themselves to our trauma center between weeks 7 and 22 in 2020 were retrospectively compared to a mean of the patients of the three previous years (2017–2019). The evaluated variables were the number of patients, age, gender, country of residence, place of accident, time of treatment, injured body region and anatomical structure, number of surgical intervention and severely injured patients. Results Comparing the mean count of treated patients per week in 2020 of the pre-lockdown period (n = 804.6) with the lockdown period (n = 201.8) a decrease in admissions by 69.7% could be observed. The admission incidence was 9.9 times higher in previous years than in 2020 during the lockdown period. Among the injuries treated during the lockdown the largest increase in relative numbers was in home injuries, head or face injuries and superficial or penetrating injuries. There was a decrease of seriously injured patients as well as patients that needed surgery during the lockdown compared to previous years. Conclusions We observed a significant change in the pattern and volume of injuries during a strict lockdown. Intervention programs to reduce the risk of home injuries should be introduced. Furthermore, in order to save resources during a pandemic, specific guidelines on patient management and treatment should be established for the respective medical specialties. Trial registration: 1157/2020, 10.12.2020.
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Affiliation(s)
- Cornelia Ower
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Kerstin Stock
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Kaiser
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Muhammad M, Ayton S, Hejmadi S, Minhas JS, Morgan N, Peek AC. Single vs Dual-site service reconfiguration during Covid-19 pandemic - A tertiary care centre experience in hip fractures and a Scoping review. J Clin Orthop Trauma 2022; 29:101890. [PMID: 35540794 PMCID: PMC9072772 DOI: 10.1016/j.jcot.2022.101890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Aims and objectives The Covid-19 pandemic has had an unprecedented effect on surgical practice and healthcare delivery globally. We compared the impact of the care pathways which segregate Covid-19 Positive and Negative patients into two geographically separate sites, on hip fracture patients in our high-volume trauma center in 3 distinct eras - the pre-pandemic period, against the first Covid-19 wave with dual-site service design, as well as the subsequent surge with single-site service delivery. In addition, we sought to invoke similar experiences of centres worldwide through a scoping literature review on the current evidence on "Dual site" reconfigurations in response to Covid-19 pandemic. Methods We prospectively reviewed our hip fracture patients throughout the two peaks of the pandemic, with different service designs for each, and compared the outcomes with a historic service provision. Further, a comprehensive literature search was conducted using several databases for articles discussing Dual-site service redesign. Results In our in-house study, there was no statistically significant difference in mortality of hip fracture patients between the 3 periods, as well as their discharge destinations. With dual-site reconfiguration, patients took longer to reach theatre. However, there was much more nosocomial transmission with single-site service, and patients stayed in the hospital longer. 24 articles pertaining to the topic were selected for the scoping review. Most studies favour dual-site service reorganization, and reported beneficial outcomes from the detached care pathways. Conclusion It is safe to continue urgent as well as non-emergency surgery during the Covid-19 pandemic in a separate, geographically isolated site.
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Affiliation(s)
- Milan Muhammad
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Sarah Ayton
- Department of Elderly Medicine, University Hospitals of Leicester, Leicester, UK
| | - Shruthi Hejmadi
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - Jatinder S. Minhas
- Department of Elderly Medicine, Leicester University Hospitals, Leicester, UK
| | - Nicolette Morgan
- Department of Elderly Medicine, Leicester University Hospitals, Leicester, UK
| | - Anna C. Peek
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
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Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe. Eur J Trauma Emerg Surg 2022; 48:4385-4402. [PMID: 35523966 PMCID: PMC9075714 DOI: 10.1007/s00068-022-01978-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/16/2022] [Indexed: 12/13/2022]
Abstract
Purpose This study investigated the impact of the Covid-19 pandemic in Europe on consultations, surgeries, and traumas in the field of orthopaedic and trauma surgery. Strategies to resume the clinical activities were also discussed. Methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. All the comparative studies reporting data on the impact of Covid-19 in the field of orthopaedic and trauma surgery in Europe were accessed. Only comparative clinical studies which investigated the year 2020 versus 2019 were eligible. Results 57 clinical investigations were included in the present study. Eight studies reported a reduction of the orthopaedic consultations, which decreased between 20.9 and 90.1%. Seven studies reported the number of emergency and trauma consultations, which were decreased between 37.7 and 74.2%. Fifteen studies reported information with regard to the reasons for orthopaedic and trauma admissions. The number of polytraumas decreased between 5.6 and 77.1%, fractures between 3.9 and 63.1%. Traffic accidents admissions dropped by up to 88.9%, and sports-related injuries dropped in a range of 59.3% to 100%. The overall reduction of the surgical interventions ranged from 5.4 to 88.8%. Conclusion The overall trend of consultations, surgeries, and rate of traumas and fragility fractures appear to decrease during the 2020 European COVID pandemic compared to the pre-pandemic era. Given the heterogeneities in the clinical evidence, results from the present study should be considered carefully. Level of evidence Level IV, systematic review.
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Laghi A, Tamburi V, Polici M, Anibaldi P, Marcolongo A, Caruso D. Management decisions of an Academic Radiology Department during COVID-19 pandemic: the important support of a business analytics software. Eur Radiol 2022; 32:7048-7055. [PMID: 35380224 PMCID: PMC8981182 DOI: 10.1007/s00330-022-08709-3] [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: 01/21/2022] [Revised: 01/21/2022] [Accepted: 02/28/2022] [Indexed: 12/05/2022]
Abstract
Objectives To analyze the response in the management of both radiological emergencies and continuity of care in oncologic/fragile patients of a radiology department of Sant’Andrea Academic Hospital in Rome supported by a dedicated business analytics software during the COVID-19 pandemic. Methods Imaging volumes and workflows for 2019 and 2020 were analyzed. Information was collected from the hospital data warehouse and evaluated using a business analytics software, aggregated both per week and per quarter, stratified by patient service location (emergency department, inpatients, outpatients) and imaging modality. For emergency radiology subunit, radiologist workload, machine workload, and turnaround times (TATs) were also analyzed. Results Total imaging volume in 2020 decreased by 21.5% compared to that in 2019 (p < .001); CT in outpatients increased by 11.7% (p < .005). Median global TAT and median code-blue global TAT were not statistically significantly different between 2019 and 2020 and between the first and the second pandemic waves in 2020 (all p > .09). Radiologist workload decreased by 24.7% (p < .001) during the first pandemic wave in 2020 compared with the same weeks of 2019 and showed no statistically significant difference during the second pandemic wave, compared with the same weeks of 2019 (p = 0.19). Conclusions Despite the reduction of total imaging volume due to the COVID-19 pandemic in 2020 compared to 2019, management decisions supported by a dedicated business analytics software allowed to increase the number of CT in fragile/oncologic outpatients without significantly affecting emergency radiology TATs, and emergency radiologist workload. Key Points • During the COVID-19 pandemic, management decisions supported by business analytics software guaranteed efficiency of emergency and preservation of fragile/oncologic patient continuity of care. • Real-time data monitoring using business analytics software is essential for appropriate management decisions in a department of radiology. • Business analytics should be gradually introduced in all healthcare institutions to identify strong and weak points in workflow taking correct decisions. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08709-3.
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Affiliation(s)
- Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
| | - Virginia Tamburi
- Department of Radiology, Federico II University Hospital, Naples, Italy
| | - Michela Polici
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Paolo Anibaldi
- Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Adriano Marcolongo
- Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
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da Silva AC, da Silva Santos G, Maluf EMCP, Borba VZC. Incidence of hip fractures during the COVID-19 pandemic in the Brazilian public health care system. Arch Osteoporos 2022; 17:42. [PMID: 35253090 PMCID: PMC8898593 DOI: 10.1007/s11657-022-01078-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/12/2022] [Indexed: 02/03/2023]
Abstract
This study compared the incidence of hip fractures before and during the COVID-19 pandemic in Brazil, aged ≥ 60 years excluding all fractures related to any trauma. There was a significant reduction in the number of hip fractures and the length of hospital stay during the period of social isolation. PURPOSE To compare the incidence of hip fractures before and during the COVID-19 pandemic in Brazil and in the main regions of the country in patients covered by the Brazilian public health care system (SUS). As far as we are aware, no studies have evaluated the impact of COVID-19 pandemic on hip fractures in Brazil. METHODS Descriptive, cross-sectional study in individuals aged ≥ 60 years who presented with a hip fracture before and during the COVID-19 pandemic and received treatment covered by the SUS. The data were collected from the DATASUS electronic database. We calculated the incidence, mortality, lethality, duration of hospitalization, and average reimbursement associated with the treatment of the fractures. RESULTS There was a significant reduction in the incidence of hip fractures among individuals aged ≥ 60 years in Brazil during the period of social isolation due to COVID-19. The observed incidence was 15.58/10,000 inhabitants between March and December 2020 and 16.07/10,000 inhabitants in the same period of 2019 (p < 0.005; main decline observed in the age groups > 70 years). The average length of hospital stay reduced from 8.35 days in 2019 to 7.33 days in 2020, following a similar pattern of reduction across all regions. The Southeast was the only region with a significant reduction in mortality during the pandemic (relative risk 0.90, 95% confidence interval 0.84-0.97, p < 0.005). CONCLUSION During the COVID-19 pandemic in Brazil, the incidence rate of hip fractures and the associated duration of hospital stay decreased among patients aged ≥ 60 years.
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Affiliation(s)
| | | | | | - Victoria Zeghbi Cochenksi Borba
- Department of Internal Medicine, Endocrine Division (SEMPR), Federal University of Paraná, Av. Agostinho Leão Júnior, 285–80030-110, Curitiba (Paraná), Brazil
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Özşahin MK, Değer GU, Aydın N. The impact of COVID-19 pandemic in the first 100 days on orthopedic trauma surgery practice, the experience of a university hospital in Istanbul. ULUS TRAVMA ACIL CER 2022; 28:27-32. [PMID: 34967425 PMCID: PMC10443172 DOI: 10.14744/tjtes.2021.23796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND With the rapid and effective change created by the COVID-19 pandemic in all medical practice, we aimed to evaluate the impact of the first 100 days of the COVID-19 pandemic on the operations performed in a reference university hospital in the field of orthopedics and traumatology. Compare the results with the same period of the previous year and aim to evaluate importance of restrictions. METHODS The operations performed in orthopedics and traumatology clinic between March 18, 2020 (the day we stopped the elective surgeries), and July 1, 2020 (when the normalization process began), were collected from the electronic archive to compare with the same period of 2019. RESULTS Comparing the same periods of the year, it was seen that 102 surgeries were performed in the 2020 COVID-19 period compared to 380 operations performed in 2019. Although most of the operations performed during the COVID-19 period were traumas, the comparison revealed that trauma cases decreased by 25% from 73 to 58 (p<0.001). Among trauma patients operated in the restraint period, decrease in the pediatric group and the increase in patients over 65 years of age had seen statistically significant. Compared to the same period of the previous year, 50% increase seen in amputation cases related to diabetic foot (p<0.001). CONCLUSION The postponement of elective cases due to the COVID-19 pandemic enabled us to manage trauma cases despite decreasing capacity utilization. In addition, it was observed that the transition of schools to online education and the implementation of curfews significantly reduced the number of trauma in the pediatric group. Separation of operating rooms and wards had a huge effect on protection of non-COVID patients. We hope that, in light of this study, we can guide health policies and help other colleagues to manage the possible new waves of the pandemic process or similar processes that may occur in the future.
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Affiliation(s)
- Mahmut Kürşat Özşahin
- Department of Orthopaedics and Traumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul-Turkey
| | - Göker Utku Değer
- Department of Orthopaedics and Traumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul-Turkey
| | - Nuri Aydın
- Department of Orthopaedics and Traumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul-Turkey
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Paccou J, Lenne X, Ficheur G, Theis D, Cortet B, Bruandet A. Analysis of Hip Fractures in France During the First COVID-19 Lockdown in Spring 2020. JAMA Netw Open 2021; 4:e2134972. [PMID: 34787657 PMCID: PMC8600388 DOI: 10.1001/jamanetworkopen.2021.34972] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has posed a number of unprecedented challenges to the health care system in France, where hip fractures in the elderly population are a major public health concern. OBJECTIVE To explore the association of the first nationwide COVID-19 lockdown in France with the absolute number of hip fractures among patients 50 years or older. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the French national hospitals database to identify patients 50 years or older who were hospitalized for hip fracture in France from January to July 2019 and January to July 2020. EXPOSURES The first nationwide COVID-19 lockdown in France from March 16 to May 10, 2020. MAIN OUTCOMES AND MEASURES The main outcome was the number of hospitalizations for hip fracture from January to July 2020 (study period) compared with the number of hospitalizations for hip fracture during the same period in 2019 (control period). Hospitalization rate ratios (HRRs) comparing the study period with the control period were calculated for 3 intervals (before lockdown [January 1 to March 15], during lockdown [March 16 to May 10], and after lockdown [May 11 to July 31]) and were stratified by gender, age and hospital type. RESULTS The study included 46 393 patients hospitalized for hip fracture during January to July 2019 (34 589 [74.4%] women; mean [SD] age, 82.8 [10.5] years) and 44 767 patients hospitalized for hip fracture from January to July 2020 (33 160 [74.1%] women; mean [SD] age, 82.9 [10.5] years). During the lockdown in 2020, 10 429 patients (23.30%) were hospitalized for hip fracture compared with 11 782 patients (25.40%) during the same period in 2019 (HRR, 0.89; 95% CI, 0.86-0.91; P < .001). The lockdown period was associated with a decrease in the number of hip fractures of 11% among women (from 8756 in 2019 to 7788 in 2020) and 13% among men (from 3026 in 2019 to 2641 in 2020). When the absolute number of hip fractures was stratified by age group, the lockdown period was associated with a decrease in the number of hip fractures in all age groups except in patients older than 89 years (HRR, 0.97; 95% CI, 0.92-1.01; P = .17). In the group of patients aged 80 to 89 years, the number of hip fractures decreased from 4925 to 4370 (HRR, 0.89; 95% CI, 0.85-0.92; P < .001). During the lockdown, hospitalizations decreased by 33% (HRR, 0.67; 95% CI, 0.63-0.71; P < .001) in public university hospitals and by 24% (HRR, 0.76; 95% CI, 0.73-0.79; P < .001) in public general hospitals but increased by 46% (HRR, 1.46; 95% CI,1.38-1.54; P < .001) in private for-profit hospitals. CONCLUSIONS AND RELEVANCE In this cohort study, hospitalizations for hip fractures in France decreased by 11% during the first nationwide COVID-19 lockdown. Further studies are needed to investigate the long-lasting consequences of the COVID-19 pandemic on the incidence of osteoporotic fractures.
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Affiliation(s)
- Julien Paccou
- Department of Rheumatology, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Xavier Lenne
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Grégoire Ficheur
- Évaluation des Technologies de Santé et des Pratiques Médicales, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Didier Theis
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Bernard Cortet
- Department of Rheumatology, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Amélie Bruandet
- Department of Medical Information, Lille University Hospital, Lille, France
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Beiter K, Hayden E, Phillippi S, Conrad E, Hunt J. Violent trauma as an indirect impact of the COVID-19 pandemic: A systematic review of hospital reported trauma. Am J Surg 2021; 222:922-932. [PMID: 34148669 PMCID: PMC8129999 DOI: 10.1016/j.amjsurg.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has exacerbated many social conditions associated with violence. The objective of this systematic review was to examine trends in hospital reported violent trauma associated with the pandemic. METHODS Databases were searched in using terms "trauma" or "violence" and "COVID-19," yielding 4,473 records (2,194 de-duplicated). Exclusion criteria included non-hospital based studies and studies not reporting on violent trauma. 44 studies were included in the final review. RESULTS Most studies reported no change in violent trauma incidence. Studies predominately assessed trends with violent trauma as a proportion of all trauma. All studies demonstrating an increase in violent trauma were located in the United States. CONCLUSIONS A disproportionate rise in violence has been reported within the US. However, most studies examined violent trauma as a proportion of all trauma; results may reflect relative changes from lockdowns. Future studies should examine rates of violent trauma to provide additional context.
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Affiliation(s)
- Kaylin Beiter
- Louisiana State University Health Sciences Center, United States.
| | - Ellery Hayden
- Louisiana State University Health Sciences Center, United States
| | | | - Erich Conrad
- Louisiana State University Health Sciences Center, United States
| | - John Hunt
- Louisiana State University Health Sciences Center, United States
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Testa G, Sapienza M, Rabuazzo F, Culmone A, Valenti F, Vescio A, Pavone V. Comparative study between admission, orthopaedic surgery, and economic trends during Covid-19 and non-Covid-19 pandemic in an Italian tertiary hospital: a retrospective review. J Orthop Surg Res 2021; 16:601. [PMID: 34654447 PMCID: PMC8517555 DOI: 10.1186/s13018-021-02754-2] [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] [Received: 07/01/2021] [Accepted: 09/24/2021] [Indexed: 12/26/2022] Open
Abstract
Background The COVID-19 pandemic represents one of the most massive health emergencies in the last century and has caused millions of deaths worldwide and a massive economic and social burden. The aim of this study was to evaluate how the COVID-19 pandemic—during the Italian lockdown period between 8 March and 4 May 2020—influenced orthopaedic access for traumatic events to the Emergency Department (ER). Methods A retrospective review of the admission to the emergency room and the discharge of the trauma patients’ records was performed during the period between 8 March and 4 May 2020 (block in Italy), compared to the same period of the previous year (2019). Patients accesses, admissions, days of hospitalisation, frequency, fracture site, number and type of surgery, the time between admission and surgery, days of hospitalisation, and treatment cost according to the diagnosis-related group were collected. Chi-Square and ANOVA test were used to compare the groups. Results No significant statistical difference was found for the number of emergency room visits and orthopaedic hospitalisations (p < 0.53) between the year 2019 (9.5%) and 2020 (10.81%). The total number of surgeries in 2019 was 119, while in 2020, this was just 48 (p < 0.48). A significant decrease in the mean cost of orthopaedic hospitalisations was detected in 2020 compared (261.431 euros, equal to − 52.07%) relative to the same period in 2019 (p = 0.005). Although all the surgical performances have suffered a major decline, the most frequent surgery in 2020 was intramedullary femoral nailing. Conclusion We detected a decrease in traumatic occasions during the lockdown period, with a decrease in fractures in each district and a consequent decrease in the diagnosis-related group (DRG).
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Affiliation(s)
- Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Fabrizia Rabuazzo
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Annalisa Culmone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Fabiana Valenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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Bosco A, Tay HW, Aleem I, Citak M, Uvaraj NR, Park JB, Matsumoto M, Marin-Penna O, Buvanesh J, Khan M, Hey HWD. Challenges to the orthopedic resident workforce during the first wave of COVID-19 pandemic: Lessons learnt from a global cross-sectional survey. J Orthop 2021; 27:103-113. [PMID: 34518748 PMCID: PMC8425745 DOI: 10.1016/j.jor.2021.09.001] [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] [Received: 04/24/2021] [Revised: 07/12/2021] [Accepted: 09/01/2021] [Indexed: 01/06/2023] Open
Abstract
Background The COVID-19 pandemic has caused unprecedented concerns on the safety, well-being, quality of life(QOL), and training of the orthopedic resident physician workforce worldwide. Although orthopedic residency programs across the globe have attempted to redefine resident roles, educational priorities, and teaching methods, the global orthopedic residents’ perspective with regards to their safety, well-being, QOL, and training, taking into account regional variances remains unknown. Methods A 56-item-questionnaire-based cross-sectional survey was conducted online during the COVID-19 pandemic involving 1193 orthopedic residents from 29 countries across six geographical regions to investigate the impact of the COVID-19 pandemic on the well-being, safety, and training of orthopedic residents at a global level, as well as to analyze the challenges confronted by orthopedic residency programs around the world to safeguard and train their resident workforce during this period. Results The total response rate was 90.3%(1077/1193). Time spent on residency-training activities decreased by 24.7 h/week (95% CI, −26.5 to −22.9,p < 0.001), with 50.2% (n = 541) residents performing duties outside their residency curriculum. 80.5% (n = 869) residents had no prior experience working in infectious outbreaks. A greater percentage of residents from Middle East, Asia and Europe were redeployed to the COVID-19 frontlines, p < 0.001. Only 46.5% (n = 491) and 58.4% (n = 600) of residents underwent training in critical care or PPE (Personal Protective equipment) usage, respectively; 28.5% (n = 302) residents (majority from Africa, Middle East, South America) reported lack of institutional guidelines to handle infectious outbreaks; 15.4% (n = 160) residents (majority from Africa, Asia, Europe) had concerns regarding availability of PPE and risk of infection. An increase in technology-based virtual teaching modalities was observed. The most significant stressor for residents was the concern for their family's health. Residents' QOL significantly decreased from 80/100 (IQR 70–90) to 65/100 (IQR 50–80) before and during the pandemic, p < 0.001. Conclusions The COVID-19 pandemic has significantly impacted the safety, well-being, QOL, and training of the global orthopedic resident physician workforce to different extents across geographical regions. The findings of this study will aid educators, program leaderships, and policy makers globally in formulating flexible, generalizable, and sustainable strategies to ensure resident safety, well-being, and training, while maintaining patient care.
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Affiliation(s)
- Aju Bosco
- Orthopedic Spine Surgery Division, Institute of Orthopedics and Traumatology, Madras Medical College, EVR Road, Park Town, Chennai, 600003, TamilNadu, India
| | - Hui Wen Tay
- Department of Orthopedics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ilyas Aleem
- Department of Orthopedic Surgery, University of Michigan, 1500 East Medical Center Drive, 2912 Taubman Center, SPC 5328, Ann Arbor, MI, 48109, USA
| | - Mustafa Citak
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
| | - Nalli Ramanathan Uvaraj
- Orthopedic Spine Surgery Division, Institute of Orthopedics and Traumatology, Madras Medical College, Chennai, 600003, TamilNadu, India
| | - Jong-Beom Park
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 11765, South Korea
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University, Keio University Hospital, Shinanomachi 35, Shinjyukuku, Tokyo, 160-8582, Japan
| | - Oliver Marin-Penna
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Infanta Leonor, C/ Gran Via del Este, 80, 28031, Madrid, Spain
| | - Janakiraman Buvanesh
- Institute of Orthopedics and Traumatology, Madras Medical College, Chennai, 600003, TamilNadu, India
| | - Moin Khan
- Division of Sports Medicine & Shoulder Surgery, Department of Orthopedic Surgery, McMaster University, 1280 Main Street West, Michael DeGroote Centre for Learning and Discovery (MDCL), 3104 Hamilton, Hamilton, ON, L8S 4K1, Canada
| | - Hwee Weng Dennis Hey
- University Orthopedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228, Singapore
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Melander S, Almström J, Enlund G, Frykholm P. The COVID-19 pandemic first wave in Sweden: A national registry study of the effects on pediatric anesthesia and surgery. Paediatr Anaesth 2021; 31:846-853. [PMID: 33971054 PMCID: PMC8242453 DOI: 10.1111/pan.14203] [Citation(s) in RCA: 4] [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: 02/01/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic is pushing healthcare systems to their limits. Dramatic reductions in the adult elective surgery are ubiquitous, but corresponding changes in pediatric services are not well described. The Swedish Perioperative Registry contains data on all anesthetic procedures in Sweden, and therefore, provides a unique opportunity to analyze the effect of the pandemic on the pediatric anesthesia capacity on a national level. We hypothesized that there would be a significant reduction in pediatric elective procedures. The aim was to determine the effects on pediatric surgical and anesthetic services during the first wave of the COVID-19 pandemic in Sweden. METHODS For this retrospective registry cohort study, we extracted all procedures performed on patients <18 years of age in 2020 and 2019. Weeks 12 to 26 of 2020 were defined as the first wave, and data were analyzed according to level of care, type of surgery, procedure code, and emergency or elective surgery. RESULTS We found 7015 fewer procedures during the first wave epoch. Elective cases were reduced by 53.7% while emergency surgery was not significantly affected. During the peak of the first wave in April, there was a 72.8% reduction in elective cases; ENT/maxillofacial surgery showed the greatest reduction (86.7%). The surgical and anesthesia capacity recovered to near-normal levels by the end of June 2020. CONCLUSION We conclude that the impact of COVID-19 on pediatric surgical procedures in Sweden during the first wave of the pandemic was dramatic, but elective services were restored a few months after the peak.
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Affiliation(s)
- Sixten Melander
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
| | - Jimmy Almström
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
| | - Gunnar Enlund
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
| | - Peter Frykholm
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
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Trisolino G, Toniolo RM, Marengo L, Dibello D, Guida P, Panuccio E, Evangelista A, Stallone S, Sansò ML, Amati C, Costici PF, Boero S, Farsetti P, De Sanctis N, Verdoni F, Memeo A, Gigante C. Resilience Against COVID-19: How Italy Faced the Pandemic in Pediatric Orthopedics and Traumatology. CHILDREN-BASEL 2021; 8:children8070530. [PMID: 34206218 PMCID: PMC8305147 DOI: 10.3390/children8070530] [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] [Received: 05/16/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022]
Abstract
Background: We aimed to investigate the variation of medical and surgical activities in pediatric orthopedics in Italy, during the year of the COVID-19 pandemic, in comparison with data from the previous two years. The differences among the first wave, phase 2 and second wave were also analyzed. Methods: We conducted a retrospective multicenter study regarding the clinical and surgical activities in pediatric orthopedics during the pandemic and pre-pandemic period. The hospital databases of seven tertiary referral centers for pediatric orthopedics and traumatology were queried for events regarding pediatric orthopedic patients from 1 March 2018 to 28 February 2021. Surgical procedures were classified according to the “SITOP Priority Panel”. An additional classification in “high-priority” and “low-priority” surgery was also applied. Results: Overall, in 2020, we observed a significant drop in surgical volumes compared to the previous two years. The decrease was different across the different classes of priority, with “high-priority” surgery being less influenced. The decrease in emergency department visits was almost three-fold greater than the decrease in trauma surgery. During the second wave, a lower decline in surgical interventions and a noticeable resumption of “low-priority” surgery and outpatient visits were observed. Conclusion: Our study represents the first nationwide survey quantifying the impact of the COVID-19 pandemic on pediatric orthopedics and traumatology during the first and second wave.
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Affiliation(s)
- Giovanni Trisolino
- Unit of Pediatric Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy;
- Correspondence: ; Tel.: +39-051-636-6484 or +39-340-264-3380
| | - Renato Maria Toniolo
- Department of Orthopaedics and Traumatology, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Lorenza Marengo
- Unit of Pediatric Orthopaedics and Traumatology, Istituto Giannina Gaslini, IRCCS, 16147 Genova, Italy; (L.M.); (S.B.)
| | - Daniela Dibello
- Unit of Pediatric Orthopaedics and Traumatology Giovanni XXIII Children’s Hospital, University of Bari, 70126 Bari, Italy; (D.D.); (C.A.)
| | - Pasquale Guida
- Unit of Pediatric Orthopaedics and Traumatology, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausillipon, 80122 Napoli, Italy; (P.G.); (M.L.S.)
| | - Elena Panuccio
- Department of Paediatric Orthopaedics and Traumatology, Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, 20122 Milano, Italy; (E.P.); (A.M.)
| | - Andrea Evangelista
- Unit of General Affairs, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy;
| | - Stefano Stallone
- Unit of Pediatric Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy;
| | - Maria Lucia Sansò
- Unit of Pediatric Orthopaedics and Traumatology, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausillipon, 80122 Napoli, Italy; (P.G.); (M.L.S.)
| | - Carlo Amati
- Unit of Pediatric Orthopaedics and Traumatology Giovanni XXIII Children’s Hospital, University of Bari, 70126 Bari, Italy; (D.D.); (C.A.)
| | - Pier Francesco Costici
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00050 Rome, Italy;
| | - Silvio Boero
- Unit of Pediatric Orthopaedics and Traumatology, Istituto Giannina Gaslini, IRCCS, 16147 Genova, Italy; (L.M.); (S.B.)
| | - Pasquale Farsetti
- Department of Orthopaedics Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Nando De Sanctis
- Unit of Pediatric Orthopaedics and Traumatology, Campolongo Hospital, 84025 Marina di Eboli, Italy;
| | - Fabio Verdoni
- Unit of Pediatric Orthopaedics and Traumatology, Istituto Galeazzi, IRCCS, 20161 Milan, Italy;
| | - Antonio Memeo
- Department of Paediatric Orthopaedics and Traumatology, Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, 20122 Milano, Italy; (E.P.); (A.M.)
| | - Cosimo Gigante
- Pediatric Orthopaedic Unit, Department of Woman and Child Health, Padua General Hospital, 35121 Padua, Italy;
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Schiroli D, Merolle L, Molinari G, Di Bartolomeo E, Seligardi D, Canovi L, Pertinhez TA, Mancuso P, Giorgi Rossi P, Baricchi R, Marraccini C. The impact of COVID-19 outbreak on the Transfusion Medicine Unit of a Northern Italy Hospital and Cancer Centre. Vox Sang 2021; 117:235-242. [PMID: 34156107 PMCID: PMC8447465 DOI: 10.1111/vox.13174] [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: 12/16/2020] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022]
Abstract
Background and Objectives The first wave of coronavirus disease‐2019 (COVID‐19) dramatically affected the Transfusion Medicine Unit of the Azienda Unità Sanitari Locale ‐ Istituto di Ricovero e Cura a Carattere Scientifico (AUSL‐IRCCS) di Reggio Emilia, which faced a total rearrangement of the procedures for donors and patients. This study aims to assess the major implications of COVID‐19 on our department, focusing on the blood transfusion chain and therapies, in order to support transfusion specialists in seeking efficient ways to face similar future emergencies. Materials and Methods This retrospective study compares our Transfusion Medicine Unit data collected between February and May 2020 with the same period in 2017–2019. Data on red blood cells and platelets donations, transfusions and clinical procedures were collected as aggregates from our internal electronic database. Results During the lockdown, donor centres were re‐organized to reduce the risk of contagion and avoid unnecessary blood collection. Blood donations were re‐scheduled to meet the decrease in elective surgery; consequently, plateletapheresis was implemented to supply the reduction of buffycoat‐derived platelets. Transfusions significantly decreased together with orthopaedic and vascular surgery, while they were only marginally diminished for both cancer and onco‐haematological patients. Reduced procedures for inpatients and outpatients were matched by remote medicine, addressing the need of a constant healthcare support for patients with chronic diseases. Conclusions The described measures were adopted to avoid excessive blood collection and expiration, guarantee the safety of our ward (for both patients and staff) and supply the necessary transfusion therapies. These measures may support the development of appropriate risk management plans and safety procedures for other hospitals and transfusion services that have to face similar events.
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Affiliation(s)
- Davide Schiroli
- Transfusion Medicine Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Merolle
- Transfusion Medicine Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Molinari
- Transfusion Medicine Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Daniela Seligardi
- Transfusion Medicine Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Canovi
- Transfusion Medicine Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Thelma A Pertinhez
- Transfusion Medicine Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Pamela Mancuso
- Epidemiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Roberto Baricchi
- Transfusion Medicine Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Marraccini
- Transfusion Medicine Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Kamacı S, Göker B, Çağlar Ö, Atilla B, Tokgözoğlu AM. The effect of the COVID-19 pandemic on orthopedic surgeries in a tertiary referral center. Jt Dis Relat Surg 2021; 32:333-339. [PMID: 34145808 PMCID: PMC8343866 DOI: 10.52312/jdrs.2021.78446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/04/2021] [Indexed: 01/12/2023] Open
Abstract
Objectives
The aim of this study is to investigate the effect of the novel coronavirus-2019 (COVID-19) pandemic on the operational trends in the orthopedic surgery department of a tertiary referral center. Patients and methods
A total of 305 orthopedic surgical procedures in 245 patients (136 males, 109 females; mean age: 34±26.6 years; range, 0 to 91 years) between March 16th and June 27th, 2020 were retrospectively analyzed. The same period of the year before including 860 procedures in 783 patients (364 males, 419 females; mean age: 33.6±25.8 years; range, 0 to 95 years) was also reviewed as a pre-pandemic control group. Patient demographics, surgical indications, COVID-19 polymerase chain reaction (PCR) test status, method of anesthesia, surgical subspecialties (trauma, sports, etc.), trauma mechanisms, and surgical priorities were evaluated. The pandemic and the pre- pandemic periods were compared. Results
The rate of elective surgeries decreased compared to the previous year, and priority C type surgeries had the highest frequency (42.5%). Orthopedic trauma was the leading subspecialty with 91 (29.8%) cases and had a higher share, compared to the pre-pandemic period (17.0%). Hip fractures (18.7%) were the most common cause of trauma surgery, and simple falls (42.3%) composed the largest group of trauma mechanisms, which was similar to the pre-pandemic period (hip fractures, 13.6%; simple falls, 42.5%). The distribution of surgical urgency levels and subspecialties differed significantly between the pre-pandemic and pandemic periods (p<0.001). Post- hoc analysis of subspecialty distribution revealed a significant decrease in arthroplasty (p=0.002) and hand surgery (p<0.001), and a significant increase in trauma (p<0.001) and the “other” category (p<0.001). Conclusion
Our experience in a tertiary referral center illustrated a shift toward performing emergent and urgent surgeries, when the severity of the outbreak increased. Prioritizing surgical urgencies during the outbreak changed the orthopedic surgery practice with an emphasis on trauma and oncology surgeries. Hip fractures were the most common cause of trauma surgery, and simple falls composed the largest group of trauma mechanisms.
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Affiliation(s)
| | - Barlas Göker
- Hacettepe Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 06230 Sıhhiye, Ankara, Türkiye.
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Vaishya R, Vaish A, Kumar A. Impact of COVID-19 on the practice of orthopaedics and trauma-an epidemiological study of the full pandemic year of a tertiary care centre of New Delhi. INTERNATIONAL ORTHOPAEDICS 2021. [PMID: 33835246 DOI: 10.1007/s00264-021-05021-5/figures/5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE In an observational study, we studied the impact of COVID-19 pandemic on our clinical practice of trauma and orthopaedics, in tertiary care hospital of New Delhi. METHODS We collated the hospital data for 2019 and 2020 and analyzed and compared it extensively. We looked for the effects of the COVID-19 pandemic on several important clinical practice parameters like outpatient attendance, inpatients admissions, and surgery. The correlation of the number of surgeries done during the pandemic time was done with the number of positive cases in Delhi, monthwise. A trend of recovery was also observed. RESULTS During the pandemic period, the attendance of outpatients fell by 71.93%, admissions by 59.35%, and surgery by 55.78%. Adult trauma surgery was the least affected (42.21%), followed by arthroscopic surgery (49.81%). Fragility hip fractures requiring bipolar hip arthroplasty were reduced by 34.15%. The maximum adverse impact of the pandemic was seen on arthroplasty surgery (hip > knee), followed by on the paediatric orthopaedic cases, and spinal surgery. We notice a "lazy V-shaped" recovery after the lockdown period. CONCLUSION COVID-19 pandemic has had a severe impact on all aspects of orthopaedics and trauma's clinical practice in our setup. These adverse effects were maximally seen during the lockdown period, with a reduction of 90.77% in the outpatients, 84.63% in the admissions, and 86.67% in the surgery.
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Affiliation(s)
- Raju Vaishya
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India.
| | - Abhishek Vaish
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India
| | - Ashok Kumar
- Orthopaedic Operating Theatres, Indraprastha Apollo Hospitals, New Delhi, 110076, India
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Aprato A, Guindani N, Massè A, Castelli CC, Cipolla A, Antognazza D, Benazzo F, Bove F, Casiraghi A, Catani F, Dallari D, D’Apolito R, Franceschini M, Momoli A, Ravasi F, Rivera F, Zagra L, Zatti G, D’Angelo F. Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5340. [PMID: 34067826 PMCID: PMC8156362 DOI: 10.3390/ijerph18105340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Background: From 10 March up until 3 May 2020 in Northern Italy, the SARS-CoV-2 spread was not contained; disaster triage was adopted. The aim of the present study is to assess the impact of the COVID-19-pandemic on the Orthopedic and Trauma departments, focusing on: hospital reorganization (flexibility, workload, prevalence of COVID-19/SARS-CoV-2, standards of care); effects on staff; subjective orthopedic perception of the pandemic. Material and Methods: Data regarding 1390 patients and 323 surgeons were retrieved from a retrospective multicentric database, involving 14 major hospitals. The subjective directors' viewpoints regarding the economic consequences, communication with the government, hospital administration and other departments were collected. Results: Surgical procedures dropped by 73%, compared to 2019, elective surgery was interrupted. Forty percent of patients were screened for SARS-CoV-2: 7% with positive results. Seven percent of the patients received medical therapy for COVID-19, and only 48% of these treated patients had positive swab tests. Eleven percent of surgeons developed COVID-19 and 6% were contaminated. Fourteen percent of the staff were redirected daily to COVID units. Communication with the Government was perceived as adequate, whilst communication with medical Authorities was considered barely sufficient. Conclusions: Activity reduction was mandatory; the screening of carriers did not seem to be reliable and urgent activities were performed with a shortage of workers and a slower workflow. A trauma network and dedicated in-hospital paths for COVID-19-patients were created. This experience provided evidence for coordinated responses in order to avoid the propagation of errors.
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Affiliation(s)
- Alessandro Aprato
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Nicola Guindani
- Regional Health Care and Social Agency Papa Giovanni XXIII, 25127 Bergamo, Italy;
| | - Alessandro Massè
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Claudio C. Castelli
- Regional Health Care and Social Agency Papa Giovanni XXIII, 25127 Bergamo, Italy;
| | - Alessandra Cipolla
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Delia Antognazza
- Department of Biotechnology and Life Sciences (DBSV), Università degli Studi dell’Insubria, 21100 Varese, Italy; (D.A.); (F.D.)
| | - Francesco Benazzo
- Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy;
| | - Federico Bove
- Azienda Ospedaliera Niguarda Ca’ Granda, 20162 Milano, Italy;
| | | | - Fabio Catani
- Orthopaedics and Traumatology, Modena University Hospital, Università degli Studi di Modena e Reggio Emilia, 41121 Modena, Italy;
| | - Dante Dallari
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Rocco D’Apolito
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (R.D.); (L.Z.)
| | | | - Alberto Momoli
- Orthopaedics and Traumatology, San Bortolo Hospital, 36100 Vicenza, Italy;
| | - Flavio Ravasi
- ASST-Melegnano-Martesana, Ortopedia di Cernusco sul Naviglio, 20070 Vizzolo Predabissi, Italy;
| | | | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (R.D.); (L.Z.)
| | - Giovanni Zatti
- Orthopaedics and Traumatology, University of Milano–Bicocca, 20900 Monza, Italy;
| | - Fabio D’Angelo
- Department of Biotechnology and Life Sciences (DBSV), Università degli Studi dell’Insubria, 21100 Varese, Italy; (D.A.); (F.D.)
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Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case-Control Study from a Single Center in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105205. [PMID: 34068405 PMCID: PMC8153577 DOI: 10.3390/ijerph18105205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
The mortality of hip fracture (HF) patients is increased by concomitant COVID-19; however, evidence is limited to only short follow-up. A retrospective matched case–control study was designed with the aim to report the 90-day mortality and determine the hazard ratio (HR) of concomitant HF and COVID-19 infection. Cases were patients hospitalized for HF and diagnosed with COVID-19. Controls were patients hospitalized for HF not meeting the criteria for COVID-19 diagnosis and were individually matched with each case through a case–control (1:3) matching algorithm. A total of 89 HF patients were treated during the study period, and 14 of them were diagnosed as COVID-19 positive (overall 15.7%). Patients’ demographic, clinical, and surgical characteristics were similar between case and control groups. At 90 days after surgery, 5 deaths were registered among the 14 COVID-19 cases (35.7%) and 4 among the 42 HF controls (9.5%). COVID-19-positive cases had a higher risk of mortality at 30 days (HR = 4.51; p = 0.0490) and 90 days (HR = 4.50; p = 0.025) with respect to controls. Patients with concomitant HF and COVID-19 exhibit high perioperative mortality, which reaches a plateau of nearly 30–35% after 30 to 45 days and is stable up to 90 days. The mortality risk is more than four-fold higher in patients with COVID-19.
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Ferrara F, Galmarini V, Tosco P, Molinari G, Capelli RM. Redeployment of specialist surgeons in the COVID-19 pandemic in a general hospital: critical issues and suggestions. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021172. [PMID: 33988153 PMCID: PMC8182580 DOI: 10.23750/abm.v92i2.10921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM to gain experience and highlight any margins for improvement, we outlined the role played by specialist surgeons (with particular reference to orthopedic surgeons), redeployed in treating COVID-19 patients in the Emergency Department of a general hospital, with severe overcrowding due to the massive and continuous arrival of patients Methods: "on the field" experience of the Authors is reported, followed by a narrative review of the literature, mainly on the topic of health-personnel redeployment during an emergency Results: a brief chronological discussion of the progressive reorganization of the hospital, in relation to the progress of the epidemic in the area, is reported, with specific reference to the experience of orthopedic and other branches specialist surgeons, that was characterized by a high degree of uncertainty about what to do, worsened by organizational difficulties due to the incessant arrival of patients and subsequent overcrowding. Observations relating to the critical aspects that have emerged and the various solutions proposed or implemented, if they have been identified, as well as the problems still open, are then made and compared to current literature. CONCLUSIONS The most significant aspect that we have tried to outline is the organizational difficulty, due to the rapid and unpredictable change in the situation: greater efficiency and flexibility, seen as the ability to overcome bureaucratic, logistical, regulatory or budgetary obstacles that prevent the rapid changes made necessary by the epidemic, could perhaps help to face better any subsequent pandemic wave, like the fierce one ongoing at the present moment.
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Affiliation(s)
- Fabrizio Ferrara
- a:1:{s:5:"en_US";s:69:"S.C. Ortopedia - ASST FBF - Sacco, Milano - Presidio Fatebenefratelli";}.
| | - Valter Galmarini
- Department of Orthopedics - ASST FBF-Sacco - Presidio Fatebenefratelli - Milano.
| | - Piermario Tosco
- Department of Orthopedics - ASST FBF-Sacco - Presidio Fatebenefratelli - Milano.
| | - Giampaolo Molinari
- Department of Orthopedics - ASST FBF-Sacco - Presidio Fatebenefratelli - Milano.
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Andreozzi V, Marzilli F, Muselli M, Previ L, Cantagalli MR, Princi G, Guzzini M, Ferretti A. The Effect of Shelter-In-Place on Orthopedic Trauma Volumes in Italy During the COVID-19 Pandemic. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021216. [PMID: 33988156 PMCID: PMC8182575 DOI: 10.23750/abm.v92i2.10827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 outbreak heavily attacked Italy, putting a strain for an extended time on the National healthcare system. Hospitals fastly rearranged the activity to cope with the crisis. This retrospective comparative study intended to investigate the impact of the lockdown imposed in Italy, in two different periods, during the COVID-19 outbreak on acute orthopedic trauma, in order to identify significant issues for improvement and future preparation. MATERIALS AND METHODS We obtained data on total trauma access to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during two periods of the COVID-19 pandemic lockdown in Italy: from March 9th, 2020 to May 4th, 2020(Phase 1), from May 10th, 2020 to June 30th, 2020(Phase 2) and then comparing them with the analogous period in 2019. We recorded demographic data; the characteristics of the lesion, including the anatomical area, fracture, sprain, dislocation, contusion, laceration, whether the lesion site was exposed or closed, where the trauma occurred and polytrauma. We also reported the waiting time in the emergency room and the mode of transport. RESULT The study sample was composed of 1655 patients, 894 (54%) males and 761 (46%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during Phase 1 and increased again to 456 during Phase 2. The average age of the Phase 1 group was 51.9 ± 24.8 years, significantly higher than that of the 2019 group (41.4 ± 25.7) and Phase 2 group (42.2 ± 22.5 years) (p<0.0001). In particular, elderly patients (>=65 years) were the most commonly involved in the Phase 1 group, while in the pre-COVID-19 period and in Phase 2 they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 66.2% of cases in the Phase 1 group, in 32.3% of cases in the Phase 2 group and in 32.3% of patients in the 2019 group. Concerning the injury type, in all groups, the most frequent injury was a fracture (45.1% in 2019; 62.7% in Phase 1; 50% Phase2) (p<0.0001). The most injured anatomical section during Phase 1 was the upper limb (43.1%), while in the pre-COVID-19 group and in Phase 2 group the most frequent injury location was the lower limb (48.3% and 40.8% respectively). CONCLUSION Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly people remained constant, indicating that not all trauma presentations would inevitably decrease during such circumstances.
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Affiliation(s)
- Valerio Andreozzi
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Fabio Marzilli
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Mario Muselli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Leonardo Previ
- 1Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Matteo Romano Cantagalli
- 1Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Giorgio Princi
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Matteo Guzzini
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Andrea Ferretti
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
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Blum P, Putzer D, Liebensteiner MC, Dammerer D. Impact of the Covid-19 Pandemic on Orthopaedic and Trauma Surgery - A Systematic Review of the Current Literature. In Vivo 2021; 35:1337-1343. [PMID: 33910811 DOI: 10.21873/invivo.12386] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM The Coronavirus disease 2019 (COVID-19) has led to significant disruptions in various medical specialties. We herein aimed to provide a systematic review of the published literature on the impact by the Covid-19 pandemic on orthopaedic and traumatological care by focusing on the number of clinical visits, surgeries and reasons for consultation. MATERIALS AND METHODS The published literature was reviewed using PubMed. Of 349 studies published between December 1, 2019 and October 1, 2020, 36 original articles met the inclusion criteria. Articles were selected on the basis of the PRISMA guidelines. October 1, 2020 was used as the concluding date of publication. RESULTS The number of elective visits declined by 50.0% to 74.0%. The number of emergency and trauma visits showed a decrease of 37.7% to 74.2%. Trauma surgery decreased by 21.2% to 66.7% and elective surgeries by 33.3% to 100%. CONCLUSION Orthopaedic and trauma surgery is clearly influenced by the pandemic. It will be important to maintain treatment and surgical care of patients in order to avoid negative effects on treatment progress.
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Affiliation(s)
- Philipp Blum
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria;
| | - David Putzer
- Department of Experimental Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael C Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
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Impact of COVID-19 on the practice of orthopaedics and trauma-an epidemiological study of the full pandemic year of a tertiary care centre of New Delhi. INTERNATIONAL ORTHOPAEDICS 2021; 45:1391-1397. [PMID: 33835246 PMCID: PMC8032552 DOI: 10.1007/s00264-021-05021-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022]
Abstract
Purpose In an observational study, we studied the impact of COVID-19 pandemic on our clinical practice of trauma and orthopaedics, in tertiary care hospital of New Delhi. Methods We collated the hospital data for 2019 and 2020 and analyzed and compared it extensively. We looked for the effects of the COVID-19 pandemic on several important clinical practice parameters like outpatient attendance, inpatients admissions, and surgery. The correlation of the number of surgeries done during the pandemic time was done with the number of positive cases in Delhi, monthwise. A trend of recovery was also observed. Results During the pandemic period, the attendance of outpatients fell by 71.93%, admissions by 59.35%, and surgery by 55.78%. Adult trauma surgery was the least affected (42.21%), followed by arthroscopic surgery (49.81%). Fragility hip fractures requiring bipolar hip arthroplasty were reduced by 34.15%. The maximum adverse impact of the pandemic was seen on arthroplasty surgery (hip > knee), followed by on the paediatric orthopaedic cases, and spinal surgery. We notice a “lazy V-shaped” recovery after the lockdown period. Conclusion COVID-19 pandemic has had a severe impact on all aspects of orthopaedics and trauma’s clinical practice in our setup. These adverse effects were maximally seen during the lockdown period, with a reduction of 90.77% in the outpatients, 84.63% in the admissions, and 86.67% in the surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-021-05021-5.
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Dallari D, Zagra L, Cimatti P, Guindani N, D'Apolito R, Bove F, Casiraghi A, Catani F, D'Angelo F, Franceschini M, Massè A, Momoli A, Mosconi M, Ravasi F, Rivera F, Zatti G, Castelli CC. Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study. J Orthop Traumatol 2021; 22:15. [PMID: 33818650 PMCID: PMC8020826 DOI: 10.1186/s10195-021-00577-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. MATERIALS AND METHODS For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C- group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. RESULTS Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C- group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. CONCLUSIONS Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. LEVEL OF EVIDENCE Therapeutic study, level 4.
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Affiliation(s)
- Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Pietro Cimatti
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Nicola Guindani
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Rocco D'Apolito
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy
| | - Federico Bove
- Department of Orthopaedic Surgery, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Alessandro Casiraghi
- Department of Orthopaedic Surgery, ASST Degli Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Policlinico Universitario di Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Fabio D'Angelo
- Division of Orthopaedics and Traumatology, ASST Dei Sette Laghi, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Viale L. Borri 57, 21100, Varese, Italy
| | | | - Alessandro Massè
- Department of Orthopaedic Surgery Ospedale Città Della Salute e Della Scienza, Università di Torino, Via G. Zuretti 29, 10126, Turin, Italy
| | - Alberto Momoli
- Department of Orthopaedic Surgery Ospedale San Bortolo, Viale F. Rodolfi 37, 36100, Vicenza, Italy
| | - Mario Mosconi
- Department of Orthopaedic Surgery, IRCCS Policlinico San Matteo di Pavia, Viale C. Golgi 19, 27100, Pavia, Italy
| | - Flavio Ravasi
- Department of Orthopaedic Surgery, ASST Melegnano Martesana-Ospedale di Vizzolo Predabissi, Via Pandina 1, 20077, Vizzolo Predabissi, Italy
| | - Fabrizio Rivera
- Department of Orthopaedic Surgery Ospedale SS Annunziata, Via Ospedali 14, 12038, Savigliano, Italy
| | - Giovanni Zatti
- Department of Orthopaedic Surgery ASST di Monza, Università Milano Bicocca, Via Pergolesi 33, 20900, Monza, Italy
| | - Claudio Carlo Castelli
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
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Fessler J, Jacobsen T, Lauritzen JB, Jørgensen HL. Mortality among hip fracture patients infected with COVID-19 perioperatively. Eur J Trauma Emerg Surg 2021; 47:659-664. [PMID: 33704515 PMCID: PMC7947941 DOI: 10.1007/s00068-021-01634-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/03/2021] [Indexed: 12/23/2022]
Abstract
Background and purpose The outbreak of the COVID-19 pandemic has resulted in an overall decline in fractures. However, the amount of hip fractures has remained relatively stable throughout the period. The objective of this study is to investigate the impact of perioperative COVID-19 infections on mortality among hip fracture patients. Methods A meta-analysis was performed by collecting current data available through a systematic literature search in the PubMed database. The search was performed Oct 18 2020. Results The meta-analysis was conducted on a trial population consisting of 1.272 hip fracture patients with a pooled prevalence of COVID-19 of 18%. Mortality among hip fracture patients without a perioperative COVID-19 infection was 7.49%. Mortality among hip fracture patients infected with COVID-19 perioperatively was associated with an odds ratio of 6.70 [(95% CI 4.64–9.68), p < 0.00001, I2 = 41%]. A sensitivity analysis showed no major impact of assumptions regarding varying definitions of COVID-19 statuses among the included studies. Conclusion Perioperative infections with COVID-19 in hip fracture patients are correlated with a significantly increased mortality. The meta-analysis showed a pooled odds ratio of 6.70 [(95% CI 4.64–9.68), p < 0.00001, I2 = 41%].
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Affiliation(s)
- Johannes Fessler
- Department of Orthopedic Surgery, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 KBH NV, Copenhagen, Denmark
| | - Thomas Jacobsen
- Department of Orthopedic Surgery, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 KBH NV, Copenhagen, Denmark
| | - Jes Bruun Lauritzen
- Department of Orthopedic Surgery, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 KBH NV, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 KBH N, Copenhagen, Denmark
| | - Henrik Løvendahl Jørgensen
- Department of Clinical Biochemistry, Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 KBH N, Copenhagen, Denmark.
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van Aert GJJ, van der Laan L, Boonman-de Winter LJM, Berende CAS, de Groot HGW, Boele van Hensbroek P, Schormans PMJ, Winkes MB, Vos DI. Effect of the COVID-19 pandemic during the first lockdown in the Netherlands on the number of trauma-related admissions, trauma severity and treatment: the results of a retrospective cohort study in a level 2 trauma centre. BMJ Open 2021; 11:e045015. [PMID: 33608406 PMCID: PMC7898225 DOI: 10.1136/bmjopen-2020-045015] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To determine the impact of the first lockdown in the Netherlands' measures during the COVID-19 pandemic on the number and type of trauma-related injuries presenting to the emergency department (ED). DESIGN A single-centre retrospective cohort study. SETTING A level 2 trauma centre in Breda, The Netherlands. PARTICIPANTS All patients with trauma seen at the ED between 11 March and 10 May 2020 (the first Dutch lockdown period) were included in this study. Comparable groups were generated for 2019 and 2018. MAIN OUTCOME MEASURES Primary outcomes were the total number of patients with trauma admitted to the ED and the trauma mechanism. Secondary outcomes were triage categories, time of ED visit, trauma severity (Injury Severity Score (ISS) >12), anatomical region of injury and treatment. RESULTS A total of 4674 patients were included in this study. During the first months of the COVID-19 pandemic, there was a decrease of 32% in traumatic injuries at the ED (n=1182) compared with the previous years 2019 (n=1717) and 2018 (n=1775) (p<0.001). Sports-related injuries decreased most during the lockdown (n=164) compared with 2019 (n=386) and 2018 (n=367) (p<0.001). We observed more frequent injuries due to a fall from standing height (p<0.001) and work-related injuries (p<0.05). The mean age was significantly higher (mean 48 years vs 42 and 43 years). There was no difference in anatomical place of injury or ISS >12. The amount of patients admitted for emergency surgery was significantly higher (14.6% vs 9.4%; 8.6%, p<0.001). Seven patients (0.6%) tested positive for COVID-19. CONCLUSIONS Measures taken in the COVID-19 outbreak result in a predictable decrease in the total number of patients with trauma, especially sports-related trauma. Although the trauma burden on the emergency room appears to be lower, more people have been admitted for trauma surgery, possibly due to increased throughput in the operating theatres.
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Affiliation(s)
| | - Lijckle van der Laan
- Surgery, Amphia Hospital, Breda, The Netherlands
- Cardiovascular science, University of Leuven, Leuven, Belgium
| | | | | | | | | | | | | | - Dagmar I Vos
- Surgery, Amphia Hospital, Breda, The Netherlands
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Aprato A, Bini N, Ferro S, Favella L, Conforti L, Massè A. Trauma workload during COVID19 lockdown: an analysis of incidence in 4 million people. Ir J Med Sci 2021; 191:39-43. [PMID: 33598880 PMCID: PMC7888695 DOI: 10.1007/s11845-021-02548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aim of this study is to report the trauma workload during COVID19 lockdown in a region of four million people and to compare it with the same period in 2019. METHODS The regional register for A&E admissions and hospitalizations has been reviewed in order to compare the number of A&D admission, the triage colour codes rates, aetiology of trauma, number of patients hospitalized for trauma, number of fractures that required surgery, type of fractures and injuries and mean patients' age. RESULTS During lockdown 7314 patients were admitted in A&E, while 22,508 patients were admitted in 2019. In 2020 and 2019 triage codes were respectively distributed as follows: red code 0.1% vs 0.2%, yellow code 8.9% vs 6.3%, green code 84% vs 84.7% and white code 6% vs 8.8%. (p = 0.042). The number of hospitalized patients for trauma was 670 in 2020, while in 2019 was 1774 (p = 0.02). The most common fracture that required surgery was femur fracture (409 in 2020 vs 635 in 2019); fracture subtype distribution and mean age of the patients were significantly different in the two groups (respectively p < 0.01 and p = 0.02). CONCLUSIONS One month of lockdown showed a 68% decrease in the number of A&E visits and a 74% decrease of fractures that required surgery. Femur fracture showed the lowest decrease moving from 635 to 409 units but increasing their incidence rate (42 to 61%).
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Affiliation(s)
| | - Nathalie Bini
- School of Medicine, University of Turin, Turin, Italy
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Montrucchio G, Brazzi L. Surgery at the time of COVID-19: let's go beyond the pandemic. Minerva Anestesiol 2021; 87:510-513. [PMID: 33591148 DOI: 10.23736/s0375-9393.21.15419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giorgia Montrucchio
- Department of Surgical Sciences, University of Turin, Turin, Italy - .,Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza, Turin, Italy -
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy.,Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza, Turin, Italy
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Maniscalco P, Ciatti C, Gattoni S, Quattrini F, Puma Pagliarello C, Patane' AC, Capelli P, Banchini F, Rivera F, Sanna F, Nonne D, Di Maggio B, Scaravilli G. Proximal humerus fractures in COVID-19 lockdown: the experience of three orthopedics and traumatology departments in the first ten weeks of the Italian epidemic. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021104. [PMID: 33682805 PMCID: PMC7975920 DOI: 10.23750/abm.v92i1.11231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/30/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Coronavirus disease (CoVID-19) is causing millions of deaths worldwide and the crisis of the global healthcare system. Aim Of The Study: evaluate the preliminary impact of CoVID-19 in three Italian Orthopedics and Traumatology Departments in the first 10 weeks of the national lockdown. We focused on proximal humerus fractures, analyzing data and results in comparison with the same period of 2019. MATERIALS AND METHODS From February 22nd to May 3rd 2020, 55 patients were admitted to our departments for promixal humerus fractures. Our cohort of patients is composed by 13 males (23.6%) and 42 females (76.4%), with an average age of 73.8 ± 11.7 years (range 44 - 94). Trauma occurred at home in 43 cases (78.2%), by the roadside in 10 cases (18.2%), in a retirement home in 1 case (1.8%), and at work in 1 case (1.8%). We proposed surgical treatment in 15/55 cases, but 4 patients refused hospitalization, mainly because of the risk of contracting n-CoV19 infection. RESULTS We noticed a decrease in proximal humerus fractures compared to 2019 (-37.5%). Particularly, we observed a significant drop in traumas occurred on the road and at work respectively 23.9% and 3.4%% in 2019, and 18.2% and 1.8% in 2020, probably due to the consequences of the national lockdown. Sports traumas had a reset during the pandemic (6 cases in 2019, 0 in 2020). As consequence, surgical treatment had a decrease due to the reduction in number of fractures, indications and patient's consent. CONCLUSION The incidence of proximal humerus fractures had a significant reduction during CoVID-19 spread. We assume that the reasons of this reduction are to be found in the national lockdown (since March 10th, 2020) and Ministerial Decrees that limited the access to the E.R. only in case of severe traumas in order to avoid CoVID-19 spread.
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Affiliation(s)
- Pietro Maniscalco
- Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
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Andreozzi V, Marzilli F, Muselli M, Previ L, Cantagalli MR, Princi G, Ferretti A. The impact of COVID-19 on orthopaedic trauma: A retrospective comparative study from a single university hospital in Italy. Orthop Rev (Pavia) 2021; 12:8941. [PMID: 33585026 PMCID: PMC7874950 DOI: 10.4081/or.2020.8941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 outbreak strongly affected Italy, putting a strain on the National healthcare system. Hospitals quickly reorganized the activity to cope with the emergency. This retrospective comparative study aimed to analyze the impact of the lockdown imposed in Italy during the COVID-19 outbreak on acute orthopedic trauma, in order to identify critical issues for improvement and future planning. We collected data on all the trauma admissions to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during the COVID- 19 pandemic lockdown in Italy, comparing them with the corresponding period in 2019. We reported demographic data; the characteristics of the injury, including the anatomical location, fracture, sprain, dislocation, contusion, laceration, whether the injury site was exposed or closed, where the injury occurred, and polytrauma. We also recorded the waiting time in the emergency room and mode of transportation. The study sample was composed of 1199 patients, 636 (53.04%) males and 563 (46.96%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during COVID-19 outbreak in 2020. The average age of the 2020 group was 51.9 ± 24.8 years, significantly higher than that of the 2019 group (41.4 ± 25.7) (p<0.0001). In particular, elderly patients (≥65 years) were the most commonly involved in the COVID-19 group, while in the pre- COVID-19 period they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 65.7% of cases in the 2020 group, and in 32.3% of patients in the 2019 group. Concerning the injury type, in both groups, the most common injury was a fracture (45.1% in 2019; 62.7% in 2020) (p<0.0001). The most injured anatomical location during COVID-19 lockdown was the hand (14.2%), while in the pre-COVID- 19 group the most frequent injury type was polytrauma (22.8%). Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly individuals remained stable, indicating that not all trauma presentations would necessarily decrease during such times.
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Affiliation(s)
- Valerio Andreozzi
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome
| | - Fabio Marzilli
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome
| | - Mario Muselli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - Leonardo Previ
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome
| | | | - Giorgio Princi
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome
| | - Andrea Ferretti
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome
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Ojeda-Thies C, Cuarental-García J, Ramos-Pascua LR. Decreased volume of hip fractures observed during COVID-19 lockdown. Eur Geriatr Med 2021; 12:759-766. [PMID: 33481186 PMCID: PMC7820835 DOI: 10.1007/s41999-020-00447-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/28/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The aim was to study the incidence and characteristics of fragility hip fractures admitted during COVID-19 lockdown. MATERIALS AND METHODS We analysed socio-demographic and baseline characteristics of patients suffering fragility hip fractures between March 1st and May 1st 2020, period most affected by COVID-19 confinement measures. Cases (n = 64) were compared with controls (n = 172) from corresponding periods in 2018 and 2019. Poisson Generalised Linear Model regression analysis was performed to compare daily case counts, and LOESS curves compared time series. RESULTS No differences were found regarding age or gender distributions, pre-fracture living, ambulatory, functional or cognitive status. More patients in 2020 had a high-risk ASA score. Fewer cases [Reduction = 26% (95% CI 1-44%)] were admitted in 2020. The reduction seemed to correspond with confinement. CONCLUSIONS Approximately, one quarter less fragility hip fractures were admitted to our hospital during lockdown. Patients' baseline status and socio-demographic characteristics were similar.
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Affiliation(s)
- Cristina Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda Córdoba s/n, 28041, Madrid, Spain.
| | - Javier Cuarental-García
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda Córdoba s/n, 28041, Madrid, Spain
| | - Luis Rafael Ramos-Pascua
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda Córdoba s/n, 28041, Madrid, Spain.,Department of Surgery, School of Medicine, Complutense University of Madrid, Madrid, Spain
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Gupta R, Singhal A, Kapoor A, Dhillon M, Masih GD. Effect of COVID-19 on surgical management of open fractures and infection rates: A tertiary care experience in Indian set-up. J Clin Orthop Trauma 2021; 12:16-21. [PMID: 33132629 PMCID: PMC7587168 DOI: 10.1016/j.jcot.2020.10.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Open fractures form one of the most common musculoskeletal injuries and are often complicated by infection. In this unprecedented situation, the additional infection rates, further add to the burden of the already compromised healthcare setup. The present study is done to see the effect of COVID-19 on management of open fractures. METHODS A retrospective evaluation of patients with open fractures from March 25th, 2020 to July 21st, 2020 (group 1) and March 25th, 2019 to July 21st, 2019 (group 2) was performed. These patients were assessed for demographic details, diagnosis, type of surgery, delay from injury to admission, delay from admission to surgery, postoperative hospital stay, acute infection rates, readmission rates and associated injuries. RESULTS A total of 52 patients with 59 open fractures in 2020 and 89 patients with 101 open fractures in 2019 met the inclusion criteria. The mean age was 34.76 years and 32.74 years in 2020 and 2019 respectively. Road side accidents were predominant in both the groups, comprising of 38 (73.07%) and 67 (75.28%) respectively(n.s.); adult patients were 42 (80.76%) and 79 (88.76%) respectively(n.s.); paediatric patients were 10 (19.23%) and 10 (11.23%) respectively(n.s.); tibia was the most common bone involved, comprising of 14 (23.72%) and 27 (26.73%) open fractures respectively(n.s.); external fixator was the most commonly used implant during COVID-19 time with 42 (71.18%) and 51 (50.49%) respectively(p = 0.005); the infection rate was 25.42% and 20.79% respectively(n.s.); the time for administration of first intravenous antibiotic dose was on 6.75 h and 4.04 h respectively(p < 0.0001); average time between the admission and surgical debridement was 24.04 h and 19.32 h respectively(n.s.); referral cases were 33 (63.46%) and 44 (49.43%) respectively(n.s.); re-admission rates were 7/52 (13.46%) and 10/89(11.23%) respectively(n.s.). CONCLUSION Despite the decrease in total trauma cases, a delay in presentation to the emergency room/administration of first dose of antibiotic and increase in temporary fixation in form of external fixator was observed. Further, an increase in infection rates, referral cases and readmission rates were observed, though not statistically significant.
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Affiliation(s)
- Ravi Gupta
- Sports Injury Center, Government Medical College Hospital, Chandigarh, India
| | - Akash Singhal
- Government Medical College and Hospital, Chandigarh, India,Corresponding author.
| | - Anil Kapoor
- Department Of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - Mehar Dhillon
- Department Of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - Gladson David Masih
- Department Of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
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Maniscalco P, Ciatti C, Gattoni S, Puma Pagliarello C, Moretti G, Cauteruccio M, Carpaneto D, Capelli P, Gurrieri L, Banchini F, Quattrini F. The impact of COVID-19 pandemic on the Emergency Room and Orthopedic Departments in Piacenza: a retrospective analysis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020028. [PMID: 33559619 PMCID: PMC7944696 DOI: 10.23750/abm.v91i14-s.11003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/18/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND AIM The Coronavirus pandemic represents one of the most massive health emergencies in the last century. Aim of the study is to evaluate the trend of E.R. accesses and orthopaedic events during the pandemic of Covid-19. MATERIALS AND METHODS we retrospectively analysed all data related to patients admitted to the E.R. Department of the Hospital of Piacenza from August 26th 2019 to August 23rd 2020, splitting this period on February 23rd 2020. RESULTS Our analysis shows a reduction of -18.0% in E.R. accesses. We calculated a growth of deaths in the E.R. equal to +220%. Our orthopaedic pathway recorded a drop of -26.8%. Traumas occurred at home increased (+19.1%). We note an actual drop only on proximal femur fractures (weighted average of -17.7%), while all the others underwent an increase. DISCUSSION The amount of E.R. accesses registered a drop -18.0%, while the pathway dedicated to emergency cases underwent an increase. The major complexity of clinical conditions influenced the number of hospitalizations and the fear of the infection increased hospitalization refusals. There has been a zeroing of school traumas, a reduction in sport, transfer home-work/work-home, work, roadside, injuries. Total amount of fractures strongly increase after the end of the lockdown. CONCLUSION our data confirmed the decrease of retirement houses, sports, works and roadsides traumas and a zeroing of schools ones, while those occurred inside domestic environment underwent a consistent raise. We noticed a reduction in femur fractures and significant spread of all fractures after the end of the lockdown.
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Affiliation(s)
- Pietro Maniscalco
- Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | | | | | | | | | | | | | | | | | - Filippo Banchini
- Surgery Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
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Briguglio M, Giorgino R, Dell'Osso B, Cesari M, Porta M, Lattanzio F, Banfi G, Peretti GM. Consequences for the Elderly After COVID-19 Isolation: FEaR (Frail Elderly amid Restrictions). Front Psychol 2020; 11:565052. [PMID: 33117231 PMCID: PMC7549544 DOI: 10.3389/fpsyg.2020.565052] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Matteo Briguglio
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Psychiatry 2 Unit, Luigi Sacco University Hospital, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, CA, United States
| | - Matteo Cesari
- Geriatric Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Porta
- IRCCS Orthopedic Institute Galeazzi, Movement Disorder Center, Milan, Italy
| | | | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy.,Vita-Salute San Raffaele University, Faculty of Medicine and Surgery, Milan, Italy
| | - Giuseppe M Peretti
- IRCCS Orthopedic Institute Galeazzi, Regenerative and Reconstructive Unit, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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MacDonald DRW, Neilly DW, Davies PSE, Crome CR, Jamal B, Gill SL, Jariwala AC, Stevenson IM, Ashcroft GP. Effects of the COVID-19 lockdown on orthopaedic trauma: a multicentre study across Scotland. Bone Jt Open 2020; 1:541-548. [PMID: 33215152 PMCID: PMC7659679 DOI: 10.1302/2633-1462.19.bjo-2020-0114.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIMS The UK government declared a national lockdown on 23 March 2020 to reduce transmission of COVID-19. This study aims to identify the effect of lockdown on the rates, types, mechanisms, and mortality of musculoskeletal trauma across Scotland. METHODS Data for all musculoskeletal trauma requiring operative treatment were collected prospectively from five key orthopaedic units across Scotland during lockdown (23 March 2020 to 28 May 2020). This was compared with data for the same timeframe in 2019 and 2018. Data collected included all cases requiring surgery, injury type, mechanism of injury, and inpatient mortality. RESULTS A total of 1,315 patients received operative treatment from 23 March 2020 to 28 May 2020 compared with 1,791 in 2019 and 1,719 in 2018. The numbers of all injury types decreased, but the relative frequency of hip fractures increased (36.3% in 2020 vs 30.2% in 2019, p < 0.0001 and 30.7% in 2018, p < 0.0001). Significant increases were seen in the proportion of DIY-related injuries (3.1% in 2020 vs 1.7% in 2019, p = 0.012 and 1.6% in 2018, p < 0.005) and injuries caused by falls (65.6% in 2020 vs 62.6% in 2019, p = 0.082 and 61.9% in 2018, p = 0.047). Significant decreases were seen in the proportion of road traffic collisions (2.6% in 2020 vs 5.4% in 2019, p < 0.0001 and 4.2% in 2018, p = 0.016), occupational injuries (1.8% in 2020 vs 3.0% in 2019, p = 0.025 and 2.3% in 2018, p = 0.012) and infections (6.8% in 2020 vs 7.8% in 2019, p = 0.268 and 10.3% in 2018, p < 0.012). Cycling injuries increased (78 in 2020 vs 64 in 2019 vs 42 in 2018). A significant increase in the proportion of self-harm injuries was seen (1.7% in 2020 vs 1.1% in 2019, p = 0.185 and 0.5% in 2018, p < 0.0001). Mortality of trauma patients was significantly higher in 2020 (5.0%) than in 2019 (2.8%, p = 0.002) and 2018 (1.8%, p < 0.0001). CONCLUSION The UK COVID-19 lockdown has resulted in a marked reduction in musculoskeletal trauma patients undergoing surgery in Scotland. There have been significant changes in types and mechanisms of injury and, concerningly, mortality of trauma patients has risen significantly.Cite this article: Bone Joint Open 2020;1-9:541-548.
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Affiliation(s)
| | - David W. Neilly
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Christopher R. Crome
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Bilal Jamal
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sarah L. Gill
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Arpit C. Jariwala
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, UK
| | - Iain M. Stevenson
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
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Espinosa-Uribe AG, Gonzalez-Saldivar JC, Valverde-Galindo LA, Meza-Flores J, Gutiérrez-de la O J. Regarding "The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war" a Mexican perspective. INTERNATIONAL ORTHOPAEDICS 2020; 44:2187-2188. [PMID: 32737519 PMCID: PMC7394268 DOI: 10.1007/s00264-020-04751-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Abraham Guadalupe Espinosa-Uribe
- Departamento de Ortopedia y traumatología, Hospital Christus Muguerza, Alta Especialidad Miguel Hidalgo 2525, Obispado, 64060, Monterrey, Nuevo León, Mexico. .,Escuela de Medicina, Especialidades Médicas, Universidad de Monterrey, Av. Ignacio Morones Prieto 4500, Jesús M. Garza, 66238, San Pedro Garza García, Nuevo Leon, Mexico.
| | - Juan Carlos Gonzalez-Saldivar
- Departamento de Ortopedia y traumatología, Hospital Christus Muguerza, Alta Especialidad Miguel Hidalgo 2525, Obispado, 64060, Monterrey, Nuevo León, Mexico.,Escuela de Medicina, Especialidades Médicas, Universidad de Monterrey, Av. Ignacio Morones Prieto 4500, Jesús M. Garza, 66238, San Pedro Garza García, Nuevo Leon, Mexico
| | - Luis Andrés Valverde-Galindo
- Departamento de Ortopedia y traumatología, Hospital Christus Muguerza, Alta Especialidad Miguel Hidalgo 2525, Obispado, 64060, Monterrey, Nuevo León, Mexico.,Escuela de Medicina, Especialidades Médicas, Universidad de Monterrey, Av. Ignacio Morones Prieto 4500, Jesús M. Garza, 66238, San Pedro Garza García, Nuevo Leon, Mexico
| | - Javier Meza-Flores
- Departamento de Ortopedia y traumatología, Hospital Christus Muguerza, Alta Especialidad Miguel Hidalgo 2525, Obispado, 64060, Monterrey, Nuevo León, Mexico.,Escuela de Medicina, Especialidades Médicas, Universidad de Monterrey, Av. Ignacio Morones Prieto 4500, Jesús M. Garza, 66238, San Pedro Garza García, Nuevo Leon, Mexico
| | - Jorge Gutiérrez-de la O
- Departamento de Ortopedia y traumatología, Hospital Christus Muguerza, Alta Especialidad Miguel Hidalgo 2525, Obispado, 64060, Monterrey, Nuevo León, Mexico.,School of Medicine, Human Anatomy Department, Universidad Autónoma de Nuevo León, Avenida Francisco I. Madero y Gonzalitos s/n Colonia Mitras Centro C.P, 64460, Monterrey, Nuevo León, Mexico
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Khanduja V, Scarlat MM. Reaching a new 'normal' after COVID pandemic and orthopaedic implications. INTERNATIONAL ORTHOPAEDICS 2020; 44:1449-1451. [PMID: 32686013 PMCID: PMC7369469 DOI: 10.1007/s00264-020-04725-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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