1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Impact of COVID-19 on Clinical Outcomes Following Total Shoulder Arthroplasty. SEMINARS IN ARTHROPLASTY 2023; 33:416-421. [PMID: 37168077 PMCID: PMC9993730 DOI: 10.1053/j.sart.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Background The coronavirus (COVID-19) pandemic has introduced patient stressors and changes to perioperative protocols in total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term effects of the COVID-19 pandemic on various patient outcomes and satisfaction following elective TSA. Methods A retrospective review was performed on 147 patients who underwent primary TSA at a single institution between the June 2019 and December 2020. Patients were divided into two cohorts: pre-COVID (June 2019-March 2020; n=74) and post-COVID (April 2020-December 2020; n=73). No elective TSA were performed between 10 March 2020 and 23 April 2020 at our institution. Data were collected prospectively both pre- and postoperatively. Range of motion (ROM) testing included active abduction, internal (IR), and external rotation (ER). Patient reported outcome measures (PROMs) included global shoulder function, Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Visual Analog Scale (VAS) pain scoring systems, and patient satisfaction. ROM and PROMs were compared at preoperative, 3-month follow-up, and 12-month follow-up intervals. Operative time, length of stay (LOS), 90-day readmission, and 90-day reoperation were also compared. Results There were no differences in baseline patient characteristics. Operative time, LOS, home discharge rate, readmission, and reoperation did not differ between groups. For both cohorts, PROMs and ROM improved at each follow-up visit postoperatively. While preoperative abduction, IR, and ER were significantly greater in the post-COVID group, all ROM measures were similar at 3-month and 12-month follow-up visits. There was no difference in pain, global function, SST, ASES, or patient satisfaction between groups at all time intervals. Conclusions Patients undergoing elective TSA amidst the COVID-19 pandemic demonstrate excellent PROMs, ROM, and high satisfaction up to 12-months postoperatively that are comparable to pre-pandemic standards. Operative time, length of stay, discharge destination, as well as 90-day readmission and reoperation rates were not impacted by the pandemic. Patients can expect similar outcomes for TSA when comparing pre-COVID to post-COVID as the pandemic continues.
Collapse
|
3
|
Butenko NN, Martynenko ES, Karpov NS, Dubinina YA, Yablochkin VI. [Treatment of periprosthetic fractures in Europe during the pandemic]. Khirurgiia (Mosk) 2023:42-48. [PMID: 37850893 DOI: 10.17116/hirurgia202304142] [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] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To study the impact of reorganization of European hospitals during the most severe phase of the SARS-CoV-2 pandemic on standards of care and early outcomes in patients with periprosthetic fractures. MATERIAL AND METHODS We reviewed available data collected from 14 hospitals in Northern Italy during the quarantine period between March 9 and May 4, 2020. The study included all patients admitted to emergency departments with periprosthetic fractures and scheduled for surgery within a 2-month period. Periprosthetic fractures were classified according to the Uniform Classification System (UCS). Distribution normality was tested using the Kolmogorov-Smirnov test. Accordingly, data were described as non-parametric. Statistical analysis was performed using the Microsoft Excel v. 16.0. RESULTS In total, 1390 patients admitted to the Department of Orthopedics and Traumatology for emergency care throughout the follow-up period including 38 (2.7%) ones with periprosthetic fractures. There were 12 (31.5%) men and 26 (68.5%) women. Mean age was 81 years (range 70-96). Screening for SARS-CoV-2 by swab was performed in 23 out of 38 patients (60.5%) at admission. It was positive in 2 (5.3%) cases. Three out of thirty-eight patients (7.9%) were diagnosed with COVID-19 due to clinical signs. Of these, 2 patients were diagnosed with COVID-19 before surgery, 3 patients - after surgery. Although the study period coincided with quarantine, the number of admissions for periprosthetic fractures (3%) was similar to that in 2019 and accounted for 3% of the total number of visits to the traumatology and orthopedics departments. CONCLUSION The study revealed no obvious changes in hospitalizations for periprosthetic fractures despite social restrictions during the first wave of the COVID-19 pandemic. In emergency, hospitals were still able to provide standard care for patients with periprosthetic fractures despite significant amount of resources redirected for the pandemic.
Collapse
Affiliation(s)
- N N Butenko
- Kuban State Medical University, Krasnodar, Russia
| | | | - N S Karpov
- Wagner Perm State Medical University, Perm, Russia
| | - Yu A Dubinina
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | | |
Collapse
|
4
|
Perego M, Iesari S, Gandolfo MT, Alfieri C, Delbue S, Cacciola R, Ferraresso M, Favi E. Outcomes of Patients Receiving a Kidney Transplant or Remaining on the Transplant Waiting List at the Epicentre of the COVID-19 Pandemic in Europe: An Observational Comparative Study. Pathogens 2022; 11:pathogens11101144. [PMID: 36297201 PMCID: PMC9610233 DOI: 10.3390/pathogens11101144] [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: 07/18/2022] [Revised: 09/20/2022] [Accepted: 09/30/2022] [Indexed: 01/19/2023] Open
Abstract
Since the declaration of the COVID-19 pandemic, the number of kidney transplants (KT) performed worldwide has plummeted. Besides the generalised healthcare crisis, this unprecedented drop has multiple explanations such as the risk of viral transmission through the allograft, the perceived increase in SARS-CoV-2-related morbidity and mortality in immunocompromised hosts, and the virtual "safety" of dialysis while awaiting effective antiviral prophylaxis or treatment. Our institution, operating at the epicentre of the COVID-19 pandemic in Italy, has continued the KT programme without pre-set limitations. In this single-centre retrospective observational study with one-year follow-up, we assessed the outcomes of patients who had undergone KT (KTR) or remained on the transplant waiting list (TWL), before (Pre-COV) or during (COV) the pandemic. The main demographic and clinical characteristics of the patients on the TWL or receiving a KT were very similar in the two periods. The pandemic did not affect post-transplant recipient and allograft loss rates. On the contrary, there was a trend toward higher mortality among COV-TWL patients compared to Pre-COV-TWL subjects. Such a discrepancy was primarily due to SARS-CoV-2 infections. Chronic exposure to immunosuppression, incidence of delayed allograft function, and rejection rates were comparable. However, after one year, COV-KTR showed significantly higher median serum creatinine than Pre-COV-KTR. Our data confirm that KT practice could be safely maintained during the COVID-19 pandemic, with excellent patient- and allograft-related outcomes. Strict infection control strategies, aggressive follow-up monitoring, and preservation of dedicated personnel and resources are key factors for the optimisation of the results in case of future pandemics.
Collapse
Affiliation(s)
- Marta Perego
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Samuele Iesari
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium
| | - Maria Teresa Gandolfo
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carlo Alfieri
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Serena Delbue
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Roberto Cacciola
- Surgery, King Salman Armed Forces Hospital, Tabuk 47512, Saudi Arabia
- HPB Surgery and Transplantation, Fondazione PTV, 00133 Rome, Italy
| | - Mariano Ferraresso
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Evaldo Favi
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-0255035603
| |
Collapse
|
5
|
Althaqeel MF, Alshanwani MN, Alqahtani K, Khan MS, Zeidan ZA, Mohaideen NK, Albahooth K, Altassan W, Alzoman ASA, Alkhaldi AS. The effect of disruption due to COVID-19 on operating room utilization: Experience from a secondary care hospital in Riyadh, Saudi Arabia. J Family Med Prim Care 2022; 11:5226-5230. [PMID: 36505539 PMCID: PMC9731053 DOI: 10.4103/jfmpc.jfmpc_1707_21] [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: 08/25/2021] [Revised: 12/08/2021] [Accepted: 02/20/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction/Background The disruption caused due to corona virus disease-2019 (Covid-19) has affected the overall health care delivery worldwide. The elective services were foremost to face the restrictions and closure, subsequently they were resumed only after adoption on newer protocols. Aims We aimed to estimate the effect of COVID-19 restrictions on operative room utilization. Methodology This is a retrospective descriptive study. The surgical volume indicators were calculated and a comparison was made between pre-COVID-19 (April-June 2019) and COVID-19 phase (April-June, 2020). Pre-operative covid assessment through the RT-PCR test among the cases waiting for elective surgeries. Results Overall surgical volume decreased by 53%, which included 87% decrease in elective procedures and 8% decrease in emergency procedures. The overall OR utilization reduced by 63%. Highest reduction in the surgical volume was noted in bariatric surgery (no surgeries conducted in the COVID-19 phase), ophthalmology (99% reduction), and Ear, Nose and Throat surgery (ENT) surgery (92% reduction). Six patients tested positive for pre-operative RT-PCR from the sample of 261 cases posted for elective surgery during resumption phase of elective services, thereby giving the positivity rate of about 2.2%. Conclusion We found a high level of reduction in the operating room utilization in a secondary care public sector hospital. The pre-operative assessment has enabled to find out the COVID-19 cases and hence preventing the unwanted spread of infection during the surgical procedures.
Collapse
Affiliation(s)
- Mamdouh F. Althaqeel
- Consultant Family and Community Medicine/General Hospital Director, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Mohammad N. Alshanwani
- Consultant Department of General Surgery, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Khalid Alqahtani
- Consultant Department of Pediatric Surgery, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Mohammad Shibly Khan
- Specialist Community Medicine, Data Warehouse Department, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia,Address for correspondence: Dr. Mohammad Shibly Khan, King Salman bin Abdulaziz Hospital, 6687, Aishah Bint Abibakr, Aluraija Alwusta, Riyadh 12769, Saudi Arabia. E-mail:
| | - Zeidan A. Zeidan
- Consultant Community Medicine, Infection Control Department, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Noorulzaman K. Mohaideen
- Public Health Specialist, Data warehouse Department, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Khalid Albahooth
- Consultant Department of General Surgery, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Walid Altassan
- Specialist Department of General Surgery, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Assem S. A. Alzoman
- Consultant Anesthesia, King Salman Hospital, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Abdulaziz S. Alkhaldi
- Specialist Department of General Surgery, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| |
Collapse
|
6
|
Yoon JS, Khoo KH, Akhavan AA, Lagziel T, Ha M, Cox CA, Blanding R, Werthman EH, Caffrey J, Hultman CS. Changes in Burn Surgery Operative Volume and Metrics due to COVID-19. J Burn Care Res 2022; 43:1233-1240. [PMID: 35986489 PMCID: PMC9384663 DOI: 10.1093/jbcr/irac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to COVID-19, hospitals underwent drastic changes to operating room policy to mitigate the spread of the disease. Given these unprecedented measures, we aimed to look at the changes in operative volume and metrics of the burn surgery service at our institution. A retrospective review was conducted for operative cases and metrics for the months of March to May for 2019, 2020, and 2021, which correspond with pre-COVID, early COVID (period without elective cases), and late COVID (period with resumed elective cases). Inclusion criteria were cases related to burns. Case types and operative metrics were compared amongst the three time periods. Compared to the hospital, the burn service had a smaller decrease in volume during early COVID (28.7% vs. 50.1%) and exceeded pre-pandemic volumes during late COVID (+21.8% vs. -4.6%). There was a significant increase in excision and grafting cases in early and late COVID periods (p < .0001 and p < .002). There was a significant decrease in laser scar procedures that persisted even during late COVID (p < .0001). The projected and actual lengths of cases significantly increased and persisted into late COVID (p < .01). COVID-19 related operating room closures led to an expected decrease in the number of operative cases. However, there was no significant decline in the number of burn specific cases. The elective cases were largely replaced with excision and grafting cases and this shift has persisted even after elective cases have resumed. This change is also reflected in increased operative times.
Collapse
Affiliation(s)
- Joshua S Yoon
- Division of Plastic, Reconstructive & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center , Baltimore, MD USA
- Department of Surgery, George Washington University Hospital , Washington, DC USA
| | - Kimberly H Khoo
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Arya A Akhavan
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Michael Ha
- Division of Plastic Surgery, University of Maryland School of Medicine , Baltimore, MD USA
| | - Carrie A Cox
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Renee Blanding
- Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Emily H Werthman
- Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing , Baltimore, MD USA
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| |
Collapse
|
7
|
Mohammed F, Mohaddis M, Cheruvu MS, Morris RM, Naim Z, Khan S, Mushtaq MB, Chandran P. Influence of COVID-19 Protocols on the Efficiency of Trauma Theater: Retrospective Observational Study. Interact J Med Res 2022; 11:e35805. [PMID: 35704770 PMCID: PMC9278405 DOI: 10.2196/35805] [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: 12/17/2021] [Revised: 02/09/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has influenced health care delivery significantly. Numerous studies have highlighted that trauma theater efficiency has decreased during the COVID-19 pandemic; however, there is limited information as to exactly which stage of the patient theater journey is causing this decreased efficiency and whether efficiency can be improved. In the trauma theater of Warrington Hospital, United Kingdom, we have attempted to maintain trauma theater efficiency despite the requirement for increased infection control. OBJECTIVE The aim of this study was to evaluate the effects of additional COVID-19 infection control protocols on trauma theater efficiency in our center, considering the length of time taken for specific theater events, and to find out whether our interventions were successful in maintaining theater efficiency. METHODS We compared the efficiency of the trauma theater in a busy unit in December 2019 (pre-COVID-19) and December 2020 (with COVID-19 protocols in place). We collected time logs for different theater events for each patient in December of both years and compared the data. RESULTS There was no significant difference in the average number of cases performed per session between the COVID-19 and pre-COVID-19 time periods (P=.17). Theater start time was significantly earlier during the COVID-19 period (P<.001). There was no significant difference between the two periods in transport time, check-in time, preprocedure time, anesthetic time, and the time between cases (P>.05). A significant difference was observed in the check-out time between the two groups in the two time periods, with checking out taking longer during the COVID-19 period (P<.001). CONCLUSIONS Our results show that our theater start times were earlier during the COVID-19 pandemic, and the overall theater efficiency was maintained despite the additional COVID-19 infection control protocols that were in place. These findings suggest that well-planned infection control protocols do not need to impede trauma theater efficiency in certain settings.
Collapse
Affiliation(s)
| | | | | | | | - Zahra Naim
- Shadan Institute of Medical Sciences, Hyderabad, India
| | | | | | | |
Collapse
|
8
|
Geldmaker LE, Hasse CH, Baird BA, Haehn DA, Anyane-Yeboah AN, Wieczorek MA, Ball CT, Dora CD, Lyon TD, Thiel DD. Impact of SARS-CoV-2 (COVID-19) on Fixed Operating Room Times in Urologic Surgeries. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2022; 6:373-380. [PMID: 35765690 PMCID: PMC9222149 DOI: 10.1016/j.mayocpiqo.2022.06.002] [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] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the impact of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, on operating room (OR) efficiency for urologic procedures using the concept of fixed OR times. Patients and Methods Over a 24-month period, urology OR data were prospectively collected. Operations were divided into fixed and variable time points. The fixed OR times were in-roomw to anesthesia-release time, anesthesia-release to cut time, in-room to cut time, and close to wheels-out time. Data from January 1, 2019, to December 31, 2019, were pre-COVID-19 data, and data from April 1, 2020, to December 31, 2020, were post-COVID-19 data. Operations were grouped into endoscopic, implant, major open, and robotic-assisted cases. In the post-COVID-19 era, all patients had a negative polymerase chain reaction test result within 48 hours of operation. The Wilcoxon rank sum test was used to compare the fixed OR times between the pre- and post-COVID-19 eras. Results A total of 3189 procedures were evaluated: 2058 endoscopic operations (1124 in the pre-COVID-19 era and 934 in the post-COVID-19 era), 343 implant procedures (192 in the pre-COVID-19 era and 151 in the post-COVID-19 era), 222 major open procedures (119 in the pre-COVID-19 era and 103 in the post-COVID-19 era), and 566 robotic-assisted procedures (338 in the pre-COVID-19 era and 228 in the post-COVID-19 era). There were no fixed OR times in any of the examined groups that were negatively impacted by COVID-19. The percentage of the total OR time occupied by fixed OR variables in the pre-COVID-19 era was 40.6% for endoscopic operations, 41.1% for implant procedures, 29.8% for major open procedures, and 21.8% for robotic-assisted procedures. Conclusion A substantial portion of the total OR time includes fixed time points. Furthermore, COVID-19 did not have a negative impact on fixed OR times in a negative testing environment. Urologic OR efficiency should be maintained in the post-COVID-19 era.
Collapse
Affiliation(s)
| | | | - Bryce A Baird
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Mikolaj A Wieczorek
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Colleen T Ball
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | | | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
9
|
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: 10] [Impact Index Per Article: 5.0] [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.
Collapse
|
10
|
Stress, anxiety, and burnout of orthopaedic surgeons in COVID-19 pandemic. INTERNATIONAL ORTHOPAEDICS 2022; 46:931-935. [PMID: 35384468 PMCID: PMC8984066 DOI: 10.1007/s00264-022-05393-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
McGinn C, Scott R, Ryan C, Donnelly N, Cullinan MF, Beckett M. Rapid disinfection of radiology treatment rooms using an autonomous ultraviolet germicidal irradiation robot. Am J Infect Control 2022; 50:947-953. [PMID: 35065149 DOI: 10.1016/j.ajic.2021.11.022] [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: 09/19/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Ultraviolet germicidal irradiation (UVGI) technologies have emerged as a promising adjunct to manual cleaning, however, their potential to shorten cleaning times remains unexplored. METHODS A <10-minute disinfection procedure was developed using a robotic UVGI platform. The efficacy and time to perform the UVGI procedure in a CT scan treatment room was compared with current protocols involving manual disinfection using biocides. For each intervention, environmental samples were taken at 12 locations in the room before and after disinfection on seven distinct occasions. RESULTS The mean UVC dose at each sample location was found to be 13.01 ± 4.36 mJ/cm2, which exceeded published UVC thresholds for achieving log reductions of many common pathogens. Significant reductions in microbial burden were measured after both UVGI (P≤.001) and manual cleaning (P≤.05) conditions, with the UVGI procedure revealing the largest effect size (r = 0.603). DISCUSSION These results support the hypothesis that automated deployments of UVGI technology can lead to germicidal performance that is comparable with, and potentially better than, current manual cleaning practices. CONCLUSIONS Our findings provide early evidence that the incorporation of automated UVGI procedures into cleaning workflow could reduce turnaround times in radiology, and potentially other hospital settings.
Collapse
|
12
|
Turnover Time Between Elective Operative Cases: Does the Witching Hour Exist for the Operating Room? World J Surg 2022; 46:2939-2945. [PMID: 36068405 PMCID: PMC9447947 DOI: 10.1007/s00268-022-06724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Efficient resource management in the operating room (OR) contributes significantly to healthcare expenditure and revenue generation for health systems. We aim to assess the influence that surgeon, anesthesiology, and nursing team assignments and time of day have on turnover time (TOT) in the OR. METHODS We performed a retrospective review of elective cases at a single academic hospital that were completed between Monday and Friday between the hours of 0700 and 2359 from July 1, 2017, through March 31, 2018. Emergent cases and unplanned, add-on cases were excluded. Data regarding patient characteristics, OR teams, TOT, and procedure start and end times were collected and analyzed. RESULTS A total of 2174 total cases across 13 different specialties were included in our study. A multivariate regression of relevant variables affecting TOT was performed. Consecutive specialty (p < 0.0001), consecutive surgeon (p < 0.0001), anesthesiologist (p < 0.0001), and prior case ending before 1400 (p < 0.0001) were independent predictors of lower TOT. A receiver operating characteristic analysis demonstrated an area under the curve of 0.848 and a cutoff of 1400 having the highest sensitivity and specificity for TOT difference. CONCLUSIONS TOT can be significantly affected by the time of the day the procedure is performed. Staffing availability during late procedures and the differences in how OR team staff are scheduled may affect OR efficiency. Additional studies may be needed to determine the long-term implications of changes implemented to decrease organizational operational costs related to the OR.
Collapse
|
13
|
Paediatric orthopaedic surgery during the SARS-CoV-2 pandemic. A safe and pragmatic approach to service provision. Surgeon 2021; 20:e338-e343. [PMID: 34600829 PMCID: PMC8418910 DOI: 10.1016/j.surge.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/11/2020] [Accepted: 08/19/2021] [Indexed: 11/23/2022]
Abstract
The SARS-COV-2 pandemic has brought unparalleled challenges to healthcare provision. Being a newly discovered virus, there is a lack of previous experience and published evidence to guide healthcare providers on how to deliver services. We would like to share our approach to service delivery in a newly open children's hospital in the United Arab Emirates with a particular focus on paediatric orthopaedic services.
Collapse
|
14
|
Golinelli D, Lenzi J, Adorno E, Gianino MM, Fantini MP. COVID-19 and regional differences in the timeliness of hip-fracture surgery: an interrupted time-series analysis. PeerJ 2021; 9:e12046. [PMID: 34540366 PMCID: PMC8415287 DOI: 10.7717/peerj.12046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It is of great importance to examine the impact of the healthcare reorganization adopted to confront the COVID-19 pandemic on the quality of care provided to non-COVID-19 patients. The aim of this study is to assess the impact of the COVID-19 national lockdown (March 9, 2020) on the quality of care provided to patients with hip fracture (HF) in Piedmont and Emilia-Romagna, two large regions of northern Italy severely hit by the pandemic. METHODS We calculated the percentage of HF patients undergoing surgery within 2 days of hospital admission. An interrupted time-series analysis was performed on weekly data from December 11, 2019 to June 9, 2020 (≈6 months), interrupting the series in the 2nd week of March. The same data observed the year before were included as a control time series with no "intervention" (lockdown) in the middle of the observation period. RESULTS Before the lockdown, 2-day surgery was 69.9% in Piedmont and 79.2% in Emilia-Romagna; after the lockdown, these proportions were equal to 69.8% (-0.1%) and 69.3% (-9.9%), respectively. While Piedmont did not experience any drop in the amount of surgery, Emilia-Romagna exhibited a significant decline at a weekly rate of -1.29% (95% CI [-1.71 to -0.88]). Divergent trend patterns in the two study regions reflect local differences in pandemic timing as well as in healthcare services capacity, management, and emergency preparedness.
Collapse
Affiliation(s)
- Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Emanuele Adorno
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
15
|
Iyengar KP, Khatir M, Mohamed MKA, Kariya AD, Jain VK, Sangani C, Adam RF, Suraliwala K. Characteristics and clinical outcomes of hip fracture patients during the first lockdown of COVID-19, lessons learnt: A retrospective cohort analysis. J Perioper Pract 2021; 31:446-453. [PMID: 34388942 DOI: 10.1177/17504589211026067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The management of hip fracture patients has been challenging across the UK in the wake of emergency coronavirus disease 2019 guidelines. AIMS This retrospective, observational cohort study analyses the impact of the first lockdown during the early part of the coronavirus disease 2019 pandemic on the management of hip fracture patients at a district general hospital in the UK. METHODS Comparative analysis to assess hip fracture patients treated at this Trust between 1 April to 31 May 2019 and 1 April to 31 May 2020 was undertaken. The primary outcome measures appraised were 30 and 60-day mortality and the secondary outcome measure included time to surgery. RESULTS There was a higher 30 and 60-day mortality rate in the first lockdown period at 8.1% and 13.5%, respectively, compared to 1.96% and 5.88% in 2019. A significantly lower proportion of hip fracture patients at 59.46% were operated within the 36h target time frame during the first lockdown. CONCLUSION In our Trust, hip fractures were treated as obligatory injuries. However, the mortality was higher in the 2020 cohort with a significant reduction in patients achieving the recommended '36 hours' time to surgery target and accruement of Best Practice Tariff. Enhanced infection control strategies have prepared us for the future.
Collapse
Affiliation(s)
| | | | | | | | - Vijay Kumar Jain
- Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Riad F Adam
- Southport and Ormskirk NHS Trust, Southport, UK
| | | |
Collapse
|
16
|
Zagra L, D'Apolito R, Guindani N, Zatti G, Rivera F, Ravasi F, Mosconi M, Momoli A, Massè A, Franceschini M, D'Angelo F, Dallari D, Catani F, Casiraghi A, Bove F, Castelli CC. Do standards of care and early outcomes of periprosthetic fractures change during the COVID-19 pandemic? A multicentre study. J Orthop Traumatol 2021; 22:22. [PMID: 34128114 PMCID: PMC8202961 DOI: 10.1186/s10195-021-00584-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. MATERIALS AND METHODS Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien-Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. RESULTS Median age was 81 years (range 70-96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1-4), median VAS score on admission was 3 (range, 0-6), median CFS was 4 (range, 1-8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1-5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1-5). The median LOS was 12.8 days (range 2-36 days), and 21 patients (55.3%) were discharged home. CONCLUSIONS The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Rocco D'Apolito
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy
| | - Nicola Guindani
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Giovanni Zatti
- Department of Orthopaedic Surgery ASST Di Monza, Università Milano Bicocca, Via Pergolesi 33, 20900, Monza, Italy
| | - Fabrizio Rivera
- Department of Orthopaedic Surgery, Ospedale SS Annunziata, Via Ospedali 14, 12038, Savigliano, Italy
| | - Flavio Ravasi
- Department of Orthopaedic Surgery, ASST Melegnano Martesana- Ospedale Di Vizzolo Predabissi, Via Pandina 1, 20077, Vizzolo Predabissi, Italy
| | - Mario Mosconi
- Department of Orthopaedic Surgery, IRCCS Policlinico San Matteo Di Pavia, Viale C. Golgi 19, 27100, Pavia, Italy
| | - Alberto Momoli
- Department of Orthopaedic Surgery, Ospedale San Bortolo, Viale F. Rodolfi 37, 36100, Vicenza, Italy
| | - Alessandro Massè
- Department of Orthopaedic Surgery, Ospedale Città Della Salute E Della Scienza Università Di Torino, Via G. Zuretti 29, 10126, Turin, 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
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Policlinico Universitario Di Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Alessandro Casiraghi
- Department of Orthopaedic Surgery, ASST Degli Spedali Civili Di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Federico Bove
- Department of Orthopaedic Surgery, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Claudio Carlo Castelli
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| |
Collapse
|
17
|
Patel BA, Green SF, Henessy C, Adamu-Biu F, Davda K, Chennagiri R, Kankate R, Ghani Y. Lessons Learnt from Managing Orthopaedic Trauma During the First Wave of the COVID-19 Pandemic at a UK District General Hospital. Indian J Orthop 2021; 55:1037-1045. [PMID: 34024932 PMCID: PMC8130789 DOI: 10.1007/s43465-021-00419-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/05/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Coronavirus disease (COVID-19) pandemic has contributed to over 1,000,000 deaths worldwide. Hospitals responded by expanding services to accommodate the forecasted rise in COVID-19-related admissions. We describe the effects these changes had on management of orthopaedic trauma and patient outcomes at a district general hospital in Southern England. METHODS Data were extrapolated retrospectively from two separate 6-week periods in 2019 and 2020 (1st April-13th May) using electronic records of patients referred to the orthopaedic team. Soft tissue injuries were included where a confirmed diagnosis was made with radiological evidence. Patients were excluded if no orthopaedic intervention was required. Data were compared between the two time periods. RESULTS There were fewer attendances to hospital in 2020 compared with 2019 (178 vs. 328), but time from presentation to surgery significantly increased in 2020 (2.94 days vs. 4.91 days, p = 0.009). There were fewer operative complications in 2020 (36/145 vs. 11/88, p < 0.001). However, ordinal logistic regression analysis found a significantly greater complication severity in 2020 including death (p = 0.039). Complication severity was unrelated to COVID-19 status. CONCLUSIONS Restructuring of orthopaedic services in response to the COVID-19 pandemic has been associated with significant delays to surgery and higher post-operative complication severity. Our results demonstrate the need for fast-track emergency operative orthopaedic services in UK district general hospitals whilst the COVID-19 pandemic continues.
Collapse
Affiliation(s)
- B. A. Patel
- grid.413032.70000 0000 9947 0731Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK ,grid.499457.20000 0004 4667 5409Health Education Thames Valley, Oxford School of Surgery, Oxford, OX4 2GX UK
| | - S. F. Green
- grid.413032.70000 0000 9947 0731Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK ,grid.416201.00000 0004 0417 1173Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - C. Henessy
- grid.413032.70000 0000 9947 0731Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK ,grid.4991.50000 0004 1936 8948Faculty of Health Sciences, St Catharine’s College, Oxford University, Oxford, OX1 3UJ UK
| | - F. Adamu-Biu
- grid.413032.70000 0000 9947 0731Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK ,grid.8348.70000 0001 2306 7492John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - K. Davda
- Department of Trauma and Orthopaedics, Buckinghamshire NHS Healthcare Trust, Amersham, HP21 8AL UK
| | - R. Chennagiri
- grid.413032.70000 0000 9947 0731Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK ,Department of Trauma and Orthopaedics, Buckinghamshire NHS Healthcare Trust, Amersham, HP21 8AL UK
| | - R. Kankate
- Department of Trauma and Orthopaedics, Buckinghamshire NHS Healthcare Trust, Amersham, HP21 8AL UK
| | - Y. Ghani
- grid.413032.70000 0000 9947 0731Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK ,Department of Trauma and Orthopaedics, Buckinghamshire NHS Healthcare Trust, Amersham, HP21 8AL UK
| |
Collapse
|
18
|
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.
Collapse
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.)
| |
Collapse
|
19
|
Zagra L, Faraldi M, Andreata M, Ottaiano I, Basile G, Lombardi G. A seven week observational analysis of clinical activities in a North Italian orthopaedic hospital during the second wave of SARS-CoV-2 pandemic: far from usual volumes, but different from the first wave. INTERNATIONAL ORTHOPAEDICS 2021; 45:2473-2482. [PMID: 33983467 PMCID: PMC8116436 DOI: 10.1007/s00264-021-05064-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
Purpose We previously described the radical changes occurred in an orthopaedic hospital in Milan (Italy) during the first SARS-CoV-2 pandemic outbreak. Currently, during the second wave, the situation is still far from normality. Here we describe the changes that took place, and are still ongoing, in the clinical practice. Methods Number and type of admissions, outpatients activity, ER and urgent procedures in SARS-CoV-2 negative and positive patients have been analyzed over seven weeks (October 26th–December 13th, 2020) and compared with the correspondent period in 2019 and the same timeframe during the first wave (February 24th–April 10th). Results 2019 vs. 2020: Overall admissions decreased by 39.8%; however, while admissions for elective surgery dropped by 42.0%, urgent surgeries increased by 117.0%. Rehabilitation admissions declined by 85.2%. White and green priority ER consultations declined by 41.6% and 52.0%, respectively; yellow and red increased by 766.7% and 400.0%, respectively. Second vs. first wave: Overall admissions increased by 58.6% with a smoother decrement in weekly admissions than during the first wave. Disparity of acute admissions vs. rehabilitation expanded: Acute cases increased by 63.6% while rehabilitation cases decreased by 8.7%. Admissions to triage procedures increased by 72.3%. Conclusions Activity levels are far from normality during the second COVID-19 wave. Elective surgery and outpatients-related activities are still strongly limited compared to 2019 while the number of urgent cases treated increased consistently. SARS-CoV-2 positive emergencies are slightly higher than during the first wave. These important changes are expected to impact on health service and hospital budget for long.
Collapse
Affiliation(s)
- Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Martina Faraldi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Mauro Andreata
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Giuseppe Basile
- ER Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, Poznań, Poland
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|