Effect of coronavirus (COVID-19) pandemic on orthopedic trauma patients presenting in the emergency department of a maximum care hospital and level 1 trauma center

Retrospective Analysis of Nosocomial SARS-CoV-2 Infections in Orthopedic and Traumatological Inpatients

SARS-CoV-2 has had a measurable impact on the field of orthopedic and traumatological surgery. To date, scarce data on intramural SARS-CoV-2 infections in orthopedic and traumatological patients have been reported. Therefore, the aim of our study was to investigate the effect of nosocomial SARS-CoV-2 infections in orthopedic and traumatological inpatients regarding symptoms of infection, mortality, duration of hospitalization, and other relevant patient-dependent factors. Patients admitted to hospital for an orthopedic or traumatological indication were screened retrospectively for nosocomial SARS-CoV-2 infections and included in this study. An age-, sex-, and ICD 10-matched control group was assigned and demographic data, clinical symptoms of a SARS-CoV-2 infection as well as mortality, length of hospital stays, time to surgery, pre-existing conditions, LKF-points representing the financial effort, and the Charlson Comorbidity Index were collected. A significantly higher length of stay was observed in the SARS-CoV-2 group (25 days; 4-60; SD 12.5) when compared to the control group (11 days; 2-36; SD 7; p < 0.05). LKF points were significantly higher in the SARS-CoV-2 group (13,939 points vs. 8542 points). No significant difference in mortality could be observed. An infection with SARS-CoV-2 in inpatients significantly increases length of hospital stay and cost of treatment. Although no significant difference in mortality was found, care should be taken to avoid intramural SARS-CoV-2 infections, resulting in prolonged hospitalization, higher costs, and potentially further individual risks.

Does the COVID-19 personal protective equipment impair the surgeon's performance?

INTRODUCTION

Despite increasing vaccination rates, new viral variants of SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2) are advancing the COVID 19 (coronavirus disease 2019) pandemic and continue to challenge the entire world. Surgical care of SARS-CoV-2 positive patients requires special protective measures. We hypothesized that "COVID-19" personal protective equipment (PPE) during surgery of SARS-CoV-2 positive or potentially positive patients would negatively affect the surgeon and thus the surgical outcome.

MATERIALS AND METHODS

Ten experienced trauma surgeons participated in the study. Each surgeon performed two simulated surgeries of a distal tibial fracture on a Sawbone® under standardized conditions either wearing regular PPE or special COVID-19 PPE. Baseline values at rest were acquired for heart rate, blood pressure, saturation of peripheral oxygen (SpO₂), respiratory rate and capillary blood gas (CBG) analysis including capillary partial pressure of oxygen (pO₂) and carbon dioxide (pCO₂), followed by four different standardized tests of attentional performance (TAP). Subsequently, the surgeon performed the first surgery according to a randomly determined order, with regular or COVID-19 PPE conditions in an operation theatre. After each surgery vital signs were acquired and CBG and TAP were performed again.

RESULTS

In our simulated surgical procedure heart rate, respiratory rate, systolic and diastolic blood pressure did not show relevant differences. Percutaneously measured SpO₂ decreased with additional layers of PPE, while CBG parameters were not affected. TAP tests showed a significant impairment of attention if PPEs were compared to the baseline, but both PPEs had similar results and no meaningful differences could be measured.

CONCLUSIONS

According to our results, for surgical procedures additional PPE required during COVID-19 pandemic does not relevant affect the surgeon's mental and physical performance. Surgeries under COVID-19 PPE conditions appear safe and do not increase patient risk.

LEVEL OF EVIDENCE

Level I.

COVID-19 disruptions to elective postoperative care did not adversely affect early complications or patient reported outcomes of primary TKA

INTRODUCTION

Elective orthopedic care, including in-person office visits and physical therapy (PT), was halted on March 16, 2020, at a large, urban hospital at the onset of the local COVID-19 surge. Post-discharge care was provided predominantly through a virtual format. The purpose of this study was to assess the impact of postoperative care disruptions on early total knee arthroplasty (TKA) outcomes, specifically 90-day complications, 120-day rate of manipulation under anesthesia (MUA) and 1-year patient-reported outcome measures (PROMs).

MATERIALS AND METHODS

Institutional records were queried to identify 624 patients who underwent primary, unilateral TKA for osteoarthritis and who were discharged home between 1/1/20 and 3/15/20. These patients were compared to 558 controls discharged between 1/1/19 and 3/15/2019. Cohort demographics and in-hospital characteristics were equivalent apart from inpatient morphine milligram equivalent (MME) consumption. Patient-reported access to PT (p < 0.001) and post-discharge care (p < 0.001) were worse among study patients. Study patients were prescribed fewer post-discharge PT sessions (19.8 vs. 23.5; p < 0.001) and utilized telehealth more frequently (p < 0.001). Mann-Whitney U, T, Fisher's Exact, and chi-squared tests were used to compare outcomes.

RESULTS

Ninety-day CMS complications were lower among study patients (3.5% vs. 5.9%; p = 0.05). Rates of MUA were similar between groups. Study patients reported similar PROMs and marginally inferior VR-12 mental and LEAS functional outcomes at 1 year.

CONCLUSION

Disruptions to elective orthopedic care in March 2020 seemed to have had no major consequences on clinical outcomes for TKA patients. Our findings question the usefulness of pre-pandemic post-discharge protocols, which may over-emphasize in-person visits and PT.

Impact of the First and Second Wave of the SARS-CoV-2 Pandemic on Severe Trauma and the Care Structures in the German TraumaNetzwerk DGU®

(1) Background: The aim of this study was to investigate the effects of the pandemic on transfer rates of severely injured patients within the German TraumaNetzwerk of the DGU. Furthermore, cause of accident, rescue times, and trauma cases are compared to pre-pandemic times. (2) Methods: For this investigation patients documented in the TraumaRegister DGU^® from 2018 to 2020 were analyzed. The years 2018 and 2019 served as a comparison to 2020, the first COVID-19 pandemic year. All primary admissions and transfers were included if treated on an intensive care unit. (3) Results: Demographics (age, sex) and injury severity in 2020 were comparable with 2018/2019. In 2020, a significant decrease (3.7%) in car accidents was found. In contrast, a significant increase (3.2%) in bicycle accidents was seen. During the second wave, there was a significant burden of COVID-19 patients on hospitals. In this time, we found a significant increase in early transfers of trauma patients primarily from small level 3 to large level 1 centers. There was also a small but significant increase in rescue time, especially during the 2nd wave. (4) Conclusions: Our data confirm the importance of the network structures established in the TraumaNetzwerk DGU^®, especially during the pandemic. The established structures allow smaller hospitals to spread their resources and prevent internal collapse. Therefore, the structures of the TraumaNetzwerk DGU^® play a prominent role in stabilizing the healthcare system by helping to maintain both surgical and critical care capacity and providing adequate emergency care.