Does elective orthopaedic surgery in pandemic era increase risk of developing COVID-19? A combined analysis of retrospective and prospective study at Cipto Mangunkusumo Hospital, Jakarta, Indonesia

The Effect of the COVID-19 Pandemic on Patient Selection, Surgical Procedures, and Postoperative Complications in a Specialized Dental Implant Clinic

During the coronavirus disease 2019 (COVID-19) pandemic, aerosol-generating procedures, including dental implant treatments, are considered high-risk. With dental implant treatment mostly an elective procedure, we aimed to assess whether the pandemic influenced patient selection, surgical procedures, and postoperative complications. We compared dental implant treatments during (March to December 2020) and before (December 2018 to February 2020) the COVID-19 pandemic based on patient and implant parameters, as well as postoperative complications. For analysis, we used the Chi-squared test with the Holm–Sidak correction for multiple comparisons. The number of implants placed during the COVID-19 pandemic (696 implants in 406 patients, 70 implants per month) was comparable to pre-pandemic levels (1204 implants in 616 patients, 80 implants per month). Regarding patient parameters, there were no significant differences in respiratory (p = 0.69) and cardiovascular conditions (p = 0.06), diabetes (p = 0.69), and smoking (p = 0.68). Regarding implant parameters, there was a significant difference in the distribution of augmentative procedures (no augmentation, guided bone regeneration, and sinus floor elevation, p = 0.01), but no significant differences in the types of edentulous spaces (p = 0.19) and the timing of implant placement (p = 0.52). Regarding complications, there were significantly fewer minor complications (p < 0.001) and early (i.e., before loading) implant failures (p = 0.02) compared with pre-pandemic levels. Our results suggest that the COVID-19 pandemic had no effect on patient selection and only a slight effect on the surgical procedures. However, postoperative complications, including early failures, were significantly less prevalent during the pandemic.

Evaluation of the COVID-19 Infection Rate in the Perioperative Period of Elective Surgeries of the Hand and Microsurgery

BACKGROUND

After the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (coronavirus disease 2019 [COVID-19]), the world started reducing the number of elective surgeries to reduce the transmission of the coronavirus. Some priority elective surgeries were performed, and there was no increase in contagion rates due to safety protocols and protection measures. The study aims to present the coronavirus infection rate of elective hand surgeries and microsurgery performed during pandemics.

METHODS

A retrospective study evaluating 188 patients submitted to elective surgical procedures. The exclusion criteria were patients infected by COVID-19 before the surgery and patients who submitted to trauma surgery. Only 108 patients were eligible for this study. The mean age was 47.8 years (range: 15 days-81 years). There were 63 females and 45 males. They were divided into 2 groups: outpatient (n = 49) and inpatient (n = 59) procedures.

RESULTS

The overall COVID infection rate was 6.48%. The outpatient infection rate was 2.08%, whereas the inpatient infection rate was 10.17% (Student t test: P = .089). The main factor correlated with infection in the postoperative period was the number of postoperative outpatient visits (Student t test: P = .089). No statistical differences were observed between the variables studied, but there was a tendency for patients who submitted to inpatient surgery to get infected by COVID-19 (P = .089). The statistical power was 0.8 (Cohen's d test), showing that large samples are needed to analyze the correlation better.

CONCLUSION

We concluded that the safety of performing elective hand surgery during the pandemic remains unclear, and more studies with larger samples are needed.

Implementation of Clean Hospital Strategy and Prioritizing Covid-19 Prevention Factors Using Best-Worst Method

Many nations have suffered the catastrophe of COVID-19, and one of the first countries affected by the pandemic was Iran; all industries and individuals have been adversely affected by the pandemic. Health care systems and patients' conditions, in particular, were disrupted due to canceling elective surgery. To put it more sharply, a delay in performing elective surgery may potentially impact patients' survival and the quality of their lives. To cope with the new situation, in the first stage, the Clean Hospital strategy was proposed in order to minimize the effects of this pandemic on elective surgical services. The mentioned strategy is a try to provide a solution and resume elective surgeries in the pandemic period. In the second stage, panel discussion, Delphi method, and the best-worst method (BWM) were employed to prioritize the factors that inhibit Coronavirus transmission. The proposed strategy and the results of this study could be used by policymakers and health departments to resume elective surgeries and control the infection to maintain a hospital or a section of it clear. The overall result of the study showed that the most important Covid-19 prevention factors in Clean Hospitals were personal protection (w = 0.212), screening checklist (w = 0.182), and check body temperature (w = 0.126), respectively (C1 > C2 > C3). According to the financial, time, and human resource limitations, first, resources were allocated to higher priority criteria, and in order of priority, all items (C1, C2, …., C9) were used in the Clean hospital strategy.

A One-year COVID-19 Pandemic Effect on the Orthopaedic Field in Indonesia: A Cross-sectional Multi-center Study

BACKGROUND: The World Health Organization announced the COVID-19 outbreak as a global pandemic on March 11, 2020. Despite the fact that orthopedists are not considered front-line staff in the fight against the pandemic, the pandemic has had an enormous impact on orthopedics daily practice. A few studies have looked at the pandemic effect on the orthopedics field, but none have looked at the impact of a 1-year pandemic, especially in Indonesia. MATERIALS AND METHODS: This cross-sectional multi-center study was conducted at seven tertiary referral hospitals in Indonesia. Through hospital medical records, data were collected for a year, starting from the month the Indonesian government announced the first case of COVID-19 (March 2020–February 2021) and compared to data from the year before COVID-19 as a control (March 2019–February 2020). In addition, the researchers analyzed the number of patients in the emergency room (ER), outpatient clinic, inpatient, and operating room. RESULTS: Overall, the number of orthopedic patients in the ER declined by 44% from 11.053 to 6.139 patients during the 1st year of the pandemic, with 28 patients reported as getting COVID-19. The outpatient clinic decreased by 34%, from 10.9780 to 72.200 patients, with two confirmed cases. Furthermore, the inpatient unit decreased from 15.365 to 9.526 patients, a 38% decrease, with the highest recorded case confirmed at 78 patients. The last, with 73 confirmed, showed a 27% reduction in OR from 12.954 to 9.431 patients. CONCLUSION: In this study, analysis on the effect of the COVID-19 pandemic on the field of orthopedics in seven tertiary referral hospitals in Indonesia shows a significant decrease almost in all units. LEVEL EVIDENCE: III, Cross-sectional multi-center study.

Surgery Department during Coronavirus Disease 2019 Virus Universitas Sebelas Maret to Sebelas Maret University

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has severely affected the provision of health-care services in hospitals around the world, including bringing challenges to those who perform surgical procedures. Multidepartment data analysis will reflect the pandemic’s impact and challenges in managing surgical cases in various surgery departments. AIM: This study aims to assess the impact of COVID-19 lockdowns on surgical cases carried out in eight tertiary care center surgery departments. METHODS: Retrospective data from all patients in the eight surgery departments of Dr. Moewardi General Hospital, Surakarta, during the lockdown period due to COVID-19 were collected and compared to the period before the lockdown. Then, the data were analyzed regarding the effects of following the standard operating procedure for surgical services in the hospital during the lockdown period. RESULTS: All the surgery departments involved in the study showed a significant reduction in the number of patients treated during the lockdown period than before the lockdown, with a total number of cases across all departments of 2432, a decrease from 4503 before the lockdown. In surgical patient care, several special measures during the COVID-19 pandemic were carried out in outpatient, intraoperative, and inpatient services to reduce the virus spread to patients and health workers. CONCLUSION: The COVID-19 pandemic has severely affected the provision of health services in hospitals with a reduction in the number and types of patients in each surgery department, and the obligation to follow hospital protocols against COVID-19 has resulted in various treatments and services being delayed in all surgery departments.