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Axenhus M, Schedin-Weiss S, Tjernberg L, Winblad B. The impact of the COVID-19 pandemic on neurosurgery in the elderly population in Sweden. BMC Public Health 2024; 24:823. [PMID: 38491396 PMCID: PMC10941451 DOI: 10.1186/s12889-024-18332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic prompted a refocus of health care resources to acute care which has impacted on the capacity of healthcare systems to conduct neurological surgeries. The elderly population has been shown to be particularly vulnerable to the consequences of the pandemic. Less neurosurgery can result in great impact on public health by increasing morbidity and mortality in patients with malignancies and traumatic injuries. The aim of this study was to investigate the effects of the COVID-19 pandemic on neurosurgical procedures in the elderly population in Sweden. METHODS In this retrospective observational study, the reported incidence of all neurosurgical procedures registered in the 21 Regions of Sweden during 2015-2021 in people aged 65 year or older was collected. Surgical procedures were classified according to the NOMESCO system of classification. Neurosurgery incidence was defined as the number of NOMESCO associated interventions per 100.000 inhabitants. ICD-10 codes associated with neurosurgery-related diagnoses and deaths were also collected. Expected incidence of neurosurgery, neurosurgery-associated deaths and brain cancer diagnoses was estimated and compared to actual outcomes. Decrease in the incidence of neurosurgery was compared to regional COVID-19 incidence, other types of surgery and surgery waiting times. RESULTS The incidence of several categories of neurosurgery decreased in Sweden during 2020 and 2021, although not as much as other surgical categories. Women were more affected than men by the decrease in neurosurgery which could be partly explained by a decrease in brain cancer diagnoses amongst women. There was an association between regional decrease in neurosurgery incidence and longer surgery waiting time. COVID-19 incidence in the region did not have an effect on regional decreases in neurosurgery incidence. CONCLUSIONS The COVID-19 pandemic resulted in a reduction in the number of neurosurgical procedures performed in Sweden during 2020-2021, although not as much as in other European countries. There was regional difference in Sweden with respect to number of surgeries, and waiting time for elective surgeries although there was no increase in mortality.
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Affiliation(s)
- Michael Axenhus
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Sophia Schedin-Weiss
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lars Tjernberg
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University hospital, Huddinge, Sweden
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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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Solé Florensa P, González Sanchez J, Gil Torrano A, Peroy Garcia J, Jové Talavera R, Mas Atance J. [Translated article] Impact of COVID-19 pandemia on spine surgery in 2nd level hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T255-T262. [PMID: 36863518 PMCID: PMC9974204 DOI: 10.1016/j.recot.2023.02.020] [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: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. OBJECTIVES The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. METHODS We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. RESULTS We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. CONCLUSION The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.
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Affiliation(s)
- P Solé Florensa
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
| | - J González Sanchez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - A Gil Torrano
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Peroy Garcia
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - R Jové Talavera
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Mas Atance
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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Park HJ, Chang MJ, Kim TW, Chang CB, Kang SB. Differences in Resumption of Orthopedic Surgery According to Characteristics of Surgery during COVID-19 Pandemic: National Registry Data. Clin Orthop Surg 2023; 15:327-337. [PMID: 37008965 PMCID: PMC10060775 DOI: 10.4055/cios22177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 04/04/2023] Open
Abstract
Background Healthcare services have been restricted after the coronavirus disease 2019 (COVID-19) outbreak. With the pandemic still ongoing, the patterns of orthopedic surgery might have changed. The purpose of this study was to determine whether the reduced volumes of orthopedic surgery were recovered over time. Among the trauma and elective surgery, which accounted for most orthopedic surgical procedures, we also sought to elucidate whether the changes in the volumes of orthopedic surgery differed according to the type of surgery. Methods The volumes of orthopedic surgery were analyzed using the Health Insurance Review and Assessment Service of Korea databases. The surgical procedure codes were categorized depending on the characteristics of the procedures. The actual volumes of surgery were compared with the expected volumes to elucidate the effect of COVID-19 on surgical volumes. The expected volumes of surgery were estimated using Poisson regression models. Results The reducing effect of COVID-19 on the volumes of orthopedic surgery weakened as COVID-19 continued. Although the total volumes of orthopedic surgery decreased by 8.5%-10.1% in the first wave, those recovered to a 2.2%-2.8% decrease from the expected volumes during the second and third waves. Among the trauma and elective surgery, open reduction and internal fixation and cruciate ligament reconstruction decreased as COVID-19 continued, while total knee arthroplasty recovered. However, the volumes of hemiarthroplasty of the hip did not decrease through the year. Conclusions The number of orthopedic surgeries, which had decreased due to COVID-19, tended to recover over time, although the pandemic was still ongoing. However, the degree of resumption differed according to the characteristics of surgery. The findings of our study will be helpful to estimate the burden of orthopedic surgery in the era of persistent COVID-19.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Application of Virtual Reality Systems in Bone Trauma Procedures. Medicina (B Aires) 2023; 59:medicina59030562. [PMID: 36984563 PMCID: PMC10058640 DOI: 10.3390/medicina59030562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Background and Objectives: Bone fractures contribute significantly to the global disease and disability burden and are associated with a high and escalating incidence and tremendous economic consequences. The increasingly challenging climate of orthopaedic training and practice re-echoes the established potential of leveraging computer-based reality technologies to support patient-specific simulations for procedural teaching and surgical precision. Unfortunately, despite the recognised potential of virtual reality technologies in orthopaedic surgery, its adoption and integration, particularly in fracture procedures, have lagged behind other surgical specialities. We aimed to review the available virtual reality systems adapted for orthopaedic trauma procedures. Materials and Methods: We performed an extensive literature search in Medline (PubMed), Science Direct, SpringerLink, and Google Scholar and presented a narrative synthesis of the state of the art on virtual reality systems for bone trauma procedures. Results: We categorised existing simulation modalities into those for fracture fixation techniques, drilling procedures, and prosthetic design and implantation and described the important technical features, as well as their clinical validity and applications. Conclusions: Over the past decade, an increasing number of high- and low-fidelity virtual reality systems for bone trauma procedures have been introduced, demonstrating important benefits with regard to improving procedural teaching and learning, preoperative planning and rehearsal, intraoperative precision and efficiency, and postoperative outcomes. However, further technical developments in line with industry benchmarks and metrics are needed in addition to more standardised and rigorous clinical validation.
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An Investigation for Future Practice of Elective Hip and Knee Arthroplasties during COVID-19 in Romania. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020314. [PMID: 36837514 PMCID: PMC9961101 DOI: 10.3390/medicina59020314] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
Background and Objectives: Elective arthroplasty in Romania has been severely affected by the COVID-19 pandemic, and its effects are not quantified so far. The aim of this paper is to determine the impact of COVID-19 on arthroplasty interventions and how they varied in Romania. Materials and Methods: We performed a national retrospective analysis of patients who underwent primary and revision elective hip and knee interventions at the 120 orthopedic-traumatology hospitals in Romania that are registered in the National Endoprosthesis Registry from 1 January 2019 to 1 September 2022. First, we examined the monthly trend in the number of surgeries for seven categories of arthroplasties. We calculated the percentage change in the average number of cases per month and compared them with other types of interventions. We then examined the percentage change in the average monthly number of arthroplasty cases, relative to the number of COVID-19 cases reported nationwide, the influence of the pandemic on length of hospital stay, and the percentage of patients discharged at home who no longer follow recovery protocols. Finally, we calculated the impact of the pandemic on hospital revenues. Results: There was an abrupt decrease in the volume of primary interventions in hip and knee patients by up to 69.14% with a low degree of patient care, while the average duration of scheduled hospitalizations increased. We found a 1-2-day decrease in length of hospital stays for explored arthroplasties. We saw an increasing trend of home discharge, which was higher for primary interventions compared to revision interventions. The total hospital revenues were 50.96% lower in 2020 compared to 2019, and are currently increasing, with the 2022 estimate being 81.46%. Conclusions: The conclusion of this study is that the COVID-19 pandemic severely affected the volume of arthroplasty of the 120 hospitals in Romania, which also had unfavorable financial implications. We proposed the development of new procedures and alternative clinical solutions, as well as personalized home recovery programs, to be activated if necessary, for possible future outbreaks.
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Kalogeropoulos A, Savvidou OD, Bissias C, Sarafis P, Savvidis M, Tanos A, Pikoulis E, Papagelopoulos PJ, Exadaktylos A, Eggli S. Milder impact of the COVID-19 pandemic on the practice of orthopaedic surgery in Greece and Cyprus than other European countries. Knee Surg Sports Traumatol Arthrosc 2023; 31:110-120. [PMID: 36114340 PMCID: PMC9483367 DOI: 10.1007/s00167-022-07159-0] [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: 03/22/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this study was to highlight the impact of the COVID-19 pandemic on the practice of orthopaedics in Greece and Cyprus. METHODS The survey used the online questionnaire from AGA (Gesellschaft für Arthroskopie und Gelenkchirurgie; Society for Arthroscopy and Joint Surgery) to facilitate the comparison between different European countries. The questionnaire was distributed online to members of the HAOST (Hellenic Association of Orthopaedic Surgery and Trauma), the ΟΤΑΜΑΤ (Orthopaedic and Trauma Association of Macedonia and Thrace) and the CAOST (Cypriot Association of Orthopaedic Surgery and Trauma). The questionnaire consisted of 29 questions, which included demographic data, questions on the impact of the pandemic on the practice of orthopaedic surgery and questions on the impact on the personal and family life of orthopaedic surgeons. RESULTS The questionnaire was sent to 1350 orthopaedic surgeons in Greece and Cyprus, 303 of whom responded (response rate 22.44%). 11.2% of the participants reported cancellation of overall orthopaedic procedures. According to 35.6-49.8% of the participants, arthroscopic procedures were continued. As regards elective primary arthroplasties, 35.3% of the participants reported that these continued to be performed at their hospitals. Post-operative follow-ups as well as physiotherapy were affected by the pandemic, and changes were also observed in the habits of orthopaedic surgeons in their personal and family lives. CONCLUSION The orthopaedic service in Greece and Cyprus decreased during the first wave of the COVID-19 pandemic. Arthroscopic procedures and total joint replacements decreased significantly, but not to the same extent as in other countries. Health systems were not fully prepared for the first wave of the pandemic and the various countries took social measures at different times and to different extents. Thus, studying the impact of the pandemic on the practice of orthopaedic surgery in different countries can help health systems to better prepare for future pandemics; public health can then be shielded and hospitals can continue to provide high-quality orthopaedic care. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
| | - Olga D. Savvidou
- 1st Department of Orthopedic Surgery, National and Kapodistrian University of Athens, ATTIKON” University General Hospital, Athens, Greece
| | | | - Pavlos Sarafis
- Department of Nursing, University of Thessaly, Volos, Greece
| | | | | | - Emmanouil Pikoulis
- 3rd Department of General Surgery, National and Kapodistrian University of Athens, ATTIKON” University General Hospital, Athens, Greece
| | - Panayiotis J. Papagelopoulos
- 1st Department of Orthopedic Surgery, National and Kapodistrian University of Athens, ATTIKON” University General Hospital, Athens, Greece
| | | | - Stefan Eggli
- Orthopädie Und Traumatologie, Sonnenhofspital, Buchserstrasse 30, 3006 Bern, Switzerland
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Solé Florensa P, González Sanchez J, Gil Torrano A, Peroy Garcia J, Jové Talavera R, Mas Atance J. Impact of COVID-19 pandemia on spine surgery in 2nd level hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022:S1888-4415(22)00348-4. [PMID: 36494012 PMCID: PMC9724500 DOI: 10.1016/j.recot.2022.11.007] [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] [Received: 10/10/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. OBJECTIVES The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. METHODS We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. RESULTS We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. CONCLUSION The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.
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Muacevic A, Adler JR. What Does Postponement of Non-urgent Orthopedic Surgeries During the COVID-19 Pandemic Mean for Patients With Gonarthrosis in Turkey? A Qualitative Study. Cureus 2022; 14:e32448. [PMID: 36644090 PMCID: PMC9833837 DOI: 10.7759/cureus.32448] [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: 12/10/2022] [Indexed: 12/14/2022] Open
Abstract
Objective During the COVID-19 pandemic, the surgical treatment of orthopedic diseases for elective surgical planning was suspended. This study aimed to evaluate patients' experiences with gonarthrosis regarding the postponement of non-urgent orthopedic surgeries during the COVID-19 pandemic. Materials and Methods This phenomenological qualitative study was carried out with patients diagnosed with grade 3 or 4 gonarthrosis in the orthopedics and traumatology outpatient clinic of a hospital in western Turkey between February 2021 and March 2021. Interviews with patients were conducted face-to-face using the semi-structured interview guide focusing on patients' feelings, thoughts, and experiences. Each participant was interviewed once. Data collection was halted based on the saturation of data. Data from semi-structured interviews with patients were analyzed using Colaizzi's content analysis method. Results The analysis of the study data yielded three themes: "lack of knowledge", "desperation" and "lack of opportunity to cure the gonarthrosis disease". Four sub-themes were identified under these three categories. While "not knowing what to do" and "unconscious drug use" were the sub-themes of the theme of lack of knowledge, "hopelessness" and "economic difficulties" were the sub-themes of the theme of desperation. Conclusion It was determined that patients were helpless due to difficulties accessing health services for other diseases during the COVID-19 pandemic. They experienced severe fear because it was unclear how long this process would continue.
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DÖNMEZ M, ERKESKİN ZÖ, AKIN T, ÇETİNKAYA E, AKGÜL Ö, AKGÜN AE, BERKEM H, YÜKSEL BC, ER S. Acute cholecystitis during the COVID-19 pandemic: is percutaneous cholecystostomy a good alternative for treatment? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1164599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aim: To evaluate the efficacy, safety, and results of percutaneous cholecystostomy in patients with acute cholecystitis diagnosed with COVID-19.
Material and Method: The demographic characteristics, comorbidities, and acute cholecystitis grading of patients according to the Tokyo guideline 2018 (TG18) were evaluated. Mortality, laboratory parameters, radiological findings, physical status scores according to the American Society of Anesthesiologists (ASA) assessment, and the Charlson Comorbidity Index (CCI) were retrospectively evaluated in a total of 38 patients who underwent percutaneous cholecystostomy.
Results: The mean age of the 38 patients was 75±9 years, and 21 (55.3%) were female and 17 (44.7%) were male. According to TG18, 33 (86.8%) of the patients had grade II and five (13.2%) had grade III cholecystitis, while there was no grade I case. The mean CCI of the patients was 7.32±2.1. The ASA scores were mostly IIIE, followed by IIE. The COVID-19 test was positive in 33 (86.8%) of the patients. Mortality developed in four (10.5%) patients during hospitalization.
Conclusion: Percutaneous cholecystostomy can be considered as a safe, effective, and alternative method in the treatment of patients with acute cholecystitis.
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Affiliation(s)
- Mustafa DÖNMEZ
- Ankara Yildirim Beyazit University, Faculty of Medicine, General Surgery Department
| | | | - Tezcan AKIN
- Ankara Şehir Hastanesi, Genel Cerrahi Kliniği
| | | | - Özgür AKGÜL
- Ankara Şehir Hastanesi, Genel Cerrahi Kliniği
| | | | | | | | - Sadettin ER
- Ankara Şehir Hastanesi, Genel Cerrahi Kliniği
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Malhotra K, Mangwani J, Houchen-Wollof L, Mason LW. Rate of COVID-19 infection and 30 day mortality between blue and green (dedicated COVID-19 safe) pathways: Results from phase 1 and 2 of the UK foot and ankle COVID-19 national (UK-FAlCoN) audit. Foot Ankle Surg 2022; 28:1055-1063. [PMID: PMID: 35256273 PMCID: PMC8872704 DOI: 10.1016/j.fas.2022.02.017] [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: 09/26/2021] [Revised: 01/05/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The primary aim was to determine the differences in COVID-19 infection rate and 30-day mortality in patients undergoing foot and ankle surgery between different treatment pathways over the two phases of the UK-FALCON audit, spanning the first and second UK national lockdowns. SETTING This was an ambispective (retrospective Phase 1 and prospective Phase 2) national audit of foot and ankle procedures in the UK in 2020 completed between 13th January 2020 and 30th November 2020. PARTICIPANTS All adult patients undergoing foot and ankle surgery in an operating theatre during the study period were included from 46 participating centres in England, Scotland, Wales and Northern Ireland. Patients were categorised as either a green pathway (designated COVID-19 free) or blue pathway (no protocols to prevent COVID-19 infection). RESULTS 10,846 patients were included, 6644 from phase 1 and 4202 from phase 2. Over the 2 phases the infection rate on a blue pathway was 1.07% (69/6470) and 0.21% on a green pathway (9/4280). In phase 1, there was no significant difference in the COVID-19 perioperative infection rate between the blue and green pathways in any element of the first phase (pre-lockdown (p = .109), lockdown (p = .923) or post-lockdown (p = .577)). However, in phase 2 there was a significant reduction in perioperative infection rate when using the green pathway in both the pre-lockdown (p < .001) and lockdown periods (Odd's Ratio 0.077, p < .001). There was no significant difference in COVID-19 related mortality between pathways. CONCLUSIONS There was a five-fold reduction in the perioperative COVID-19 infection rate when using designated COVID-19 green pathways over the whole study period; however the success of the pathways only became significant in phase 2 of the study, where there was a 13-fold reduction in infection rate. The study shows a developing success to using green pathways in reducing the risk to patients undergoing foot and ankle surgery.
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Affiliation(s)
- Karan Malhotra
- Trauma and Orthopaedic Consultant, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - Jitendra Mangwani
- Trauma and Orthopaedic Consultant, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK
| | - Linzy Houchen-Wollof
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK
| | - Lyndon W. Mason
- Trauma and Orthopaedic Consultant, Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK,Correspondence to: Trauma and Orthopaedic Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK
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de Souza Maciel Ferreira JE, Rocha de Oliveira L, Galvão Pereira K, Marques Frota N, Frota Cavalcante T, Santos Monte A, Lopes Chaves AF. Estratégias organizacionais no centro cirúrgico diante da pandemia de COVID 19: uma revisão integrativa. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introdução: os sistemas de saúde foram desafiados a desenvolver estratégias organizacionais para a prestação de cuidados cirúrgicos. Objetivo: apresentar as estratégias dos serviços de saúde no que se refere às práticas de cuidados cirúrgicos em tempos de pandemia de COVID-19. Materiais e métodos: revisão integrativa, desenvolvida em seis etapas, cuja busca dos artigos ocorreu na Biblioteca Virtual de Saúde, SciELO, PubMed e ScienceDirect. Os descritores controlados em saúde adotados foram “Centros Cirúrgicos” e “Infecções por Coronavírus”, de acordo com os sistemas DeCS e MeSH Terms. Foram selecionados 60 artigos de 405 estudos encontrados. Resultados: as principais estratégias utilizadas pelos serviços de saúde foram: a suspensão e adiamento de cirurgias eletivas durante as ondas de contágio da doença; e a triagem cuidadosa dos pacientes para COVID-19 antes e após intervenções cirúrgicas. Discussão: a suspensão e o adiamento de cirurgias eletivas devem ser avaliados com cautela pela equipe de saúde, de forma individualizada, para cada paciente, visto que situações clínicas não urgentes podem agravar ao longo do tempo, aumentando as chances de morbimortalidade desses pacientes. Conclusão: a triagem dos pacientes e dos profissionais da saúde para COVID-19 são estratégias importantes para evitar a contaminação desses sujeitos. A suspensão e o adiamento de cirurgias eletivas, durante as ondas de contágio por COVID-19, são recomendados para aumentar a capacidade de leitos disponíveis para pacientes graves hospitalizados por essa doença. Essa recomendação também auxilia no remanejamento de profissionais desse setor para as unidades com a demanda de cuidados de saúde mais elevada.
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13
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Dijkstra S, Otten M, Leeftink G, Kamphorst B, Olde Meierink A, Heinen A, Bijlsma R, Boucherie RJ. Limited waiting areas in outpatient clinics: an intervention to incorporate the effect of bridging times in blueprint schedules. BMJ Open Qual 2022; 11:bmjoq-2021-001703. [PMID: 35728864 PMCID: PMC9214409 DOI: 10.1136/bmjoq-2021-001703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Distancing measures enforced by the COVID-19 pandemic impose a restriction on the number of patients simultaneously present in hospital waiting areas. Objective Evaluate waiting area occupancy of an intervention that designs clinic blueprint schedules, in which all appointments of the pre-COVID-19 case mix are scheduled either digitally or in person under COVID-19 distancing measures, whereby the number of in-person appointments is maximised. Methods Preintervention analysis and prospective assessment of intervention outcomes were used to evaluate the outcomes on waiting area occupancy and number of in-person consultations (postintervention only) using descriptive statistics, for two settings in the Rheumatology Clinic of Sint Maartenskliniek (SMK) and Medical Oncology & Haematology Outpatient Clinic of University Medical Center Utrecht (UMCU). Retrospective data from October 2019 to February 2020 were used to evaluate the pre-COVID-19 blueprint schedules. An iterative optimisation and simulation approach was followed, based on integer linear programming and Monte Carlo simulation, which iteratively optimised and evaluated blueprint schedules until the 95% CI of the number of patients in the waiting area did not exceed available capacity. Results Under pre-COVID-19 blueprint schedules, waiting areas would be overcrowded by up to 22 (SMK) and 11 (UMCU) patients, given the COVID-19 distancing measures. The postintervention blueprint scheduled all appointments without overcrowding the waiting areas, of which 88% and 87% were in person and 12% and 13% were digitally (SMK and UMCU, respectively). Conclusions The intervention was effective in two case studies with different waiting area characteristics and a varying number of interdependent patient trajectory stages. The intervention is generically applicable to a wide range of healthcare services that schedule a (series of) appointment(s) for their patients. Care providers can use the intervention to evaluate overcrowding of waiting area(s) and design optimal blueprint schedules to continue a maximum number of in-person appointments under pandemic distancing measures.
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Affiliation(s)
- Sander Dijkstra
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, Overijssel, The Netherlands
| | - Maarten Otten
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, Overijssel, The Netherlands
| | - Gréanne Leeftink
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, Overijssel, The Netherlands
| | | | | | - Anouk Heinen
- Sint Maartenskliniek, Nijmegen, Gelderland, The Netherlands
| | - Rhodé Bijlsma
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard J Boucherie
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, Overijssel, The Netherlands
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14
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Abdullah HR, Lam SSW, Ang BY, Pourghaderi A, Nguyen FNHL, Matchar DB, Tan HK, Ong MEH. Resuming elective surgery after COVID-19: A simulation modelling framework for guiding the phased opening of operating rooms. Int J Med Inform 2021; 158:104665. [PMID: 34923449 PMCID: PMC8674476 DOI: 10.1016/j.ijmedinf.2021.104665] [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] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop a 2-stage discrete events simulation (DES) based framework for the evaluation of elective surgery cancellation strategies and resumption scenarios across multiple operational outcomes. MATERIALS AND METHODS Study data was derived from the data warehouse and domain knowledge on the operational process of the largest tertiary hospital in Singapore. 34,025 unique cases over 43 operating rooms (ORs) and 18 surgical disciplines performed from 1 January 2019 to 31 May 2020 were extracted for the study. A clustering approach was used in stage 1 of the modelling framework to develop the groups of surgeries that followed distinctive postponement patterns. These clusters were then used as inputs for stage 2 where the DES model was used to evaluate alternative phased resumption strategies considering the outcomes of OR utilization, waiting times to surgeries and the time to clear the backlogs. RESULTS The tool enabled us to understand the elective postponement patterns during the COVID-19 partial lockdown period, and evaluate the best phased resumption strategy. Differences in the performance measures were evaluated based on 95% confidence intervals. The results indicate that two of the gradual phased resumption strategies provided lower peak OR and bed utilizations but required a longer time to return to BAU levels. Minimum peak bed demands could also be reduced by approximately 14 beds daily with the gradual resumption strategy, whilst the maximum peak bed demands by approximately 8.2 beds. Peak OR utilization could be reduced to 92% for gradual resumption as compared to a minimum peak of 94.2% with the full resumption strategy. CONCLUSIONS The 2-stage modelling framework coupled with a user-friendly visualization interface were key enablers for understanding the elective surgery postponement patterns during a partial lockdown phase. The DES model enabled the identification and evaluation of optimal phased resumption policies across multiple important operational outcome measures. LAY ABSTRACT During the height of the COVID-19 pandemic, most healthcare systems suspended their non-urgent elective surgery services. This strategy was undertaken as a means to expand surge capacity, through the preservation of structural resources (such as operating theaters, ICU beds, and ventilators), consumables (such as personal protective equipment and medications), and critical healthcare manpower. As a result, some patients had less-essential surgeries postponed due to the pandemic. As the first wave of the pandemic waned, there was an urgent need to quickly develop optimal strategies for the resumption of these surgeries. We developed a 2-stage discrete events simulation (DES) framework based on 34,025 unique cases over 43 operating rooms (ORs) and 18 surgical disciplines performed from 1 January 2019 to 31 May 2020 captured in the Singapore General Hospital (SGH) enterprise data warehouse. The outcomes evaluated were OR utilization, waiting times to surgeries and time to clear the backlogs. A user-friendly visualization interface was developed to enable decision makers to determine the most promising surgery resumption strategy across these outcomes. Hospitals globally can make use of the modelling framework to adapt to their own surgical systems to evaluate strategies for postponement and resumption of elective surgeries.
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Affiliation(s)
- Hairil Rizal Abdullah
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Health Services Research Centre, Singapore Health Services, Singapore; Health Services Research Institute, SingHealth Duke NUS Academic Medical Centre, Singapore; Department of Anesthesiology, Singapore General Hospital, Singapore.
| | - Sean Shao Wei Lam
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Health Services Research Centre, Singapore Health Services, Singapore; Health Services Research Institute, SingHealth Duke NUS Academic Medical Centre, Singapore; Lee Kong Chian School of Business, Singapore Management University, Singapore; SingHealth Duke-NUS Global Health Institute, Singapore Health Services, Singapore.
| | - Boon Yew Ang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Health Services Research Centre, Singapore Health Services, Singapore; Health Services Research Institute, SingHealth Duke NUS Academic Medical Centre, Singapore.
| | - Ahmadreza Pourghaderi
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Health Services Research Centre, Singapore Health Services, Singapore; Health Services Research Institute, SingHealth Duke NUS Academic Medical Centre, Singapore.
| | - Francis Ngoc Hoang Long Nguyen
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Health Services Research Centre, Singapore Health Services, Singapore; Health Services Research Institute, SingHealth Duke NUS Academic Medical Centre, Singapore.
| | - David Bruce Matchar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Health Services Research Centre, Singapore Health Services, Singapore; Health Services Research Institute, SingHealth Duke NUS Academic Medical Centre, Singapore; Department of Internal Medicine, Duke University, United States; Duke Centre of Clinical Health Policy Research, Duke University, United States.
| | - Hiang Khoon Tan
- Surgery Academic Program, SingHealth Duke NUS Academic Medical Centre, Singapore; Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore; SingHealth Duke-NUS Global Health Institute, Singapore Health Services, Singapore.
| | - Marcus Eng Hock Ong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Health Services Research Centre, Singapore Health Services, Singapore; Health Services Research Institute, SingHealth Duke NUS Academic Medical Centre, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore.
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15
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Barahona M, Infante CA, Palet MJ, Barahona MA, Barrientos C, Martinez A. Impact of the COVID-19 Outbreak on Orthopedic Surgery: A Nationwide Analysis of the First Pandemic Year. Cureus 2021; 13:e17252. [PMID: 34422505 PMCID: PMC8370446 DOI: 10.7759/cureus.17252] [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] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose To analyze the impact of the coronavirus disease 2019 (COVID-19) outbreak during the first pandemic year in a single country. Methods A cross-sectional study was designed. The free access database of the Chilean Department of Statistics and Health Information (DEIS) was used to compare the number of orthopedic procedures between 2019 and 2020. Country mobility was exported from the Institute of Complex Engineering Systems (ISCI) free-access database; this corresponds to a direct measurement of the degree of confinement of the country. Spearman correlation (rho) was used to analyze the total monthly COVID infection trend and mobility to orthopedics procedures. Results The number of orthopedic surgeries fell by 22.8% during the first year of the pandemic. All surgical procedures were adversely affected, with the fracture/trauma surgeries being the least affected. The maximum adverse impact was seen in knee arthroplasty (-64%), followed by hip arthroplasty (-41%) and knee ligament reconstruction (-44%). The number of orthopedic procedures had a mild correlation to the monthly number of COVID-19 cases (rho=-0.53, p=0.08) and a strong correlation with the country's mobility (rho=0.94, p=0.0001). Conclusions The COVID-19 outbreak diminished the number of orthopedic procedures during 2020, and the impact was directly correlated to the country's mobility. The public health network did have a more significant adverse impact in elective surgeries due to a slower recovery than private institutions. An increase in the waiting list should be expected, which will widen the difference in access to orthopedic surgery in Chile.
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Affiliation(s)
- Maximiliano Barahona
- Orthopaedic Department/Knee Surgery, Clinica Bupa Santiago, La Florida, CHL.,Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
| | - Carlos A Infante
- Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
| | - Miguel J Palet
- Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
| | - Macarena A Barahona
- Orthopaedic Department, Hospital Clínico de la Universidad de Chile, Santiago, CHL
| | - Cristian Barrientos
- Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
| | - Alvaro Martinez
- Orthopaedic Department, Hospital Clínico de la Universidad de Chile, Santiago, CHL
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16
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Dell'Isola A, Kiadaliri A, Turkiewicz A, Hughes V, Magnusson K, Runhaar J, Bierma-Zeinstra S, Englund M. The impact of first and second wave of COVID-19 on knee and hip surgeries in Sweden. J Exp Orthop 2021; 8:60. [PMID: 34389919 PMCID: PMC8363236 DOI: 10.1186/s40634-021-00382-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To investigate the impact of COVID-19 in Sweden on rates of knee and hip surgeries. METHODS We used healthcare data for the population of the southernmost region in Sweden (1.4 million inhabitants). We did an interrupted time-series analysis to estimate changes in rates and trends of joint replacements (JR), arthroscopies, and fracture surgeries for knee or hip in April-December 2020 compared to pre-COVID-19 levels adjusting for seasonal variations. RESULTS We found a drop of 54% (95% CI 42%; 68%) and 42% (95% CI 32%; 52%), respectively, in the rate of JRs and arthroscopies in April 2020 when compared to the counterfactual scenario. This was followed by an increase that brought the rates of JRs and arthroscopies back to their predicted levels also during the beginning of the second wave (November-December 2020). Acute fracture surgeries were largely unaffected, i.e. did not show any decrease as observed for the other surgeries. CONCLUSIONS In southern Sweden, we observed a marked decrease in elective knee and hip surgeries following the first wave of Covid-19. The rates remained close to normal during the beginning of the second wave suggesting that important elective surgeries for patients with end-stage osteoarthritis can still be offered despite an ongoing pandemic provided adequate routines and hospital resources.
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Affiliation(s)
- Andrea Dell'Isola
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden.
| | - Ali Kiadaliri
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden.,Centre for Economic Demography, Lund University, Lund, Sweden
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden
| | - Velocity Hughes
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden
| | - Karin Magnusson
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden.,Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sita Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden
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17
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Duralde XA. CORR Insights®: What was the Prevalence of COVID-19 in Asymptomatic Patients Undergoing Orthopaedic Surgery in One Large United States City Mid-pandemic? Clin Orthop Relat Res 2021; 479:1700-1702. [PMID: 33835094 PMCID: PMC8277295 DOI: 10.1097/corr.0000000000001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 01/31/2023]
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18
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Sharkey S, Narang K, Pacheco RJ, Anthony C. Initial assessment of framework for delivery of elective orthopaedic surgery in the United Kingdom following the COVID-19 pandemic. Musculoskelet Surg 2021; 106:427-432. [PMID: 34109553 PMCID: PMC8189549 DOI: 10.1007/s12306-021-00718-7] [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: 01/11/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
Purpose In light of the COVID-19 pandemic, a framework for safe provision of elective orthopaedic surgery must be developed in order to restore and maintain activity. The aim of this study was to explore patient attitudes to surgery and theatre efficiency as a result of the COVID-19 pandemic and assess a potential framework for the delivery of such services. Methods Prospectively collected data on theatre timings and procedures completed per session used to assess theatre efficiency comparing June 2019 to June 2020. Information on patient compliance with 14-day household isolation and attitudes to surgery were collected prospectively over a seven-week period using a questionnaire. Follow-up data were collected via telephone consultation a minimum of two weeks after discharge. Results Significant reduction in the number of points per session (p = 0.02) with a mean of 3.19 in 2019 and 2.42 in 2020. Only 18 of 31 patients were compliant with pre-operative isolation with individual failures accounting for four of 13 and failures by household members accounting for nine. Impact of COVID-19 and precautions on patient anxiety was mixed. No patients required symptomatic COVID-19 swab post-operatively. Conclusion With the restrictions of COVID-19, there are significant problems with theatre efficiency, in effect losing an operation a list. Furthermore, compliance with pre-operative isolation was poor but to the best of our knowledge no patients became unwell from COVID-19 post-operatively. Additional strategies will be required to reinstate an effective elective orthopaedic service, especially as the nation heads into another wave.
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Affiliation(s)
- S Sharkey
- Trauma and Orthopaedics Department, Goole and District Hospital, Goole, DN14 6RX, England, UK.
| | - K Narang
- Trauma and Orthopaedics Department, Goole and District Hospital, Goole, DN14 6RX, England, UK
| | - R J Pacheco
- Trauma and Orthopaedics Department, Goole and District Hospital, Goole, DN14 6RX, England, UK
| | - C Anthony
- Trauma and Orthopaedics Department, Goole and District Hospital, Goole, DN14 6RX, England, UK
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19
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Hamer J, Jones E, Chan A, Tahmasebi F. Can We Routinely Employ the Use of Low-Pressure Gynaecological Laparoscopy? A Systematic Review. Cureus 2021; 13:e15348. [PMID: 34235025 PMCID: PMC8244579 DOI: 10.7759/cureus.15348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/30/2022] Open
Abstract
Clinicians have learnt valuable lessons throughout the COV-SARS-2 pandemic, many of which have produced solutions that we aim to continue to implement within the foreseeable future. Optimising patients’ surgical pathways to reduce the length of stay and complications is an area of particular importance, both for maximal utilisation of available resources and for reduction of the exposure of inpatient and elective patients to an increased risk of infection within healthcare facilities. The aim of this review was to investigate the possible implications of using low-pressure laparoscopic gynaecological surgery versus standard- or high-pressure pneumoperitoneum surgeries. The primary outcome was postoperative pain, with secondary outcomes including duration of surgery, length of inpatient stay and rate of complications. MEDLINE, Embase and Cochrane CENTRAL were searched from inception to December 2020. We searched for published randomised control trials comparing low-pressure laparoscopic surgery (≤8 mmHg) to at least one additional standardised pneumoperitoneum pressure (≥12 mmHg and/or ≥15 mmHg). A total of 203 studies were reviewed, five of which were included in this analysis. Studies comparing low-pressure laparoscopic surgery against gasless abdominal cavities were excluded. The meta-analysis of the results was pooled and calculated within RevMan 5.0 software (Cochrane, London, England). Studies using a visual analogue scale (1-10) to compare low versus standard pneumoperitoneum pressures did not display a significant diminution of postoperative pain at ≤ 6 or 24 hours: -0.30 [95% CI -0.63, 0.03] and -0.66 [95% CI -1.35, 0.02], respectively. Studies additionally demonstrated worse visualisation of the surgical field within the low-pressure group (risk ratio 10.31; 95% CI, 1.29-82.38 I2 = 0%). Studies measuring postoperative pain using a numerical rating scale displayed significant pain reduction at all hours measured (p ≤ 0.01). The rate of intraoperative complications was 1% for all groups measured. Cumulative analysis of the duration of surgery did not differ significantly between groups (p = 0.99). The pandemic has revealed new issues that must be addressed by clinicians to promote the safety of patients and the efficiency of inpatient stay. This review has paved the way for new possibilities and innovative approaches to address the issue of optimising patient surgical pathways; however, at present, we cannot give a firm justification for the use of low-pressure gynaecological laparoscopy. Reasons for this include the minimal reduction in pain scores between low, standard and high pneumoperitoneum pressures, leading to a mixture of statistically significant results, as well as a reduction in the visualisation of the surgical field and the small population sizes in the reviewed papers. Additional research is required to further explore the potential clinical benefits of gynaecological laparoscopy to ensure its effective ambulatory use within mainstream surgical operations.
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Affiliation(s)
- Jack Hamer
- Obstetrics and Gynaecology, Russells Hall Hospital, The Dudley Group National Health Service (NHS) Foundation Trust, Dudley, GBR
| | - Edward Jones
- Anaesthesiology, Russells Hall Hospital, The Dudley Group National Health Service (NHS) Foundation Trust, Dudley, GBR
| | - Amy Chan
- Obstetrics and Gynaecology, Russells Hall Hospital, The Dudley Group National Health Service (NHS) Foundation Trust, Dudley, GBR
| | - Farshad Tahmasebi
- Obstetrics and Gynaecology, Russells Hall Hospital, The Dudley Group National Health Service (NHS) Foundation Trust, Dudley, GBR
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20
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Tawfik AM, Silver JM, Katt BM, Patankar A, Rivlin M, Beredjiklian PK. Patient Perceptions of COVID-19 Precautions and Their Effects on Experiences With Hand Surgery. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:167-171. [PMID: 33997725 PMCID: PMC8113162 DOI: 10.1016/j.jhsg.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose The purpose of this study is to evaluate patient perceptions of COVID-19 precautions and how these precautions have affected their hand and upper extremity surgery experience. Methods We sent an 18-item survey to 1,213 patients who underwent elective hand and upper extremity surgery at 1 academic institution from October 2020 to January 2021. The survey consisted of questions related to patient demographics, treatment delays due to COVID-19, and patient perceptions of COVID-19 precautions. Descriptive statistics were performed to analyze the survey responses. Responses for patients aged 18–50 and 51+ were compared using a chi-square analysis for categorical variables and a Student t-test for continuous variables. Results Out of 1,213 invitations, 384 survey respondents completed the survey (31.6%). Of the respondents, 16.8% reported delaying medical treatment for an average of 123.2 days because of COVID-19. The preventative measures were found to be adequate by 95% of patients. Only 2.6% of patients reported experiencing surgical delays due to preoperative COVID-19 testing or other COVID-19-related precautions. COVID-19 testing was seen as necessary by 88% of patients, and 74% did not find COVID-19 testing to be a barrier to their surgery. Patients aged 51+ were more likely to delay seeking medical treatment than younger patients (19.3% vs 9.1%, respectively). Furthermore, those that did delay seeking treatment waited longer on average than their younger counterparts (136.1 vs 72.9 days, respectively). Conclusions In conclusion, patients undergoing hand and upper extremity surgery typically do not find COVID-19 precautions to be a significant barrier to care and understand their importance. Despite this, many patients, particularly older ones, are delaying medical care for extended periods of time. It is important for hand surgeons to acknowledge their patients’ perspectives and work to educate patients on evolving surgical safety guidelines. Clinical relevance Patient perspectives of current COVID-19 precautions can help inform hand surgeons on areas for continued patient education.
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Affiliation(s)
- Amr M Tawfik
- Rothman Orthopaedic Institute, Philadelphia, PA.,Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jeremy M Silver
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Brian M Katt
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Aneesh Patankar
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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21
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Chatterji G, Patel Y, Jain V, Geevarughese NM, Haq RU. Impact of COVID-19 on Orthopaedic Care and Practice: A Rapid Review. Indian J Orthop 2021; 55:839-852. [PMID: 33776130 PMCID: PMC7980796 DOI: 10.1007/s43465-021-00354-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/05/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has led to a large body of literature regarding the impact of COVID-19 on orthopaedic care and practice. This rapid review aims to synthesize this published literature to give the orthopaedic fraternity an overview about the best practices that need to be followed during this period. METHODOLOGY A rapid review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement for rapid reviews on the impact of COVID-19 on orthopaedic care and practice. A Pubmed search was done to identify all literature related to the impact of COVID-19 on orthopaedic care and practice, published between December 2019 and October 2020 using a predefined search strategy. The final review included 375 peer-reviewed articles addressing the objectives. RESULTS The majority of articles were expert opinions ( 37.1%) and narrative reviews (13.1%). There were 17.3% retrospective studies and 2.1% prospective studies with only one randomized control trial and ten systematic reviews. 83.8% of articles had levels of evidence IV and V, 79.5% of the articles were published in core-orthopaedic journals. Maximum publications were from the United States of America (31.7%), followed by India (11.5%). European countries together contributed to 32.0% of all publications. CONCLUSION COVID-19 has had a significant impact on all aspects of orthopaedic care and practice. The pandemic has affected outpatient clinics, emergency and elective surgery, rehabilitation, resident training, personnel management, use of personal protective equipment, telemedicine and all sub-specialities of orthopaedics. Orthopaedic practice will require the incorporation of new technologies, restructuring of health systems and reorganizing of training programs for optimal patient care. There would also be a need for frequent review of emerging literature to provide evidence-based guidelines to the orthopaedic fraternity which will not only help in mitigation of transmission of disease but also ensure continuity of optimum patient care. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00354-0.
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Affiliation(s)
- Gautam Chatterji
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh India
| | - Yogesh Patel
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh India
| | - Vaibhav Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh India
| | | | - Rehan Ul Haq
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh India
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22
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Bockmann B, Venjakob AJ, Holschen M, Nebelung W, Schulte TL. Elective shoulder surgery during the coronavirus disease 2019 pandemic in Germany: the patients' perspective. JSES Int 2021; 5:342-345. [PMID: 33723537 PMCID: PMC7944099 DOI: 10.1016/j.jseint.2020.12.021] [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] [Indexed: 11/29/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has impeded the treatment of elective shoulder patients all over the world. Owing to the constraints in personnel and operation theater capacities, many patients who should undergo planned surgeries could not receive medical care. In our study, we examined the status quo of elective shoulder arthroscopy during the pandemic in Germany. Methods Using a nonprofit database, 40 shoulder units that performed the most arthroscopic rotator cuff repairs in Germany in 2018 were identified. Following a standardized protocol, the web pages of these units were screened, and their strategy for elective procedures during the COVID-19 pandemic was analyzed. Special emphasis was put on the use of new digital technologies. Results At the time of the study, no unit had stopped scheduling appointments for elective shoulder patients because of the pandemic. Almost all units (97.5%) offered explicit information about COVID-19 and their strategies toward it. The possibilities of visiting patients in shoulder units varied owing to local restrictions. Two units (5%) offered digital consultations. Conclusion At the time of the study, elective shoulder procedures could be planned and carried out at the largest centers in Germany. Local restrictions had a great influence on the organization of the procedure and hospital stay during the COVID-19 pandemic. Digital consultations were not available in every unit.
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Affiliation(s)
- Benjamin Bockmann
- Department of Orthopaedics and Trauma Surgery, St. Josef Hospital, Ruhr University, Bochum, Germany.,Department of Sports Orthopaedics, St. Vinzenz Hospital, Düsseldorf, Germany
| | | | - Malte Holschen
- Orthopedic Practice Clinic (OPPK) and Raphaelsklinik Münster, Münster, Germany
| | - Wolfgang Nebelung
- Department of Sports Orthopaedics, St. Vinzenz Hospital, Düsseldorf, Germany
| | - Tobias Ludger Schulte
- Department of Orthopaedics and Trauma Surgery, St. Josef Hospital, Ruhr University, Bochum, Germany
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Dungar KD, Sooriah KL. Can surgery continue safely during a pandemic? A commentary on "Surgical activity during the Covid-19 pandemic: Results for 112 patients in a French tertiary care center, a quality improvement study". Int J Surg 2020; 84:127-128. [PMID: 33157276 PMCID: PMC7609239 DOI: 10.1016/j.ijsu.2020.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Keval Dhanji Dungar
- University College London, 74 Huntley St, Bloomsbury, London, WC1E 6DE, England, United Kingdom.
| | - Kirstin Louise Sooriah
- University College London, 74 Huntley St, Bloomsbury, London, WC1E 6DE, England, United Kingdom.
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Cheshmehzangi A. Reflection on Early Lessons for Urban Resilience and Public Health Enhancement during the COVID-19. Health (London) 2020. [DOI: 10.4236/health.2020.1210101] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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