Arthroscopy and COVID-19: Impact of the pandemic on our surgical practices

The Factors Associated With Telehealth Use and Avoidance During the COVID-19 Pandemic: Longitudinal Survey

BACKGROUND

Social distancing requirements due to the COVID-19 pandemic saw a rapid increase in the delivery of telehealth consultations as an alternative to face-to-face health care services.

OBJECTIVE

The aims of this study were to assess the use and acceptability of telehealth during the early stages of the pandemic and identify factors associated with telehealth avoidance during this period.

METHODS

Data were obtained from waves 4 and 7 of a longitudinal survey designed to assess the impact of the COVID-19 pandemic on the health and behavior of a representative sample of Australian adults. Participants reported on their use or avoidance of telehealth during the assessment period, as well as the mode of telehealth used and acceptability.

RESULTS

Approximately 30% of participants reported using telehealth during the assessment periods, with the most common telehealth modality being the telephone. Acceptance of telehealth was generally high and was higher among those who used telehealth compared with those who did not. Approximately 18% of participants reported avoiding health care due to telehealth. Across assessment waves, avoidance was associated with younger age, speaking a language other than or in addition to English, having a current medical diagnosis, and lower levels of telehealth acceptability.

CONCLUSIONS

While most participants in this study were accepting of telehealth services, there remain barriers to use, especially among those from particular sociodemographic groups. At a population level, avoidance of health services in nearly one in five adults may have considerable long-term impacts on morbidity and potentially mortality. Targeted efforts to promote engagement with telehealth services are critical if these adverse outcomes are to be avoided, particularly during periods when access to face-to-face services may be limited.

Association of COVID-19 Lockdown With Increased Rate of Cyclops Syndrome in Patients With Unexpected Home-Based Self-Guided Rehabilitation After ACL Reconstruction

Background

The risk of cyclops syndrome increases significantly after anterior cruciate ligament (ACL) reconstruction (ACLR) if complete extension is not recovered before the sixth postoperative week. The lockdown in France due to the COVID-19 pandemic led to an absence of supervised rehabilitation, requiring unexpected self-rehabilitation in patients who underwent ACLR just before lockdown.

Purpose

To determine the rate of cyclops syndrome after ACLR in patients who underwent self-rehabilitation during lockdown.

Study Design

Cohort study; Level of evidence, 3.

Methods

A total of 75 patients receiving a hamstring graft for ACLR during the COVID-19 pandemic between February 10, 2022, and March 16, 2020, carried out self-rehabilitation during part of their first 6 postoperative weeks using exercise videos on a dedicated website. Clinical examination was performed at a minimum 1-year follow-up with International Knee Documentation Committee (IKDC), Lysholm, Tegner, and ACL-Return to Sport after Injury (ACL-RSI) scores. This group was compared with a matched-pair control group of 72 patients who underwent surgery in 2019 and completed postoperative supervised rehabilitation with a physical therapist. Rates and reasons for second surgery (arthrolysis, meniscal procedure) were also recorded.

Results

In the COVID group (n = 72; 3 patients were lost to follow-up), the mean follow-up was 14.5 ± 2.1 months (range, 13-21) and rate of reoperation for clinical cyclops syndrome was 11.1% (n = 8). The rate of cyclops syndrome was significantly lower (1.4%) in the control group (P = .01). In the COVID group, 8 patients underwent anterior arthrolysis at a mean of 8.6 months after the primary surgery, and 4 patients underwent another surgical intervention (meniscal procedure [n = 3], device removal [n = 1]). In the COVID group, mean Lysholm was 86.6 ± 14.1 (range, 38-100), Tegner was 5.6 ± 2.3 (range, 1-10), subjective IKDC was 80.3 ± 14.7 (range, 32-100) and ACL-RSI score was 77.3 ± 19.7 (range, 33-100).

Conclusion

The rate of cyclops syndrome after ACLR was significantly greater in the COVID group versus the matched controls. The dedicated website was not effective at supporting self-guided rehabilitation and could benefit from interactive improvements so it is at least as effective as supervised rehabilitation.

The COVID-19 pandemic impact on clinical load of plastic and reconstructive surgery in a tertiary care hospital of north India: A retrospective comparative analysis

BACKGROUND

The objective of the study was to analyze and determine statistically significant impact of the COVID-19 on clinical load of plastic and reconstructive surgery practices.

MATERIALS AND METHODS

The retrospective analysis and comparison of the number of patients visiting to outpatient clinic, number of patients admitted, number of patients operated in the plastic and reconstructive surgery department during the COVID-19 pandemic months of January 2020-June 2020 with the same months of preceding non-COVID-19 year was done. The data obtained were tabulated in Microsoft Excel spread sheet and the statistical analysis done using MedCalc statistical software.

RESULTS

The mean ± standard deviation of patients attended in outpatient department (OPD), admitted in inpatient department (IPD), emergency surgeries performed, and elective surgeries performed during -COVID-19 versus COVID-19 pandemic period is (651.167 ± 310.42 vs. 212.5 ± 307.591), (83.5 ± 16.263 vs. 34.333 ± 53.74), (5.167 ± 4.243 vs. 3.333 ± 4.95), and (74.333 ± 28.284 vs. 40.833 ± 60.811), respectively. The difference in means is highly significant statistically in the number of patients attended in OPD, admitted in IPD, and elective surgeries performed during pre-COVID versus COVID period; however, the difference in the means is not statistically significant in the number of emergency surgeries performed during pre-COVID versus COVID period.

CONCLUSION

The COVID-19 pandemic has significantly reduced the number of patients attended in OPD, admitted in IPD, and elective surgeries performed in the department of plastic surgery. However, there is a reduction in number of emergency surgeries but statistically insignificant. The strategy is to use telemedicine portal e-Sanjeevani services for OPD, encourage admission of patients with reverse transcription polymerase chain reaction negative for COVID-19, and perform reconstructive and esthetic plastic surgery operative procedures using COVID-19 appropriate precautions.

Virtual preoperative assessment in surgical patients: A systematic review and meta-analysis

STUDY OBJECTIVE

Preoperative assessment is a standard evaluation, traditionally done in-person in a preanesthesia clinic, for patients who will be undergoing a procedure involving anesthesia. Given the increased adoption of virtual care during the coronavirus disease 2019 (COVID-19) pandemic, the purpose of this systematic review and meta-analysis is to review the effectiveness of virtual preoperative assessment for the evaluation of surgical patients.

DESIGN

Systematic review and meta-analysis.

SETTING

MEDLINE (Ovid), MEDLINE InProcess/ePubs, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched from the initial coverage of the respective database to May 2021. A manual citation search of Google Scholar and PubMed was conducted to identify missed articles. Continued literature surveillance was done through July 2021.

PATIENTS

Patients aged 18 years and older undergoing virtual preoperative anesthesia assessment.

INTERVENTIONS

Virtual preoperative assessment.

MEASUREMENTS

Surgery cancellation rates, patient experience, resources saved, staff experience, success in using the data collected to diagnose and manage patients.

MAIN RESULTS

Fifteen studies (n = 31,496 patients) were included in this review. The average age of patients was 58 ± 15 years, and 47% were male. Virtual preoperative assessment resulted in similar surgery cancellation rates compared to in-person evaluation, with a pooled cancellation rate of 2% (95% confidence interval [CI]: 1-3%). Most studies reported a positive patient experience, with a pooled estimate of 90% (95% CI, 81-95%). There was a high success rate in using the information collected with virtual care, in the range of 92-100%, to diagnose and manage patients resulting in time and cost savings in the range of 24-137 min and $60-67 per patient.

CONCLUSIONS

This systematic review and meta-analysis demonstrates the utility of virtual care for preoperative assessment of surgical patients. Virtual preanesthesia evaluation had similar surgery cancellation rates, high patient satisfaction, and reduced costs compared to in-person evaluation.

The Epidemiology of Knee Arthroscopy during Coronavirus Disease 2019 Pandemic

Introduction: Coronavirus disease (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus (SARS Cov-2) has made a huge impact on global health service including in orthopaedic surgical service. Knee surgery (including arthroscopy) is one of the emerging surgical services in Indonesia. As the pandemic goes on, some of the patients prefer to postpone or cancel the surgery planning. We tried to evaluate the epidemiology of knee arthroscopy procedure during Covid-19 pandemic at our institution. Material and methods: Retrospective data collection was performed on all patients who received knee arthroscopy procedure at Prof dr. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia during the year 2020. The study evaluated the demographic data, the indication of surgery, and trends of the number of surgeries according to period time. This study also compared the data of knee arthroscopy procedures performed during the corresponding period before the pandemic in Indonesia (January to December 2019). Results: There was a total of 88 knee arthroscopy surgery performed during the period January to December 2020. There was a decrease in the number of knee arthroscopy during April and May 2020.  The decreasing number of surgeries also occurred in November 2020 which was later followed by the increasing number of surgeries in December 2020. Among all patient received knee arthroscopy during 2020, none have post-operative complication or infection due to SARS Cov-2. Conclusion: There was some difference in the epidemiology of knee arthroscopy during the COVID-19 pandemic compared to the non-pandemic era. Comprehensive preoperative screening is needed before resume elective surgical service.