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Ghoshal S, Stovall N, King AH, Miller AS, Harris MB, Succi MD. Orthopedic Surgery Volume Trends During the COVID-19 Pandemic and Postvaccination Era: Implications for Healthcare Planning. J Arthroplasty 2024; 39:1959-1966.e1. [PMID: 38513749 DOI: 10.1016/j.arth.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic decreased surgical volumes, but prior studies have not investigated recovery through 2022, or analyzed specific procedures or cases of urgency within orthopedic surgery. The aims of this study were to (1) quantify the declines in orthopedic surgery volume during and after the pandemic peak, (2) characterize surgical volume recovery during the postvaccination period, and (3) characterize recovery in the 1-year postvaccine release period. METHODS We conducted a retrospective cohort study of 27,476 orthopedic surgeries from January 2019 to December 2022 at one urban academic quaternary referral center. We reported trends over the following periods: baseline pre-COVID-19 period (1/6/2019 to 1/4/2020), COVID-19 peak (3/15/2020 to 5/16/2020), post-COVID-19 peak (5/17/2020 to 1/2/2021), postvaccine release (1/3/2021 to 1/1/2022), and 1-year postvaccine release (1/2/2022 to 12/30/2022). Comparisons were performed with 2 sample t-tests. RESULTS Pre-COVID-19 surgical volume fell by 72% at the COVID-19 peak, especially impacting elective procedures (P < .001) and both hip and knee joint arthroplasty (P < .001) procedures. Nonurgent (P = .024) and urgent or emergency (P = .002) cases also significantly decreased. Postpeak recovery before the vaccine saw volumes rise to 92% of baseline, which further rose to 96% and 94% in 2021 and 2022, respectively. While elective procedures surpassed the baseline in 2022, nonurgent and urgent or emergency surgeries remained low. CONCLUSIONS The COVID-19 pandemic substantially reduced orthopedic surgical volumes, which have still not fully recovered through 2022, particularly nonelective procedures. The differential recovery within an orthopedic surgery program may result in increased morbidity and can serve to inform department-level operational recovery.
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Affiliation(s)
- Soham Ghoshal
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Nasir Stovall
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander H King
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Amitai S Miller
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Mitchel B Harris
- Harvard Medical School, Boston, Massachusetts; Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Marc D Succi
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
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Karmali S, Saxena S, Richards O, Thompson W, McFaull SR, Pike I. What was the impact of COVID-19 restrictions on unintentional injuries, in Canada and globally? A scoping review investigating how lockdown measures impacted the global burden of unintentional injury. Front Public Health 2024; 12:1385452. [PMID: 38887259 PMCID: PMC11180821 DOI: 10.3389/fpubh.2024.1385452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Background Injuries are among the leading causes for hospitalizations and emergency department (ED) visits. COVID-19 restrictions ensured safety to Canadians, but also negatively impacted health outcomes, including increasing rates of certain injuries. These differences in trends have been reported internationally however the evidence is scattered and needs to be better understood to identify opportunities for public education and to prepare for future outbreaks. Objective A scoping review was conducted to synthesize evidence regarding the impact of COVID-19 restrictions on unintentional injuries in Canada, compared to other countries. Methods Studies investigating unintentional injuries among all ages during COVID-19 from any country, published in English between December 2019 and July 2021, were included. Intentional injuries and/or previous pandemics were excluded. Four databases were searched (MEDLINE, Embase, Web of Science, SPORTDiscus), and a gray literature search was also conducted. Results The search yielded 3,041 results, and 189 articles were selected for extraction. A total of 41 reports were included from the gray literature search. Final studies included research from: Europe (n = 85); North America (n = 44); Asia (n = 32); Oceania (n = 12); Africa (n = 8); South America (n = 4); and multi-country (n = 4). Most studies reported higher occurrence of injuries/trauma among males, and the average age across studies was 46 years. The following mechanisms of injury were reported on most frequently: motor vehicle collisions (MVCs; n = 134), falls (n = 104), sports/recreation (n = 65), non-motorized vehicle (n = 31), and occupational (n = 24). Injuries occurring at home (e.g., gardening, home improvement projects) increased, and injuries occurring at schools, workplaces, and public spaces decreased. Overall, decreases were observed in occupational injuries and those resulting from sport/recreation, pedestrian-related, and crush/trap incidents. Decreases were also seen in MVCs and burns, however the severity of injury from these causes increased during the pandemic period. Increases were observed in poisonings, non-motorized vehicle collisions, lacerations, drownings, trampoline injuries; and, foreign body ingestions. Implications Findings from this review can inform interventions and policies to identify gaps in public education, promote safety within the home, and decrease the negative impact of future stay-at-home measures on unintentional injury among Canadians and populations worldwide.
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Affiliation(s)
- Shazya Karmali
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | | | | | | | | | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Obamiro E, Trivedi R, Ahmed N. Changes in trends of orthopedic services due to the COVID-19 pandemic: A review. World J Orthop 2022; 13:955-968. [PMID: 36439371 PMCID: PMC9685630 DOI: 10.5312/wjo.v13.i11.955] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/13/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
As of June 10, 2022, the World Health Organization has recorded over 532 million documented coronavirus disease 2019 (COVID-19) [(Coronavirus) SARS-CoV-2] cases and almost 6.3 million deaths worldwide, which has caused strain on medical specialties globally. The aim of this review is to explore the impact that COVID-19 has had on orthopedic practices. Providers observed a rapid decline in the number of orthopedic patients’ admissions due to cancellation of elective procedures; however, emergent cases still required treatment. Various observational studies, case reports, and clinical trials were collected through a PubMed database search. Additional sources were found through Google. The search was refined to publications in English and between the years of 2019 and 2021. The keywords used were “COVID-19” and/or “Orthopedic Injuries”. Thirty-seven studies were retained. The pandemic brought on significant changes to the mechanism of injury, number of admissions, type of injuries, and patient outcomes. Mortality rates significantly increased particularly amongst patients with hip fractures and COVID-19. Road traffic injuries remained a common cause of injury and domestic injuries became more prevalent with lockdown. Social isolation negatively affected mental health resulting in several orthopedic injuries. Telehealth services and separation for COVID-positive and COVID-negative patients benefited both patients and providers. While hospitals and medical facilities are still facing COVID-19 case surges, it is important to understand how this pandemic has impacted preparation, care, and opportunities for prevention education and ongoing care.
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Affiliation(s)
- Eunice Obamiro
- Department of Surgery,Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
| | - Radhika Trivedi
- Department of Surgery,Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
| | - Nasim Ahmed
- Department of Surgery,Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
- Department of Surgery, Hackensack Meridian School of Medicine, Nutley, NJ 07110, United States
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Sandler AB, Baird MD, Kurapaty SS, Scanaliato JP, Dunn JC, Parnes N. A New Normal: Trends of Upper Extremity Orthopaedic Injuries Nationwide During the COVID-19 Pandemic. Cureus 2022; 14:e30299. [DOI: 10.7759/cureus.30299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
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Springthorpe T, Pearce M, Nowicka M, Niazi N, Pillai A. The Relationship of the COVID-19 pandemic with the Incidence and Management of Upper Limb Fractures: Double-Centre Study. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:871-876. [PMID: 36452423 PMCID: PMC9702022 DOI: 10.22038/abjs.2022.59285.2929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 04/28/2022] [Indexed: 05/16/2023]
Abstract
Background The COVID-19 pandemic brought about the placement of severe social restrictions in the United Kingdom, limiting activity and impacting public behavior. Limited studies have been published on the relationship of the coronavirus pandemic with the presentation and management of upper limb fractures. The aims of this study were first to assess the change in the incidence of upper limb fractures at key points during the COVID-19 pandemic such as the enactment and lifting of lockdowns, and second to evaluate the relationship between local COVID-19 burden and measures of service efficiency across our trust. Methods We undertook a retrospective analysis of all upper limb fracture referrals, admissions, and surgical procedures from the 1st of March 2020 to the 28th of February 2021. Changes in upper limb fracture incidence were mapped to significant changes in social restrictions. Measurements of service efficiency including time from admission to theatre and length of stay for admitted upper limb fracture patients were mapped to local COVID-19 burden. Subgroup analysis was undertaken to compare across age groups, including the pediatric population, all adults, and the elderly. Results The study involved 1251, 659, and 641 patients with upper limb fracture referrals, admissions, and procedures across the trust, respectively. Referrals (n=128) and procedures (n=72) both peaked in August 2020. Admissions peaked in both May and December 2020 (63 for both). Admissions and procedures both demonstrated a decrease in March and April 2020 compared to the rest of the study period (40 and 38 admissions, as well as 48 and 29 procedures respectively). Across the cohort, referrals and admissions did not demonstrate a statistically significant relationship with the relaxing of social restrictions (P=0.504). There were statistically significant differences among referrals, admissions, and procedures when stratifying patients by age (p =<0.001). Length of stay demonstrated an inverse relationship with COVID-19 burden throughout the study period, with the shortest average length of stay recorded in months with the highest number of local COVID-19 cases. The average time from injury occurrence to theatre increased during the winter months (P=0.001). Conclusion There is a relationship between changes in social restrictions and the incidence of upper limb fractures. These changes also had differing impacts on upper limb fracture rates when stratifying by patient age groups. The orthopedic service demonstrated adaptability in response to the local COVID-19 burden, and further research is needed to determine what effect this had on clinical outcomes.
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Affiliation(s)
- Thomas Springthorpe
- Wythenshawe Hospital, Manchester Foundation Trust, Manchester, United Kingdom
| | - Matthew Pearce
- Wythenshawe Hospital, Manchester Foundation Trust, Manchester, United Kingdom
| | - Maria Nowicka
- Wythenshawe Hospital, Manchester Foundation Trust, Manchester, United Kingdom
| | - Noman Niazi
- Wythenshawe Hospital, Manchester Foundation Trust, Manchester, United Kingdom
| | - Anand Pillai
- Wythenshawe Hospital, Manchester Foundation Trust, Manchester, United Kingdom
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Obed D, Salim M, Ammo T, Gildt MM, Krezdorn N, Vogt PM, Dastagir K. The effect of the COVID-19 pandemic lockdown measures on plastic, reconstructive and hand surgery emergency presentations – A comparative retrospective study in a regional referral center in Germany. Ann Med Surg (Lond) 2022; 82:104650. [PMID: 36124314 PMCID: PMC9476368 DOI: 10.1016/j.amsu.2022.104650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 11/02/2022] Open
Abstract
Background Methods Results Conclusions The COVID-19 lockdown caused a shift in surgical emergency case presentations. Increasing domestic and decreasing recreational and work injuries were noted. Middle-aged females were at high risk to sustain injuries during lockdown. Hand injuries showed consistent severity and hospital admission rates. Resource allocation remains crucial in future pandemic waves.
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Yoon JS, Khoo KH, Akhavan AA, Lagziel T, Ha M, Cox CA, Blanding R, Werthman EH, Caffrey J, Hultman CS. Changes in Burn Surgery Operative Volume and Metrics due to COVID-19. J Burn Care Res 2022; 43:1233-1240. [PMID: 35986489 PMCID: PMC9384663 DOI: 10.1093/jbcr/irac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to COVID-19, hospitals underwent drastic changes to operating room policy to mitigate the spread of the disease. Given these unprecedented measures, we aimed to look at the changes in operative volume and metrics of the burn surgery service at our institution. A retrospective review was conducted for operative cases and metrics for the months of March to May for 2019, 2020, and 2021, which correspond with pre-COVID, early COVID (period without elective cases), and late COVID (period with resumed elective cases). Inclusion criteria were cases related to burns. Case types and operative metrics were compared amongst the three time periods. Compared to the hospital, the burn service had a smaller decrease in volume during early COVID (28.7% vs. 50.1%) and exceeded pre-pandemic volumes during late COVID (+21.8% vs. -4.6%). There was a significant increase in excision and grafting cases in early and late COVID periods (p < .0001 and p < .002). There was a significant decrease in laser scar procedures that persisted even during late COVID (p < .0001). The projected and actual lengths of cases significantly increased and persisted into late COVID (p < .01). COVID-19 related operating room closures led to an expected decrease in the number of operative cases. However, there was no significant decline in the number of burn specific cases. The elective cases were largely replaced with excision and grafting cases and this shift has persisted even after elective cases have resumed. This change is also reflected in increased operative times.
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Affiliation(s)
- Joshua S Yoon
- Division of Plastic, Reconstructive & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center , Baltimore, MD USA
- Department of Surgery, George Washington University Hospital , Washington, DC USA
| | - Kimberly H Khoo
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Arya A Akhavan
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Michael Ha
- Division of Plastic Surgery, University of Maryland School of Medicine , Baltimore, MD USA
| | - Carrie A Cox
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Renee Blanding
- Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Emily H Werthman
- Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing , Baltimore, MD USA
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
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Albright JA, Testa EJ, Hanna J, Shipp M, Lama C, Arcand M. Trends in upper extremity injuries presenting to emergency departments during the COVID-19 pandemic. Am J Emerg Med 2022; 55:20-26. [PMID: 35245777 PMCID: PMC8865962 DOI: 10.1016/j.ajem.2022.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction Methods Results Conclusion Level of evidence
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Management of resources for orthopedic oncology and trauma patients during COVID-19 pandemic: A retrospective cohort study. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210318027o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective. This study aims to evaluate changes in surgical
strategy and orthopedic epidemiology, and to compare the frequency of
surgeries before and during the COVID-19 pandemic. Methods. For periods
from April 1 to May 31 in years 2019 and 2020, retrospective data on patient
demographics and types of orthopedic surgical procedures were obtained from
hospital databases in a tertiary referral hospital. Results. During the
COVID-19 pandemic, the most common orthopedic surgical procedures performed
were trauma surgery (n = 81), while other procedures were referred to
oncology (n = 19), biopsy (n = 11), debridement (n = 10), amputation (n =
6), surgery of dysplastic hip (n = 5) and knee ligament repair (n = 1). The
majority of trauma cases were hip fracture surgeries (n = 23). The mean age
of patients was 70.5 years. Sixty-three patients were female and seventy
were male. Only one patient had a history of COVID-19 infection. In the same
period during the year before the pandemic, 86 patients had trauma surgery,
while 49 had oncological surgery and the mean patient?s age was 54.5.
Sixty-two patients were female, and seventy-three were male in this group.
The number of tumor surgeries before the pandemic was higher compared to the
same period during the pandemic (p < 0.05). Conclusion. During the
pandemic, although all orthopedic surgeries decreased, the rate of
osteoporotic hip fractures surgery was similar as in pre-pandemic state.
This finding emphasizes the increased need to implement preventive measures
regarding hip fractures during lockdown periods. The relation of hip and
spine osteoporotic fractures surgery was not different before and during the
pandemic.
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Morgan C, Sugand K, Ashdown T, Nathoo N, MacFarlane R, Dyke R, Park C, Aframian A, Domos P, Horwitz MD, Sarraf KM, Dattani R. Impact of the National Lockdown Due to the COVID-19 Pandemic On Upper Limb Trauma Workload in Central London: A Multi-Centre Longitudinal Observational Study During Implementation and Ease of National Lockdown. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:23-31. [PMID: 35291242 PMCID: PMC8889424 DOI: 10.22038/abjs.2021.53205.2639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/07/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study assessed the impact of the COVID-19 pandemic on acute upper limb referrals and operative case-mix at the beginning and ease of British lockdown. METHODS A longitudinal multicentre observational cohort study was conducted for both upper limb trauma referrals and operative case-mix over a 12-week period (6 weeks from the beginning and 6 weeks from the ease of the national lockdown). Statistical analysis included median (± median absolute deviation), risk and odds ratios, and Fisher's exact test to calculate the statistical significance, set at p ≤ 0.05. RESULTS There was a 158% (n = 456 vs. 177) increase in upper limb referrals and 133% (n = 91 vs. 39) increase in the operative trauma caseload at the ease of lockdown compared with its commencement. An increase in sporting injuries was demonstrated (p=0.02), specifically cycling (p=0.004, OR=2.58). A significant increase in COVID-19 testing was demonstrated during the ease of lockdown (p=0.0001) with more patients having their management changed during the beginning of the pandemic (9.6% vs. 0.7%, p=0.0001). Of these patients, 47% went on to have delayed surgery within 6 months. No patients who underwent surgery tested positive for COVID-19 infection within 14 days post-operatively and no mortalities were recorded at 30 days. CONCLUSION The ease of lockdown has seen upper limb referrals and operations more than double compared to early lockdown. With no patients testing positive for COVID-19 within 14 days of the procedure, this demonstrates that having upper limb surgery during the current pandemic is safe.
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Affiliation(s)
- Catrin Morgan
- Chelsea and Westminster NHS Foundation Trust, London, England, UK
| | - Kapil Sugand
- Imperial College Healthcare NHS Trust, London, England, UK
| | - Thomas Ashdown
- Imperial College Healthcare NHS Trust, London, England, UK
| | - Nikita Nathoo
- Barnet Hospital, Royal Free NHS Foundation Trust, London, England UK
| | | | - Rory Dyke
- Imperial College Healthcare NHS Trust, London, England, UK
| | - Chang Park
- Imperial College Healthcare NHS Trust, London, England, UK
| | - Arash Aframian
- Chelsea and Westminster NHS Foundation Trust, London, England, UK
| | - Peter Domos
- Barnet Hospital, Royal Free NHS Foundation Trust, London, England UK
| | - Maxim D. Horwitz
- Chelsea and Westminster NHS Foundation Trust, London, England, UK
| | | | - Rupen Dattani
- Chelsea and Westminster NHS Foundation Trust, London, England, UK
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Beiter K, Hayden E, Phillippi S, Conrad E, Hunt J. Violent trauma as an indirect impact of the COVID-19 pandemic: A systematic review of hospital reported trauma. Am J Surg 2021; 222:922-932. [PMID: 34148669 PMCID: PMC8129999 DOI: 10.1016/j.amjsurg.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has exacerbated many social conditions associated with violence. The objective of this systematic review was to examine trends in hospital reported violent trauma associated with the pandemic. METHODS Databases were searched in using terms "trauma" or "violence" and "COVID-19," yielding 4,473 records (2,194 de-duplicated). Exclusion criteria included non-hospital based studies and studies not reporting on violent trauma. 44 studies were included in the final review. RESULTS Most studies reported no change in violent trauma incidence. Studies predominately assessed trends with violent trauma as a proportion of all trauma. All studies demonstrating an increase in violent trauma were located in the United States. CONCLUSIONS A disproportionate rise in violence has been reported within the US. However, most studies examined violent trauma as a proportion of all trauma; results may reflect relative changes from lockdowns. Future studies should examine rates of violent trauma to provide additional context.
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Affiliation(s)
- Kaylin Beiter
- Louisiana State University Health Sciences Center, United States.
| | - Ellery Hayden
- Louisiana State University Health Sciences Center, United States
| | | | - Erich Conrad
- Louisiana State University Health Sciences Center, United States
| | - John Hunt
- Louisiana State University Health Sciences Center, United States
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Cordova LZ, Savage N, Ram R, Ellis L, Tobin V, Rozen WM, Seifman MA. Effects of COVID-19 lockdown measures on emergency plastic and reconstructive surgery presentations. ANZ J Surg 2021; 91:415-419. [PMID: 33538101 PMCID: PMC8013506 DOI: 10.1111/ans.16625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 12/02/2022]
Abstract
Background In Australia, the COVID‐19 pandemic has caused severe social disruptions, including restrictions to the movement of people. Healthcare centres around the world have seen changes in the nature of injuries acquired during the COVID‐19 pandemic; we therefore hypothesize that social isolation measures have changed the pattern of plastic and reconstructive surgery presentations. Methods A prospective cohort study was designed comparing patient presentations during the enforced COVID‐19 lockdown to two previous periods. All emergency referrals requiring operative intervention by the plastic and reconstructive surgery unit of our institution were included. Patient demographics, place and mechanism of injury, drug and alcohol involvement, delays to presentation, length of admission and complication rates were collected. Results Demographics and complication rates were similar across all groups. A 31.8% reduction in total number of emergency cases was seen during the lockdown period. Increase in do‐it‐yourself injuries (P = 0.001), bicycle injuries (P = 0.001) and injuries acquired via substance abuse (P = 0.041) was observed. Head and neck injuries, mostly due to animal bites and falls, were also more prevalent compared to the same period the previous year (P = 0.007). As expected, over 80% of plastic surgery operations during the COVID‐19 period were due to injuries acquired at home, a significant increase compared to previous periods. Conclusion Despite changes in the pattern of presentations requiring plastic and reconstructive emergency surgery, traumatic injuries continued to occur during the pandemic. Thus, planning will be essential to ensure resource allocation for emergency procedures is sustained as second and third waves of COVID‐19 cases emerge worldwide.
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Affiliation(s)
- Leonardo Z Cordova
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Melbourne, Victoria, Australia
| | - Nicholas Savage
- Peninsula Clinical School, Central Clinical School Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rachna Ram
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Melbourne, Victoria, Australia
| | - Lisa Ellis
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Melbourne, Victoria, Australia
| | - Vicky Tobin
- Peninsula Clinical School, Central Clinical School Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Warren M Rozen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Melbourne, Victoria, Australia.,Peninsula Clinical School, Central Clinical School Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Marc A Seifman
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Melbourne, Victoria, Australia
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Jin Q, Zhou H, Lu H. Clinical Analysis of Causes and Countermeasures of Hand Injury During the COVID-19 Outbreak and Work Resumption Period: A Retrospective Study in a Designated Hospital in China. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211067496. [PMID: 34935527 PMCID: PMC8721885 DOI: 10.1177/00469580211067496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A total of 95 patients with hand injuries were admitted to the orthopedics department within half a year of the COVID-19 outbreak. Data were collected between January 23, 2020 and July 23, 2020. Data such as patients' demographics, type of injury, location, side of lesions, mechanism of injury, injury site, and surgical management were collected and subsequently analyzed. On the one hand, the total number of emergency visits due to hand injury during the COVID-19 outbreak decreased by 37%, compared to the same period in the previous year. On the other hand, work resumption injuries increased by 40%. Injuries within the resumption period occurred predominantly at work (64.7%) and were significantly higher than the same period in 2019 (37.3%) (P < .001). Machine-related injuries were the most frequent injuries seen in our hospital (58.8%). The majority of cases were from cut injuries (82.4%), with fingers being the most common site of these injuries. Simple fractures and dislocations were also reported during the study. Most injuries were classified as either minor or moderate (90%) during the outbreak. However, during the resumption of work, major injuries were more prevalent (40%). The proportion of major injuries this year's work resumption stage (40%) has almost doubled compared to the previous year (21.8%, P = .006). The resumption of work following the COVID-19 outbreak is a time of high-risk for hand injuries. The overall number of patients with hand injuries admitted into our department has decreased compared to the corresponding period last year. However, workplace injuries, particularly machine-related ones, considerably increased during the first six months after the COVID-19 outbreak. As a result, the proportion of major injuries drastically increased. Emergency and surgical health care providers should be aware of this pattern of hand injuries during this untypical time in order to effectively prepare and plan services.
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Affiliation(s)
- Qianjun Jin
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Hui Lu MD, Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou-310003, China. Email address:
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Waseem S, Nayar S, Hull P, Carrothers A, Rawal J, Chou D, Khanduja V. The global burden of trauma during the COVID-19 pandemic: A scoping review. J Clin Orthop Trauma 2021; 12:200-207. [PMID: 33223749 PMCID: PMC7666557 DOI: 10.1016/j.jcot.2020.11.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose; The COVID-19 pandemic has necessitated profound adaptations in the delivery of healthcare to manage a rise in critically unwell patients. In an attempt to slow the spread of the virus nationwide lockdown restrictions were introduced. This review aims to scope the literature on the impact of the pandemic and subsequent lockdown on the presentation and management of trauma globally. Methods; A scoping review was conducted in accordance with PRISMA-ScR guidelines. A systematic search was carried out on the Medline, EMBASE and Cochrane databases to identify papers investigating presentation and management of trauma during the COVID-19 pandemic. All studies based on patients admitted with orthopaedic trauma during the COVID-19 pandemic were included. Exclusion criteria were opinion-based reports, reviews, studies that did not provide quantitative data and papers not in English. Results; 665 studies were screened, with 57 meeting the eligibility criteria. Studies reported on the footfall of trauma in the UK, Europe, Asia, USA, Australia and New Zealand. A total of 29,591 patients during the pandemic were considered. Mean age was 43.7 years (range <1-103); 54.8% were male. Reported reductions in trauma footfall ranged from 20.3% to 84.6%, with a higher proportion of trauma occurring secondary to interpersonal violence, deliberate self-harm and falls from a height. A decrease was seen in road traffic collisions, sports injuries and trauma occurring outdoors. There was no significant change in the proportion of patients managed operatively, and the number of trauma patients reported to be COVID-19 positive was low. Conclusion; Whilst the worldwide COVID-19 pandemic has caused a reduction in the number of trauma patients; the services managing trauma have continued to function despite infrastructural, personnel and pathway changes in health systems. The substantial effect of the COVID-19 pandemic on elective orthopaedics is well described, however the contents of this review evidence minimal change in the delivery of effective trauma care despite resource constraints during this global COVID-19 pandemic.
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Affiliation(s)
- S. Waseem
- Major Trauma Centre, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB20QQ, United Kingdom
| | - S.K. Nayar
- Department of Trauma and Orthopaedics, Whittington Hospital, Madgala Avenue, London, N195NF, United Kingdom
| | - P. Hull
- Major Trauma Centre, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB20QQ, United Kingdom
| | - A. Carrothers
- Major Trauma Centre, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB20QQ, United Kingdom
| | - J. Rawal
- Major Trauma Centre, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB20QQ, United Kingdom
| | - D. Chou
- Major Trauma Centre, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB20QQ, United Kingdom
| | - V. Khanduja
- Major Trauma Centre, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB20QQ, United Kingdom,Corresponding author. Institutional address: Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB20QQ, United Kingdom
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15
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Virtual Clinical Services for Rehabilitation in Hand Surgery. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:368. [PMID: 32954231 PMCID: PMC7486043 DOI: 10.1016/j.jhsg.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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