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Franco VP, Gonçalves GM, Fração OC, Sungaila HYF, Cocco LF, Dobashi ET. EVALUATION OF THE EPIDEMIOLOGY OF EXPOSED FRACTURES BEFORE AND DURING THE COVID-19 PANDEMIC. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e268179. [PMID: 37547240 PMCID: PMC10399993 DOI: 10.1590/1413-785220233104e268179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/17/2023] [Indexed: 08/08/2023]
Abstract
Objective To assess the impact of the COVID-19 pandemic on the epidemiology and clinical outcomes of open fractures considering the periods before and during the pandemic. Methods An observational and retrospective study, which included patients aged over 18 years, admitted to the Orthopedics and Traumatology Ward of Hospital São Paulo, of the Federal University of São Paulo (UNIFESP). Data was collected in two moments: pre-pandemic (March 1, 2019, to February 29, 2020) and during the pandemic (March 1, 2020, to February 28, 2021). Results In total, 183 patients were evaluated with a mean age of 36 years ± 14 years. In the pre-pandemic period, 94 patients underwent surgery, 81 men (85.37%) and 13 women (14.2%), with a mean age of 36 ± 3 years. During the pandemic period, 89 patients were subjected to surgery, 77 men (86.6%) and 12 women (13.4%), with a mean age of 38 ± 3 years. Conclusion During the pandemic, open fractures were still more common in men. Regarding hospital indicators, the prevalence of infections in the surgical wound and the length of stay of patients with open fractures increased, however, with little significance. Fractures classified as Gustilo IIIA were the most common, while the most common according to the AO classification were 33, 34, 42, 43, 2R3, and 2R3 + 2U2. The frequency of run overs during the pandemic decreased. However, firearm projectile injuries and falls and occupational injuries increased. Level of Evidence III, Retrospective Comparative Study.
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Affiliation(s)
- Vinicius Pagliaro Franco
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Gabriel Massarico Gonçalves
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Orlando Copetti Fração
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Heloisa Yumi Fujiya Sungaila
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Luiz Fernando Cocco
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Eiffel Tsuyoshi Dobashi
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
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ALENCAR NETO JONATASBRITODE, OLIVEIRA ERICADAMASCENO, BRANCO MÁRCIOCARVALHOCASTELO, OZÓRIO RENANGALVÃO, SOUSA ANTÔNIOANDERSONFONSECADE, CAVALCANTE MARIALUZETECOSTA, ARAÚJO RAMILLELIMA. THE IMPACT OF COVID-19 ON THE EPIDEMIOLOGICAL PROFILE OF FRACTURES. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e252472. [PMID: 36451796 PMCID: PMC9670789 DOI: 10.1590/1413-785220223005e252472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/12/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To analyze the epidemiological transition of fractures in patients who were treated in a tertiary hospital which is reference in traumatology during the COVID-19 pandemic to assess the changes in trauma service. METHODS This is a retrospective and descriptive analysis of data on orthopedics lesions treated at Instituto Doutor Jose Frota between December 16, 2019 and June 16, 2020 (three months before and after the first case of COVID-19 in Ceará). RESULTS In total, we evaluated 913 patients, 28.5% of which were women and 71.5%, men. We found a significative reduction (p < 0.05) in the proportion of female patients operated in the analyzed time. We also observed an increase in patients' mean age, 35.4 years before the pandemic, and 38.48 (p = 0.04) during the consecutive period. Trauma mechanisms significantly changed (p < 0.05), with a proportional increase of high-energy traumas and reduction of instances of falling. We found a 11.9% reduction in orthopedic surgeries, from 655 to 577 at the time after the first case of COVID-19 (p = 0.071). Mean hospitalization length (p < 0.001) and time until surgeries decreased (p < 0.001). CONCLUSION We observed the impact of lockdown in this hospital of trauma especially via the decreased number of operated cases and the change in patients' profile and trauma mechanism. Level of Evidence III, Retrospective Comparative Study.
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Affiliation(s)
| | - ERICA DAMASCENO OLIVEIRA
- Hospital Geral de Fortaleza, Department of Orthopedic Surgery and Traumatology, Fortaleza, CE, Brazil
| | | | | | | | | | - RAMILLE LIMA ARAÚJO
- Centro Universitário Christus, Department of Odontology, Fortaleza, CE, Brazil
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McGuinness SL, Josphin J, Eades O, Clifford S, Fisher J, Kirkman M, Russell G, Hodgson CL, Kelsall HL, Lane R, Skouteris H, Smith KL, Leder K. Organizational responses to the COVID-19 pandemic in Victoria, Australia: A qualitative study across four healthcare settings. Front Public Health 2022; 10:965664. [PMID: 36249244 PMCID: PMC9557753 DOI: 10.3389/fpubh.2022.965664] [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: 06/10/2022] [Accepted: 09/07/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Organizational responses that support healthcare workers (HCWs) and mitigate health risks are necessary to offset the impact of the COVID-19 pandemic. We aimed to understand how HCWs and key personnel working in healthcare settings in Melbourne, Australia perceived their employing organizations' responses to the COVID-19 pandemic. Method In this qualitative study, conducted May-July 2021 as part of the longitudinal Coronavirus in Victorian Healthcare and Aged Care Workers (COVIC-HA) study, we purposively sampled and interviewed HCWs and key personnel from healthcare organizations across hospital, ambulance, aged care and primary care (general practice) settings. We also examined HCWs' free-text responses to a question about organizational resources and/or supports from the COVIC-HA Study's baseline survey. We thematically analyzed data using an iterative process. Results We analyzed data from interviews with 28 HCWs and 21 key personnel and free-text responses from 365 HCWs, yielding three major themes: navigating a changing and uncertain environment, maintaining service delivery during a pandemic, and meeting the safety and psychological needs of staff . HCWs valued organizational efforts to engage openly and honesty with staff, and proactive responses such as strategies to enhance workplace safety (e.g., personal protective equipment spotters). Suggestions for improvement identified in the themes included streamlined information processes, greater involvement of HCWs in decision-making, increased investment in staff wellbeing initiatives and sustainable approaches to strengthen the healthcare workforce. Conclusions This study provides in-depth insights into the challenges and successes of organizational responses across four healthcare settings in the uncertain environment of a pandemic. Future efforts to mitigate the impact of acute stressors on HCWs should include a strong focus on bidirectional communication, effective and realistic strategies to strengthen and sustain the healthcare workforce, and greater investment in flexible and meaningful psychological support and wellbeing initiatives for HCWs.
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Affiliation(s)
- Sarah L. McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Alfred Health, Melbourne, VIC, Australia,*Correspondence: Sarah L. McGuinness
| | - Johnson Josphin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Owen Eades
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sharon Clifford
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Maggie Kirkman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Grant Russell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Carol L. Hodgson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Alfred Health, Melbourne, VIC, Australia
| | - Helen L. Kelsall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Riki Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Karen L. Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Ambulance Victoria, Melbourne, VIC, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Royal Melbourne Hospital, Melbourne, VIC, Australia
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SANTOS DIEGODASILVA, BARROS EDIVANDOMOURA, HOSNI NICOLEDITTRICH, SCATIGNA BRUNOFRANCESCO, FALÓTICO GUILHERMEGUADAGNINI, TAKATA EDMILSONTAKEHIRO. IMPACT OF COVID-19 ON MORTALITY AND HOSPITALIZATION IN OLDER ADULTS WITH HIP FRACTURE. ACTA ORTOPÉDICA BRASILEIRA 2022; 30:e255298. [DOI: 10.1590/1413-785220223005e255298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022]
Abstract
ABSTRACT Objective: To evaluate the impact of the COVID-19 pandemic on hospital admission and mortality indicators in older adults with fractures of the proximal femur. Methods: Observational and retrospective study that took place from June 2016 to 2020. Patients of both genders who underwent surgical treatment for fractures of the proximal end of the femur, aged over 60 years, were included. Results: The population consisted of 379 patients, treated before (group 1; N = 278; 73.35%) and during the pandemic (group 2; N = 101; 26.65%). Higher mortality was observed in group 2 (N = 24; 23.8%) versus group 1 (N = 10; 3.6%), p < 0.001. The highest proportion of deaths in group 2 was maintained in patients aged 70-79 years (p = 0.011), 80-89 years (p ≤ 0.001) and > 90 years (p ≤ 0.001). In addition, the preoperative time and hospital stay were longer in group 2 compared to group 1 (p ≤ 0.001). Conclusion: The present study demonstrated that the pandemic period increased the mortality rate and the preoperative and hospitalization time in older patients with femur fractures. Thus, the pandemic has affected the care of fractures of the proximal femur in older adults, which reinforces the need to adopt measures to reduce complications and mortality. Level of Evidence II, Retrospective Study.
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Portela MC, de Aguiar Pereira CC, Lima SML, de Andrade CLT, Martins M. Patterns of hospital utilization in the Unified Health System in six Brazilian capitals: comparison between the year before and the first six first months of the COVID-19 pandemic. BMC Health Serv Res 2021; 21:976. [PMID: 34535135 PMCID: PMC8445784 DOI: 10.1186/s12913-021-07006-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/08/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To analyze the temporal evolution of the pattern of hospital use in the context of the COVID-19 pandemic in Brazil. METHODS This retrospective observational study compared hospital use and mortality in the Brazilian Unified Health System (SUS) in the first six months of the COVID-19 pandemic with the year before the onset of the pandemic in six Brazilian capitals (São Paulo, Rio de Janeiro, Manaus, Fortaleza, Recife, and Brasilia). It was based on secondary administrative data from the SUS Hospital Information System (SIH), focusing on the number of hospitalizations per fortnight, age, and gender of patients, hospital length of stay, and the proportions of surgical, elective, with the use of ICU, and resulting in death hospitalizations. It also compared the number of hospitalizations and mortality related to frequent diagnostic groups. RESULTS A significant drop was identified in the number of hospitalizations as of March 2020, with the first peak of COVID-19 hospitalizations in five capitals recorded in May 2020. In the six capitals, we observed significant reductions in the mean number of hospitalizations per fortnight from the beginning of the pandemic. We also identified an increase in the mean age of the patients and the proportion of male patients. The proportion of surgical and elective hospitalizations dropped significantly in all capitals, while the proportion of hospitalizations with ICU use increased significantly. Significant increases in-hospital mortality were also recorded in the six capitals with the pandemic, including or excluding COVID-19 hospitalizations from the comparison. CONCLUSION The pandemic caused changes in the pattern of use and hospital indicators in the first six months in the cities considered, evidencing the need for attention to diseases with a hospital production altered by the COVID-19 course and health system performance problems in the face of challenges.
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Affiliation(s)
- Margareth Crisóstomo Portela
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - Claudia Cristina de Aguiar Pereira
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sheyla Maria Lemos Lima
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Carla Lourenço Tavares de Andrade
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Mônica Martins
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Blum P, Putzer D, Liebensteiner MC, Dammerer D. Impact of the Covid-19 Pandemic on Orthopaedic and Trauma Surgery - A Systematic Review of the Current Literature. In Vivo 2021; 35:1337-1343. [PMID: 33910811 DOI: 10.21873/invivo.12386] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM The Coronavirus disease 2019 (COVID-19) has led to significant disruptions in various medical specialties. We herein aimed to provide a systematic review of the published literature on the impact by the Covid-19 pandemic on orthopaedic and traumatological care by focusing on the number of clinical visits, surgeries and reasons for consultation. MATERIALS AND METHODS The published literature was reviewed using PubMed. Of 349 studies published between December 1, 2019 and October 1, 2020, 36 original articles met the inclusion criteria. Articles were selected on the basis of the PRISMA guidelines. October 1, 2020 was used as the concluding date of publication. RESULTS The number of elective visits declined by 50.0% to 74.0%. The number of emergency and trauma visits showed a decrease of 37.7% to 74.2%. Trauma surgery decreased by 21.2% to 66.7% and elective surgeries by 33.3% to 100%. CONCLUSION Orthopaedic and trauma surgery is clearly influenced by the pandemic. It will be important to maintain treatment and surgical care of patients in order to avoid negative effects on treatment progress.
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Affiliation(s)
- Philipp Blum
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria;
| | - David Putzer
- Department of Experimental Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael C Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
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Motta Filho GDR, Leal AC, Amaral MVGD, Maia PAV, Duarte MEL, Bähr GL. Impact of the Strategies Adopted to Face the COVID-19 Pandemic in a Brazilian Reference Institute for High Complexity Surgery in Orthopedics and Traumatology. Rev Bras Ortop 2021; 56:161-167. [PMID: 33935311 PMCID: PMC8075648 DOI: 10.1055/s-0041-1728703] [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: 12/16/2020] [Accepted: 02/11/2021] [Indexed: 11/17/2022] Open
Abstract
COVID-19 pandemics required substantial reorganization and adaptation of healthcare services all over the world. This study aims to analyze the effect of operational strategies implemented in Brazil to manage the extra strain placed on healthcare services by the COVID-19 pandemic of 2020. In particular, this investigation examines the strategy to convert an institute specialized in elective orthopedic procedures of high complexity into a trauma unit for all musculoskeletal trauma patients of an entire federative unit. A retrospective study was conducted comparing hospital variables at the peak period of the pandemic (from March 16, 2020 to June 30, 2020) with the same period in 2019 as a comparative baseline. The variables analyzed included number of professionals away from work, surgeries performed, outpatient care, transfers, length of stay, number of patients diagnosed with COVID-19 and patient mortality. During the COVID-19 peak period, there was a 48.5% reduction in surgical productivity and 72.4% reduction in outpatient care compared with the same period in 2019. The number of transfers increased substantially (124.5%), while 94 confirmed cases and 77 suspected cases of COVID-19 were reported. The mortality rate increased by 245%. The present study highlighted the effect of COVID-19 on a tertiary orthopedic hospital. Despite the dramatic changes in hospital operations, due to the implementation of protocols to manage the pandemic, the results demonstrated the feasibility and efficiency of such protocols in prioritizing quality and safety for patients and the healthcare workforce.
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Affiliation(s)
| | - Ana Carolina Leal
- Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | | | | | - Maria Eugênia Leite Duarte
- Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Germana Lyra Bähr
- Programas Especiais, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
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Gupta N, Balcom SA, Gulliver A, Witherspoon RL. Health workforce surge capacity during the COVID‐19 pandemic and other global respiratory disease outbreaks: A systematic review of health system requirements and responses. Int J Health Plann Manage 2021. [PMCID: PMC8013474 DOI: 10.1002/hpm.3137] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Health system decision‐makers need comprehensive evidence to mitigate surges in the demand for human resources for health (HRH) during infectious disease outbreaks. This study aimed to assess the state of the evidence on policy and planning responses to HRH surge capacity during the coronavirus disease (COVID‐19) pandemic and other viral respiratory disease outbreaks of global significance in the 21st century. We systematically searched eight bibliographic databases to extract primary research articles published between January 2000 and June 2020 capturing temporal changes in health workforce requirements and responses surrounding respiratory virus pandemics. Following the Preferred Reporting Items for Systematic Reviews and Meta‐analyses standard, 16 studies met our inclusion criteria. Five focused on COVID‐19, three on H1N1, and eight modelled a hypothetical pandemic. Investigations of different training, mobilization, and redeployment options to address pandemic‐time health system capacity were reviewed; however, few scenarios drew on observational HRH data, and heterogeneity of study approaches and outcomes generally precluded comparability across contexts. Notable evidence gaps included occupational and psychosocial factors affecting healthcare workers' absenteeism and risk of burnout, gendered considerations of HRH capacity, evaluations in low‐ and lower‐middle income countries, and policy‐actionable assessments to inform post‐pandemic recovery and sustainability of services for noncommunicable disease management.
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Affiliation(s)
- Neeru Gupta
- University of New Brunswick Fredericton Canada
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