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Meisgeier A, Pienkohs S, Moosdorf L, Neff A. Impact of the COVID-19 pandemic on maxillofacial trauma surgery in Germany - implications from the national DRG database. Oral Maxillofac Surg 2024; 28:1241-1250. [PMID: 38600413 PMCID: PMC11330376 DOI: 10.1007/s10006-024-01248-9] [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: 09/28/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The COVID-19 pandemic has affected the personal and social lives of millions of people and also impacted the etiological factors of midfacial trauma such as falls, interpersonal violence or traffic accidents. The aim of this study was to analyze the influence of the COVID-19 pandemic on maxillofacial trauma surgery in the German healthcare system. METHODS Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system used in all German hospitals was received from the German Federal Statistical Office. Various trauma-associated procedures of the Operation and Procedure Classification System (OPS), a German modification of the International Classification of Medical Procedures (ICPM), were statistically associated with different epidemiological factors between 2012 and 2021. RESULTS A statistically significant decrease (p < 0.05) in surgeries regarding maxillofacial fractures was registered during the years 2020 and 2021. Young male patients had the largest decline in maxillofacial trauma surgeries during this period (p < 0.05). In contrast. elderly patients 80 years and older showed a dramatic increase in the frequency of fractures in both the midface and the mandible (p < 0.05). CONCLUSIONS During the COVID 19 pandemic there has been a shift in the number, composition and etiology of maxillofacial fracture surgeries. Measures of social distancing and personal risk avoidance had a societal positive effect on the frequency of facial injuries. This stands in contrast to the drastic increase in fractures of elderly people who should be protected primarily by the measures taken. These results can help to understand these influences better in future pandemics. TRIAL REGISTRATION German Clinical Trials Register No: DRKS00032778.
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Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany.
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany
| | - Laura Moosdorf
- Center for Orthopaedics and Trauma Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, Marburg, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany
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Anastasio AT, Chopra A, Ridenour RM, Cook CE, Fletcher AN, Parekh SG. Mechanism of Injury for Traumatic Mid-Foot Lisfranc Injuries: Impact of the COVID-19 Pandemic. Cureus 2024; 16:e58644. [PMID: 38770506 PMCID: PMC11104421 DOI: 10.7759/cureus.58644] [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: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Background During the COVID-19 pandemic, Americans transitioned away from their normal routines, drove in motor vehicles less, and reduced their physical activity, ultimately influencing the incidence and nature of orthopedic injuries that were operatively managed. The purpose of this study was to evaluate the effect of the COVID-19 pandemic lockdown and subsequent deconditioning on the mechanism of injury and severity of Lisfranc injury. Methods This retrospective study included patients with a traumatic Lisfranc injury who were surgically treated by a foot and ankle fellowship-trained orthopedic surgeon between 2015 and 2021. Electronic health records were queried for patient demographics, mechanism of injury, physical exam findings, and pain scores. Preoperative radiographs were reviewed to grade Lisfranc injuries using the previously described Nunley-Vertullo classification system. Descriptive and univariate statistics were performed to compare 15 patients in the pre-COVID-19 cohort and 15 patients in the post-COVID-19 cohort. Results In the pre-COVID-19 cohort, 80% (n=12/15) of the patients were female, the mean age was 46±15 years, the mean BMI was 29.7±7 kg/m2, and the mean follow-up period was 18.1±12 months. In the post-COVID-19 cohort, 53% (n=8/15) of the patients were female, the mean age was 48.5±17 years, the mean BMI was 31.4±7 kg/m2, and the mean follow-up period was 9.5±4 months. Significantly higher proportions of plantar ecchymosis (n=8/15, 53%), neuropathic pain (n=7/15, 47%), and swelling (n=12/15, 80%) were present in the post-COVID-19 cohort. A low-energy mechanism of injury was sustained by 73% (n=11/15) of the pre-COVID-19 cohort and 80% (n=12/15) of the post-COVID-19 cohort. Lisfranc injuries for the pre-COVID-19 cohort and the post-COVID-19 cohort demonstrated the following classifications: Grade 1 (33%, n=5/15 vs. 40%, n=6/15), Grade 2 (60%, n=9/15 vs. 53%, n=8/15), and Grade 3 (7%, n=1/15 vs. 7%, n=1/15). Conclusion Although a higher proportion of plantar ecchymosis, neuropathic pain, and swelling was observed, there was no association between a low mechanism of injury and a higher grade of Lisfranc injury following the COVID-19 pandemic.
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Affiliation(s)
| | - Aman Chopra
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Ryan M Ridenour
- Department of Orthopaedic Surgery, Greater Pittsburgh Orthopaedic Associates, Pittsburgh, USA
| | - Chad E Cook
- Department of Orthopaedic Surgery, Duke University, Durham, USA
| | | | - Selene G Parekh
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, South Brunswick, USA
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Nath U, Akbari AR, Alam B, Dahiya R, Pillai A. The Impact of the COVID-19 Pandemic and Lockdown on Adult Foot and Ankle Fractures Presenting to the Largest Trust in the United Kingdom. Cureus 2023; 15:e48262. [PMID: 38054152 PMCID: PMC10695078 DOI: 10.7759/cureus.48262] [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: 11/04/2023] [Indexed: 12/07/2023] Open
Abstract
Background The COVID-19 pandemic induced unprecedented changes in medical practices, prompting a reassessment of their impact on adult foot and ankle fractures within the National Health Service (NHS). This study employs a retrospective observational approach, leveraging the Pathpoint™ eTrauma platform for a comprehensive analysis of prospectively collected data. Methods Data encompassing weekly fracture incidence, weekly surgical procedures, patient demographics, and mean wait time from injury presentation to surgery were systematically evaluated. The study population included all adults (18+) admitted during five distinct periods: pre-pandemic, national lockdown 1, post-lockdown, national lockdown 2, and national lockdown 3. Results An analysis of 434 foot and ankle fractures revealed that national lockdown 1 exhibited the lowest fracture incidence (4.97 per week) and surgeries performed (4.77 per week), reflecting a notable reduction in trauma cases and elective procedures. Conversely, post-lockdown displayed the highest fracture incidence (7.46 per week) and surgeries performed (6.31 per week), suggesting a resurgence in both trauma and elective surgical activities. The pre-pandemic cohort, characterized by the highest mean age (51.98 years) and mean wait time (8.74 days), served as a temporal baseline. Conclusion While the incidence of fractures decreased during all three national lockdowns compared to pre-pandemic or post-lockdown periods, a gradual increase was observed in subsequent lockdowns. Notably, mean wait times showed a significant reduction, reaching the lowest point (5.79 days) during national lockdown 3. These findings underscore the complex interplay between pandemic-related disruptions, evolving guidelines, and adaptive measures within the healthcare system, influencing the dynamics of foot and ankle fracture management.
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Affiliation(s)
- Upamanyu Nath
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR
| | | | - Benyamin Alam
- Otolaryngology, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
| | - Rohan Dahiya
- Internal Medicine, Wythenshawe Hospital, Manchester, GBR
| | - Anand Pillai
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR
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Garcia-Ptacek S, Xu H, Annetorp M, Jerlardtz VB, Cederholm T, Engström M, Kivipelto M, Lundberg LG, Metzner C, Olsson M, Nyvang JS, Sühl Öberg C, Åkesson E, Religa D, Eriksdotter M. Temporal trends in hospitalizations and 30-day mortality in older patients during the COVID pandemic from March 2020 to July 2021. PLoS One 2023; 18:e0291237. [PMID: 37708110 PMCID: PMC10501674 DOI: 10.1371/journal.pone.0291237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/24/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND A reduction in mortality risk of COVID-19 throughout the first wave of the pandemic has been reported, but less is known about later waves. This study aimed to describe changes in hospitalizations and mortality of patients receiving inpatient geriatric care for COVID-19 or other causes during the pandemic. METHODS Patients 70 years and older hospitalized in geriatric hospitals in Stockholm for COVID-19 or other causes between March 2020-July 2021 were included. Data on the incidence of COVID-positive cases and 30-day mortality of the total ≥ 70-year-old population, in relation to weekly hospitalizations and mortality after hospital admissions were analyzed. Findings The total number of hospitalizations was 5,320 for COVID-19 and 32,243 for non-COVID-cases. In COVID-patients, the 30-day mortality rate was highest at the beginning of the first wave (29% in March-April 2020), reached 17% at the second wave peak (November-December) followed by 11-13% in the third wave (March-July 2021). The mortality in non-COVID geriatric patients showed a similar trend, but of lower magnitude (5-10%). During the incidence peaks, COVID-19 hospitalizations displaced non-COVID geriatric patients. INTERPRETATION Hospital admissions and 30-day mortality after hospitalizations for COVID-19 increased in periods of high community transmission, albeit with decreasing mortality rates from wave 1 to 3, with a probable vaccination effect in wave 3. Thus, the healthcare system could not compensate for the high community spread of COVID-19 during the pandemic peaks, which also led to displacing care for non-COVID geriatric patients.
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Affiliation(s)
- Sara Garcia-Ptacek
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
| | - Martin Annetorp
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | | | - Tommy Cederholm
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Engström
- Department of Geriatric Medicine, Sabbatsbergsgeriatriken, Stockholm, Sweden
| | - Miia Kivipelto
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Göran Lundberg
- Department of Geriatric Medicine, Dalengeriatriken Aleris Närsjukvård AB, Stockholm, Sweden
| | - Carina Metzner
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Olsson
- Department of Geriatric Medicine, Capio Geriatrik Löwet, Stockholm, Sweden
- Department of Geriatric Medicine, Capio Geriatrik Sollentuna, Stockholm, Sweden
| | | | - Carina Sühl Öberg
- Department of Geriatric Medicine, Handengeriatriken, Aleris Närsjukvård AB, Stockholm, Sweden
| | - Elisabet Åkesson
- Department of Neurobiology, Division of Neurogeriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Dorota Religa
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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Burdick GB, Beydoun RS, Bell KL, Fathima B, Pietroski AD, Warren JR, Wolterink TD, Kasto JK, Sanii RY, Muh S. Time-to-Surgery and Short-Term Outcomes of Trimalleolar Ankle Fracture During the COVID-19 Pandemic. Cureus 2023; 15:e44478. [PMID: 37791182 PMCID: PMC10544381 DOI: 10.7759/cureus.44478] [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: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction During the coronavirus disease 2019 (COVID-19) pandemic, a rapid and significant transformation in patient management occurred across the healthcare system in order to mitigate the spread of the disease and address resource constraints. Numerous surgical cases were either postponed or canceled, permitting only the most critical and emergent cases to proceed. The impact of these modifications on patient outcomes remains uncertain. The purpose of this study was to compare time-to-surgery and outcomes of open reduction and internal fixation for trimalleolar ankle fractures during the pandemic to a pre-pandemic group. We hypothesized that the pandemic group would have a prolonged time-to-surgery and worse outcomes compared to the pre-pandemic cohort. Materials and methods This retrospective cohort study was conducted within a single healthcare system, examining the treatment of trimalleolar ankle fractures during two distinct periods: April to July 2020 (COVID-19 group) and January to December 2018 (2018 group). Cases were identified using Current Procedural Terminology code 27822. Information on demographics, fracture characteristics, and outcomes was obtained through chart review. Outcomes analyzed included time-to-surgery, mean visual analog scale scores, ankle strength and range of motion, and complications. Results COVID-19 and 2018 groups consisted of 32 and 100 patients, respectively. No significant difference was observed in group demographics and comorbidities (p > 0.05). Fracture characteristics were similar between groups apart from tibiofibular syndesmosis injury, 62.5% (20/32) in COVID-19 vs 42.0% (42/100) in 2018 (p = 0.03). Time-to-surgery was not significantly different between the two groups (8.84 ± 6.78 days in COVID-19 vs 8.61 ± 6.02 days in 2018, p = 0.85). Mean visual analog scale scores, ankle strength, and ankle range of motion in plantarflexion were not significantly different between the two groups at three and six months postoperatively (p > 0.05). Dorsiflexion was significantly higher in the COVID-19 group at three months (p = 0.03), but not six months (p = 0.94) postoperatively. No significant difference in postoperative complication was seen between groups, 25.0% (8/32) COVID-19 group compared to 15.0% (15/100) 2018 group (p = 0.11). Conclusions Patients who underwent surgery during the early months of the COVID-19 pandemic did not experience prolonged time-to-surgery and had similar outcomes compared to patients treated prior to the pandemic.
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Affiliation(s)
- Gabriel B Burdick
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, USA
| | - Rami S Beydoun
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, USA
| | - Kerri L Bell
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA
| | - Bushra Fathima
- Department of Neurosurgery, Yale School of Medicine, New Haven, USA
| | | | - Jonathan R Warren
- Department of Orthopaedic Surgery, University of Missouri Kansas City, Kansas City, USA
| | - Trevor D Wolterink
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, USA
| | - Johnny K Kasto
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA
| | - Ryan Y Sanii
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA
| | - Stephanie Muh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA
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Heinz T, Wild M, Eidmann A, Weißenberger M, Rak D, Nedopil AJ, Rudert M, Stratos I. Impact of COVID-19 on Fracture Incidence in Germany: A Comparative Age and Gender Analysis of Pre- and Post-Outbreak Periods. Healthcare (Basel) 2023; 11:2139. [PMID: 37570379 PMCID: PMC10418784 DOI: 10.3390/healthcare11152139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
In March 2020, Germany imposed a nationwide lockdown to curb the spread of COVID-19, prompting questions about the impact on the incidence of common fractures. This study examined 15 fracture types in pre-outbreak (2010-2019) and post-outbreak (2020-2021) periods, using data categorized by age (18-64 years, >65 years) and sex (male, female). Linear regression assessed annual growth rates, and mean fracture numbers were compared across periods for significant differences. Results indicated a positive correlation between fracture incidence rates and time for various types, such as cervical, thoracic, lumbar, and pelvic spine fractures, rib fractures, femoral neck, pertrochanteric femur, femoral shaft, and ankle fractures. Frequencies of proximal humerus, distal radius, femoral neck, pertrochanteric femur, femoral shaft, and ankle fractures in 2020 and 2021 were within predicted ranges from previous years. However, rib fractures and spinal fractures (cervical, thoracic, lumbar, and pelvic spine) occurred less frequently during this time. Notably, this study found a consistent decline in most fracture types for individuals aged 18-64 after the pandemic's onset, while the fracture incidence of hip fractures, often referred to as fragility fractures, for those over 65 remained unchanged. Fibula fractures showed the most considerable decrease in both age groups. In conclusion, the COVID-19 pandemic substantially impacted fracture incidence, with lower rates among individuals under 65 and unchanged fragility fractures in the elderly population.
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Affiliation(s)
- Tizian Heinz
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Moritz Wild
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Annette Eidmann
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Manuel Weißenberger
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Dominik Rak
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Alexander Johannes Nedopil
- Department of Orthopedic Surgery, Orthopedic Surgeon Adventist Health Lodi Memorial, Lodi, CA 95240, USA;
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Ioannis Stratos
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
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Surís X, Vela E, Clèries M, Llargués E, Camins J, Larrosa M. Effects of COVID-19 confinement on the incidence and mortality of major osteoporotic fractures: an observational study in Catalonia, Spain. Arch Osteoporos 2022; 17:150. [PMID: 36441292 PMCID: PMC9702769 DOI: 10.1007/s11657-022-01193-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
There is little information on how the COVID-19 lockdown influenced the epidemiology of major osteoporotic fractures (MOF). We analyzed the incidence and mortality of MOF in 2020 compared with 2018-2019 in Catalonia, Spain. The incidence of MOF decreased steeply, and post-fracture mortality increased during the lockdown and throughout 2020. PURPOSE To analyze the effect of the COVID-19 pandemic and lockdown on major osteoporotic fracture (MOF) incidence and mortality in Catalonia in 2020 and describe how age, sex, and the prior comorbidity burden influenced the epidemiology of MOF types. METHODS In this retrospective observational study, data on age and sex in people aged ≥ 50 years with a new diagnosis of MOF in 2018, 2019, and 2020 were collected. Average daily rates (ADR) were estimated overall and for five MOF: hip, distal forearm, proximal humerus, vertebrae, and pelvis. Morbidity was assessed using Adjusted Morbidity Groups. ADR in 2020 and the previous years were compared for overall and site-specific MOF in four consecutive time periods: pre-confinement, lockdown, deconfinement, and post-confinement. Thirty-day post-fracture mortality was assessed. COVID-19-related mortality was obtained from the Catalan COVID-19 register. RESULTS From 2018 to 2020, there were 86,412 MOF. The ADR of MOF initially increased in 2020 before the pandemic, decreased steeply during lockdown, and remained lower in the rest of the year. The decrease was steeper in vertebral, pelvic and arm fractures, and lower in hip fractures. Differences were more pronounced in younger age groups and people with fewer comorbidities. Mortality increased throughout 2020, reaching a 2.5-fold increase during lockdown. Excess mortality was directly associated with COVID-19. CONCLUSIONS Mobility restrictions due to COVID-19 were associated with a reduction in MOF incidence in Catalonia, especially in younger people and in non-hip fractures. Post-fracture mortality was higher than in previous years due to the high COVID-19 mortality in the elderly.
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Affiliation(s)
- Xavier Surís
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain.
- Rheumatology Department, Hospital General de Granollers, C/ Francesc Ribas SN 08400, Granollers, Barcelona, Spain.
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
- Catalan Health Service, Barcelona, Spain.
| | - Emili Vela
- Knowledge and Information Unit, Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System, Barcelona, Spain
| | - Montserrat Clèries
- Knowledge and Information Unit, Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System, Barcelona, Spain
| | - Esteve Llargués
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
- Internal Medicine Department, Hospital General de Granollers, Granollers, Spain
| | - Jordi Camins
- Rheumatology Department, Hospital General de Granollers, C/ Francesc Ribas SN 08400, Granollers, Barcelona, Spain
| | - Marta Larrosa
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain
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Rydberg EM, Insulan J, Rolfson O, Mohaddes M, Ahlstrom L. Knowledge support for ankle fractures in the Swedish Fracture Register - a qualitative study of physicians' experiences. BMC Health Serv Res 2022; 22:382. [PMID: 35321701 PMCID: PMC8941301 DOI: 10.1186/s12913-022-07799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study is to investigate the experiences of physicians presented with a knowledge support system while registering data on ankle fractures in the Swedish Fracture Register. The present study aims to answer the following research questions: • “How is receiving knowledge support while registering a fracture in the Swedish Fracture Register experienced by the physicians using it?”. • “Can a feeling of increased usability of a quality register be achieved by providing the user with real-time feedback?”. Methods A total of 20 physicians using the Swedish Fracture Register were recruited using a purposive sampling strategy. Qualitative content analysis was performed on individual semi-structured interviews performed in May and June 2020. Results The present study demonstrates that the knowledge support system in the Swedish Fracture Register was perceived by the physicians as strengthening the evidence base and improving the quality of ankle fracture treatment. The knowledge support system was evaluated as a good tool for validating clinical decisions and managing the information that needs to be processed to make informed decisions. Conclusions The present study affirms that being provided with knowledge support is appreciated by physicians, increase value for work and enhance the initiative to register. The physicians experienced that the knowledge support provided an appreciated validation of the clinical decisions taken and a feeling of improved care. When incorporating knowledge support into an NQR, consideration must be given to physicians’ fears of becoming overly reliant on a template and losing control of the clinical base.
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Affiliation(s)
- Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Göteborgsvägen 31, SE-431 80 Mölndal, Gothenburg, Sweden.
| | - Johan Insulan
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Rolfson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Göteborgsvägen 31, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Maziar Mohaddes
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Göteborgsvägen 31, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Linda Ahlstrom
- Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Göteborgsvägen 31, SE-431 80 Mölndal, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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9
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NYGREN H, KOPRA J, KRÖGER H, KUITUNEN I, MATTILA VM, PONKILAINEN V, RIKKONEN T, SUND R, SIROLA J. The effect of COVID-19 lockdown on the incidence of emergency department visits due to injuries and the most typical fractures in 4 Finnish hospitals. Acta Orthop 2022; 93:360-366. [PMID: 35257188 PMCID: PMC8902588 DOI: 10.2340/17453674.2022.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE COVID-19 lockdowns have affected personal mobility and behavior worldwide. This study compared the number of emergency department (ED) visits due to injuries and typical low-energy fractures in Finland during the COVID-19 lockdown period in spring 2020 to the reference period in 2019. PATIENTS AND METHODS The data was collected retrospectively from the electronic patient records of 4 hospitals covering 1/5 of the Finnish population. We included the patients who were admitted to a hospital ED due to any injury during the lockdown period (March 18-May 31, 2020) and the reference period (March 18-May 31, 2019). We compared the differences between the average daily ED admissions in the 2 years using the zero-inflated Poisson regression model. RESULTS The overall number of ED visits due to injuries decreased by 16% (mean 134/day vs. 113/day, 95% CI -18 to -13). The number of ED visits due to wrist fractures decreased among women aged over 50 years by 40% (CI -59 to -9). Among women, the number of ED visits due to ankle fractures decreased by 32% (CI -52 to -5). The number of ED visits due to fractures of the upper end of the humerus decreased by 52% (CI -71 to -22) among women. The number of ED visits due to hip fractures increased by 2% (CI -16 to 24). INTERPRETATION Restrictions in personal mobility decreased the number of ED visits due to injuries during the pandemic. The effect can mainly be seen as a decreased number of the most typical low-energy fractures among women. In contrast, lockdown restrictions had no effect on the number of hip fractures.
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Affiliation(s)
- Henri NYGREN
- University of Eastern Finland, School of Medicine, Kuopio
| | - Juho KOPRA
- University of Eastern Finland, School of Medicine, Kuopio
| | - Heikki KRÖGER
- University of Eastern Finland, School of Medicine, Kuopio,Kuopio University Hospital, Kuopio
| | - Ilari KUITUNEN
- University of Eastern Finland, School of Medicine, Kuopio,Mikkeli Central Hospital, Mikkeli
| | - Ville M MATTILA
- Department of Orthopaedics, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere
| | | | - Toni RIKKONEN
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio
| | - Reijo SUND
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio
| | - Joonas SIROLA
- University of Eastern Finland, School of Medicine, Kuopio,Kuopio University Hospital, Kuopio
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Möller M, Wolf O, Bergdahl C, Mukka S, Rydberg EM, Hailer NP, Ekelund J, Wennergren D. The Swedish Fracture Register - ten years of experience and 600,000 fractures collected in a National Quality Register. BMC Musculoskelet Disord 2022; 23:141. [PMID: 35148730 PMCID: PMC8832767 DOI: 10.1186/s12891-022-05062-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Before the creation of the Swedish Fracture Register (SFR), there was no national quality register that prospectively collects data regarding all types of fractures regardless of treatment in an emergency setting. Observational data on fractures registered in a sustainable way may provide invaluable tools for quality improvements in health care and research. DESCRIPTION Ten years after its implementation, the Swedish Fracture Register has 100% coverage among orthopaedic and trauma departments in Sweden. The completeness of registrations reached in 2020 69-96% for hip fractures at the different departments, with the majority reporting a completeness above 85%. The Swedish Fracture Register is a fully web-based national quality register created and run by orthopaedic professionals, with financial support from public healthcare providers and the government. All users have full access to both the registration platform and all aggregated statistics in real time. The web-based platform was created for use in health quality registers and it has easily gained acceptance among users. The register has gradually developed by the addition of more fracture types and skeletal parts. Research activity is high and 31 scientific publications have been published since 2016. The strategy from the start was to publish validation data and basic epidemiological data. However, over the past few years, publications on outcomes, such as re-operations and mortality, have been published and four register-based, randomised, controlled trials are ongoing. CONCLUSION It is possible to create a fracture register, to gain professional acceptance and to collect fracture data in a sustainable way on a national level if the platform is easy to use. Such a platform can also be used as a randomisation platform for prospective studies.
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Affiliation(s)
- Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden.
| | - Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Carl Bergdahl
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Science (Orthopaedics), Umeå University, Umeå, Sweden
| | - Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Jan Ekelund
- Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
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