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Chan SL, Zhang AY, Lam SSW, Rao V, Kanagalingam D, Tan HK, Chow PKH, Mathur S. The impact of elective surgery postponement during COVID-19 on emergency bellwether procedures in a large tertiary centre in Singapore. Int J Qual Health Care 2024; 36:mzae022. [PMID: 38506629 PMCID: PMC10958764 DOI: 10.1093/intqhc/mzae022] [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: 09/19/2023] [Revised: 01/26/2024] [Accepted: 03/20/2024] [Indexed: 03/21/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic drove many healthcare systems worldwide to postpone elective surgery to increase healthcare capacity, manpower, and reduce infection risk to staff. The aim of this study was to assess the impact of an elective surgery postponement policy in response to the COVID-19 pandemic on surgical volumes and patient outcomes for three emergency bellwether procedures. A retrospective cohort study of patients who underwent any of the three emergency procedures [Caesarean section (CS), emergency laparotomy (EL), and open fracture (OF) fixation] between 1 January 2018 and 31 December 2021 was conducted using clinical and surgical data from electronic medical records. The volumes and outcomes of each surgery were compared across four time periods: pre-COVID (January 2018-January 2020), elective postponement (February-May 2020), recovery (June-November 2020), and postrecovery (December 2020-December 2021) using Kruskal-Wallis test and segmented negative binomial regression. There was a total of 3886, 1396, and 299 EL, CS, and OF, respectively. There was no change in weekly volumes of CS and OF fixations across the four time periods. However, the volume of EL increased by 47% [95% confidence interval: 26-71%, P = 9.13 × 10-7) and 52% (95% confidence interval: 25-85%, P = 3.80 × 10-5) in the recovery and postrecovery period, respectively. Outcomes did not worsen throughout the four time periods for all three procedures and some actually improved for EL from elective postponement onwards. Elective surgery postponement in the early COVID-19 pandemic did not affect volumes of emergency CS and OF fixations but led to an increase in volume for EL after the postponement without any worsening of outcomes.
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Affiliation(s)
- Sze Ling Chan
- Health Services Research Centre, SingHealth, 20 College Road, Academia, Level 6, Singapore 169856, Singapore
- Health Services & Systems Research, Duke–NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Alwin Yaoxian Zhang
- Division of Surgery & Surgical Oncology, National Cancer Centre Singapore and Singapore General Hospital, 30 Hospital Boulevard, Singapore 168583, Singapore
| | - Sean Shao Wei Lam
- Health Services Research Centre, SingHealth, 20 College Road, Academia, Level 6, Singapore 169856, Singapore
- Health Services & Systems Research, Duke–NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Vijaya Rao
- SingHealth Duke–NUS Global Health Institute, 8 College Road, Singapore 169857, Singapore
- International Collaboration Office, SingHealth, 168 Jalan Bukit Merah, #11-01 Surbana One, Singapore 150168, Singapore
| | - Devendra Kanagalingam
- Division of Surgery & Surgical Oncology, National Cancer Centre Singapore and Singapore General Hospital, 30 Hospital Boulevard, Singapore 168583, Singapore
- Department of Obstetrics & Gynaecology, Singapore General Hospital, 20 College Road, Academia, Level 5, Singapore 169856, Singapore
| | - Hiang Khoon Tan
- Division of Surgery & Surgical Oncology, National Cancer Centre Singapore and Singapore General Hospital, 30 Hospital Boulevard, Singapore 168583, Singapore
- SingHealth Duke–NUS Global Health Institute, 8 College Road, Singapore 169857, Singapore
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA
| | - Pierce Kah Hoe Chow
- Division of Surgery & Surgical Oncology, National Cancer Centre Singapore and Singapore General Hospital, 30 Hospital Boulevard, Singapore 168583, Singapore
- Surgery Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Sachin Mathur
- Division of Surgery & Surgical Oncology, National Cancer Centre Singapore and Singapore General Hospital, 30 Hospital Boulevard, Singapore 168583, Singapore
- Department of General Surgery, Singapore General Hospital, 20 College Road, Academia, Level 5, Singapore 169856, Singapore
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Butler LR, Abbott E, Mengsteab P, Dominy CL, Poeran J, Allen AK, Ranade SC. Epidemiology of pediatric trauma and fractures during and beyond the COVID-19 pandemic. J Child Orthop 2023; 17:322-331. [PMID: 37560351 PMCID: PMC10285363 DOI: 10.1177/18632521231180161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/01/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Previous literature has shown decreases in pediatric trauma during the COVID-19 outbreak, but few have analyzed beyond the peak of the pandemic. This study assesses the epidemiology of pediatric trauma cases in a high-volume teaching hospital in New York City before, during, and after the height of the COVID-19 pandemic. METHODS Institutional data on pediatric trauma orthopedic cases from January 1, 2018 to November 30, 2021 were extracted. The following time frames were studied: (1) April 1-June 22 in 2018 and 2019 (pre-pandemic), (2) April 1-June 22, 2020 (peak pandemic), and (3) April 1-June 22, 2021 (post-peak pandemic). Inferential statistics were used to compare patient and trauma characteristics. RESULTS Compared to the pre-pandemic cohort (n = 6770), the peak pandemic cohort (n = 828) had a greater proportion of fractures (p < 0.01) and had a significantly decreased overall traumas per week rate (p < 0.01) and fractures per week rate (p < 0.01). These decreased trauma (p < 0.01) and fracture rates (p < 0.01) persisted for the post-peak pandemic cohort (n = 2509). Spatial analysis identified zip code clusters throughout New York City with higher rates of emergency department presentation during the peak pandemic compared to pre-pandemic, and these areas aligned with lower-income neighborhoods. CONCLUSION During the peak of the pandemic, overall trauma and fracture volumes decreased, the types of prevalent injuries changed, and neighborhoods of different economic resources were variably impacted. These trends have mostly persisted for 12 months post-peak pandemic. This longitudinal analysis helps inform and improve long-term critical care and public health resource allocation for the future. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Liam R Butler
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Erin Abbott
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Paulos Mengsteab
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Calista L Dominy
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jashvant Poeran
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Abigail K Allen
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Sheena C Ranade
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Konda SR, Esper GW, Meltzer-Bruhn AT, Ganta A, Egol KA. Hip Fracture Care during COVID-19: Evolution through the Pandemic. Cureus 2023; 15:e42696. [PMID: 37654921 PMCID: PMC10465306 DOI: 10.7759/cureus.42696] [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: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION The purpose of this epidemiologic study was to analyze the care provided by our institution to middle-aged and geriatric hip fracture patients throughout the pandemic to examine for any differences compared to pre-pandemic care and across the pandemic stages. METHODS Consecutive patients >55 years old treated for hip fractures at our institution between October 2014 and January 2022 were analyzed for demographics, coronavirus disease 2019 (COVID-19) and vaccination status at admission, injury characteristics, hospital quality measures, and outcomes. Patients were divided into three separate cohorts: Pre-COVID-19 (PRECOV), COVID-19 Pre-Vaccine (PREVAX), and COVID-19 Post-Vaccine (POSTVAX). A sub-analysis removed COVID-19-positive patients across the study period. Comparative analyses were conducted. RESULTS A total of 2,633 hip fracture patients were included. For the overall cohort, there was no difference in the rate of inpatient deaths between the PRECOV, PREVAX, and POSTVAX cohorts (p=0.278). PRECOV had a significantly lower 30-day mortality rate compared to PREVAX or POSTVAX (p=0.012). Differences in complication rates for surgical site infection, urinary tract infection, and anemia (p<0.01 for all) were seen between cohorts. PRECOV had the longest length of hospital stay (p<0.01). PREVAX patients required more ICU level of care (p<0.01). When removing COVID-19-positive patients, all three cohorts had similar inpatient (p=0.872) and 30-day mortality rates (p=0.130). CONCLUSION The care of patients treated for hip fractures did not change throughout the pandemic at our institution. The elevated mortality rate due to the effects of COVID-19 seen in the pre-vaccine cohort decreased over time as the understanding of COVID-19 improved and the vaccine was introduced. We recommend continuation of the same hip fracture care protocols as used pre-pandemic.
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Affiliation(s)
- Sanjit R Konda
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Garrett W Esper
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Ariana T Meltzer-Bruhn
- Medical School, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Abhishek Ganta
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Kenneth A Egol
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
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Solé Florensa P, González Sanchez J, Gil Torrano A, Peroy Garcia J, Jové Talavera R, Mas Atance J. [Translated article] Impact of COVID-19 pandemia on spine surgery in 2nd level hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T255-T262. [PMID: 36863518 PMCID: PMC9974204 DOI: 10.1016/j.recot.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. OBJECTIVES The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. METHODS We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. RESULTS We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. CONCLUSION The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.
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Affiliation(s)
- P Solé Florensa
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
| | - J González Sanchez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - A Gil Torrano
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Peroy Garcia
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - R Jové Talavera
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Mas Atance
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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Lang S, Walter N, Schindler M, Baertl S, Szymski D, Loibl M, Alt V, Rupp M. The Epidemiology of Spondylodiscitis in Germany: A Descriptive Report of Incidence Rates, Pathogens, In-Hospital Mortality, and Hospital Stays between 2010 and 2020. J Clin Med 2023; 12:jcm12103373. [PMID: 37240479 DOI: 10.3390/jcm12103373] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Spondylodiscitis can lead to significant morbidity and mortality. Understanding its up-to-date epidemiological characteristics and trends is important to improve patient care. METHODS This study analyzed trends in the incidence rate of spondylodiscitis cases in Germany between 2010 and 2020, as well as the pathogens, in-hospital mortality rate, and length of hospital stay. Data were obtained from the Federal Statistical Office and the Institute for the Hospital Remuneration System database. The ICD-10 codes "M46.2-", "M46.3-" and "M46.4-" were evaluated. RESULTS The incidence rate of spondylodiscitis increased to 14.4/100,000 inhabitants, with 59.6% cases occurring in patients 70 years or older and affecting mainly the lumbar spine (56.2%). Absolute case numbers increased from 6886 by 41.6% to 9753 in 2020 (IIR = 1.39, 95% CI 0.62-3.08). Staphylococci and Escherichia coli were the most coded pathogens. The proportion of resistant pathogens was 12.9%. In-hospital mortality rates increased to a maximum of 64.7/1000 patients in 2020, intensive care unit treatment was documented in 2697 (27.7%) cases, and the length of stay per case was 22.3 days. CONCLUSION The sharply increasing incidence and in-hospital mortality rate of spondylodiscitis highlights the need for patient-centered therapy to improve patient outcomes, especially in the geriatric, frail population, which is prone to infectious diseases.
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Affiliation(s)
- Siegmund Lang
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Nike Walter
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Melanie Schindler
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Susanne Baertl
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
- Centrum für Muskuloskeletale Chirurgie, Universitätsmedizin Berlin, Charitéplatz1, 10117 Berlin, Germany
| | - Dominik Szymski
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Markus Loibl
- Department of Spine Surgery, Schulthess Clinic Zurich, Lenghalde 2, 8008 Zurich, Switzerland
| | - Volker Alt
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Markus Rupp
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Muacevic A, Adler JR. The Effect of the COVID-19 Pandemic on the Characteristics of Inpatients at the Orthopaedics and Traumatology Clinic in a Secondary Care Public Hospital in Turkey. Cureus 2023; 15:e34706. [PMID: 36755768 PMCID: PMC9902808 DOI: 10.7759/cureus.34706] [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: 01/31/2023] [Indexed: 02/10/2023] Open
Abstract
Objective The aim of this study was to evaluate patients who were hospitalized at an orthopaedics and traumatology clinic in a secondary care public hospital in Turkey during the first two years of the COVID-19 pandemic. Methods This was a cross-sectional and retrospective study that included a total of 7439 patients - those who had been hospitalized between 11 March 2020, the date of the first confirmed case of COVID-19 in Turkey, and 10 March 2022 (2949 patients), and those hospitalized in the same clinic between 11 March 2018 and 10 March 2020, designated as the pre-pandemic group (control group; 4490 patients). Patients were divided into three groups: <18 years old, 18-65 years old and >65 years old and compared separately in terms of clinical, diagnostic and therapeutic characteristics as pandemic patients and control group. Results Despite the decline in both the number of admissions to the emergency service and visits to the outpatient clinic among inpatients during the pandemic period, the rate of admissions to the emergency department remained higher than that of the control group throughout the pandemic period (p<0.001). Surgical procedures were lower both numerically and proportionally in the patients who presented during the pandemic than in the pre-pandemic period (p<0.001). While the rate of traumatic surgery was higher in the pandemic group (29%) than in the pre-pandemic group (26.7%), the rate of elective surgery was higher in the pre-pandemic group (71.3%) than in the pandemic one (67.5%) (p=0.037 and p=0.001).The number of patients with fractures in all age groups decreased numerically in the pandemic cohort. While no significant difference was observed between pandemic and pre-pandemic cohorts in terms of the length of hospitalization in all age groups, Intensive Care Unit (ICU) hospitalization rate was found to have increased significantly in adult and elderly patient groups during the pandemic (p<0.001). Conclusion In our study, when the number of patients who underwent orthopaedic surgical treatment, in general, was examined, it appeared that the number of both traumatic and elective surgeries decreased during the pandemic significantly. It was found that the ICU stay rate increased significantly in adult and elderly patient groups during the pandemic. Although there were no confirmed cases of COVID-19 among the patients included in the study, it is known that the pandemic and especially the lockdown periods adversely affected the mental, physical and biological health of individuals. In this context our study will be able to serve as a guide for taking measures like: 1. increasing the ICU capacity of hospitals, 2. providing in-service training to improve the experience of nurses, doctors or other healthcare workers, especially in specialized units such as ICUs, operating rooms and emergency services, considering the number of personnel who may be affected by the pandemic, and 3. ensuring a balanced distribution of orthopaedic operations in private and public hospitals, to reduce the negative effects on orthopaedic health services of other pandemics that may arise in the future.
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Solé Florensa P, González Sanchez J, Gil Torrano A, Peroy Garcia J, Jové Talavera R, Mas Atance J. Impact of COVID-19 pandemia on spine surgery in 2nd level hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022:S1888-4415(22)00348-4. [PMID: 36494012 PMCID: PMC9724500 DOI: 10.1016/j.recot.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. OBJECTIVES The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. METHODS We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. RESULTS We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. CONCLUSION The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.
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Puttock DR, Howard DP, Eastley NC, Ashford RU. Apparent trends in the use of femoral megaprostheses: an analysis from the National Joint Registry. ARTHROPLASTY (LONDON, ENGLAND) 2022; 4:50. [PMID: 36451228 PMCID: PMC9713154 DOI: 10.1186/s42836-022-00150-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/16/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Megaprosthetic replacement (MPR) of the femur is typically reserved for salvage or oncological reconstruction. Presently little is known about the provision of femoral MPRs performed nationally, the trends in indications for their use, and their outcomes beyond published unit-level data. Although the National Joint Registry (NJR) collects data as part of a mandatory arthroplasty audit process, MPR data entry on this platform is thought to be inconsistent. The aim of this study is to determine current trends for femoral MPR procedures as submitted to the NJR. METHODS Data for all procedures submitted to the NJR using the following implants were extracted: METS (Stanmore/Stryker), MUTARS (Implantcast), Segmental (Zimmer), GMRS (Stryker) and MEGA C (LINK). Pseudoanonymized data were analyzed through the NJR's research Data Access Portal and are reported using descriptive statistics. RESULTS A total of 1781 procedures were identified. Submitted cases increased for primary and revision hip and knee categories over the study period, although they plateaued in recent years. MPR implants were most commonly used in revision hip arthroplasty procedures. MPR use for the management of peri-prosthetic fractures has increased and now represents the most commonly reported indication for MPR use in both hip and knee revision categories. Few centers submitted large MPR case volumes (which were noted to be lower than published unit case series, indicating NJR under-reporting), and the vast majority of centers submitting MPR cases did so in low volume. CONCLUSIONS Due to the limitations identified, reported case volumes must be interpreted with caution. An MPR-specific NJR data entry form has been developed to allow more accurate and tailored reporting of MPR procedures, to support specialist service provision, and to provide meaningful data for future research.
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Affiliation(s)
- Darren R. Puttock
- grid.269014.80000 0001 0435 9078Leicester Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - Daniel P. Howard
- grid.269014.80000 0001 0435 9078Leicester Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - Nicholas C. Eastley
- grid.269014.80000 0001 0435 9078Leicester Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - Robert U. Ashford
- grid.269014.80000 0001 0435 9078Leicester Orthopaedics, University Hospitals of Leicester, Leicester, UK
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Vicenti G, Bizzoca D, Pesare E, Grasso M, Ginestra W, Moretti B. Second and Third Pandemic Waves in Apulia: How COVID-19 Affected Orthopedic and Trauma Care-A Single-Center Study. J Clin Med 2022; 11:6526. [PMID: 36362754 PMCID: PMC9654803 DOI: 10.3390/jcm11216526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/24/2022] [Accepted: 10/31/2022] [Indexed: 07/30/2023] Open
Abstract
PURPOSE In orthopedics and traumatology, as a direct consequence of the COVID-19 first wave, there was a massive reorganization and a stop to all elective activities, which were postponed. In this study, we aimed to analyze the impact of the COVID-19 pandemic on orthopedic surgery in Apulia during the second wave, from March to June 2021 (when Apulia was under social distancing restrictions), and during the third wave, from September to December 2021 (when Apulia was under no restrictions). We compared these months to the same periods in 2019 for an evaluation of the surgical decrease during the pandemic period. METHODS We performed a retrospective analysis of major orthopedic procedures, day-surgery procedures and urgent procedures (trauma and non-traumatic amputation) performed during the second and third waves of the pandemic in our clinic, and we compared these data with the same procedures performed in the corresponding periods of 2019, before the pandemic. RESULTS Surgical activity was significantly decreased during both periods; the only increase in surgical activity in 2021 compared to 2019 was in total hip, knee and shoulder arthroplasty, with a surge of +7.69% registered in the period September-December 2021. CONCLUSIONS Longer waiting lists and limited healthcare resources were the big challenges for the orthopedic community, and they still represent a substantial issue to confront today.
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Affiliation(s)
- Giovanni Vicenti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Davide Bizzoca
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
- PhD Program in Public Health, Clinical Medicine and Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Elisa Pesare
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Michele Grasso
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Walter Ginestra
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Biagio Moretti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
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Morri M, Ruisi R, Peccerillo V, Franchini N, Magli AO, Forni C. The impact of the pandemic on functional outcomes for joint replacement patients: An observational study. Medicine (Baltimore) 2022; 101:e30395. [PMID: 36086684 PMCID: PMC10980505 DOI: 10.1097/md.0000000000030395] [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: 04/27/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Elective surgeries, as joint replacement, were resumed after the first COVID-19 pandemic wave in 2020 and a phase of coexistence with the virus began. Surgery was organized in a new way that incorporated procedures aimed at reducing the risk of spreading the virus. The aim of this study is to describe the early functional results for patients undergoing hip and knee replacements at the time healthcare services were being reopened and to compare them with the same outcomes recorded in the prepandemic period. This is a controlled retrospective study. All patients consecutively admitted during 2020 and who underwent hip and knee replacement were enrolled in the study. Patient records from January to March 2020 constituted the prepandemic control group, while patient records from May to December 2020 constituted the study group. Functional recovery was described through the patient's ability to walk using antebrachial devices and to climb up and down 3 steps. The day after surgery on which these activities were first performed was also recorded. The prepandemic group consisted of 183 patients and the pandemic group of 280 patients. The mean age of patients was 66 years (±13.1), female was 44.9% and hip replacement was 66.5%. The number of patients who climbed stairs and the timing thereof was comparable for the 2 groups (68.5% vs 72.2%, respectively; P = .403). There was no significant difference in the incidence of patients able to walk with antebrachial device and incidence of pressure ulcers and major complications. Multivariate analysis confirmed that the incidence of stair climbing was not associated with the prepandemic or pandemic inclusion. During the reopening of orthopedic surgery activity, the reorganization and treatment pathway did not affect the functional outcome achieved by patients underwent joint replacement. Constant monitoring of the functional outcomes will be required so as to further increase the number of joint replacement surgeries.
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Affiliation(s)
- Mattia Morri
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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11
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Althaqeel MF, Alshanwani MN, Alqahtani K, Khan MS, Zeidan ZA, Mohaideen NK, Albahooth K, Altassan W, Alzoman ASA, Alkhaldi AS. The effect of disruption due to COVID-19 on operating room utilization: Experience from a secondary care hospital in Riyadh, Saudi Arabia. J Family Med Prim Care 2022; 11:5226-5230. [PMID: 36505539 PMCID: PMC9731053 DOI: 10.4103/jfmpc.jfmpc_1707_21] [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: 08/25/2021] [Revised: 12/08/2021] [Accepted: 02/20/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction/Background The disruption caused due to corona virus disease-2019 (Covid-19) has affected the overall health care delivery worldwide. The elective services were foremost to face the restrictions and closure, subsequently they were resumed only after adoption on newer protocols. Aims We aimed to estimate the effect of COVID-19 restrictions on operative room utilization. Methodology This is a retrospective descriptive study. The surgical volume indicators were calculated and a comparison was made between pre-COVID-19 (April-June 2019) and COVID-19 phase (April-June, 2020). Pre-operative covid assessment through the RT-PCR test among the cases waiting for elective surgeries. Results Overall surgical volume decreased by 53%, which included 87% decrease in elective procedures and 8% decrease in emergency procedures. The overall OR utilization reduced by 63%. Highest reduction in the surgical volume was noted in bariatric surgery (no surgeries conducted in the COVID-19 phase), ophthalmology (99% reduction), and Ear, Nose and Throat surgery (ENT) surgery (92% reduction). Six patients tested positive for pre-operative RT-PCR from the sample of 261 cases posted for elective surgery during resumption phase of elective services, thereby giving the positivity rate of about 2.2%. Conclusion We found a high level of reduction in the operating room utilization in a secondary care public sector hospital. The pre-operative assessment has enabled to find out the COVID-19 cases and hence preventing the unwanted spread of infection during the surgical procedures.
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Affiliation(s)
- Mamdouh F. Althaqeel
- Consultant Family and Community Medicine/General Hospital Director, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Mohammad N. Alshanwani
- Consultant Department of General Surgery, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Khalid Alqahtani
- Consultant Department of Pediatric Surgery, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Mohammad Shibly Khan
- Specialist Community Medicine, Data Warehouse Department, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia,Address for correspondence: Dr. Mohammad Shibly Khan, King Salman bin Abdulaziz Hospital, 6687, Aishah Bint Abibakr, Aluraija Alwusta, Riyadh 12769, Saudi Arabia. E-mail:
| | - Zeidan A. Zeidan
- Consultant Community Medicine, Infection Control Department, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Noorulzaman K. Mohaideen
- Public Health Specialist, Data warehouse Department, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Khalid Albahooth
- Consultant Department of General Surgery, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Walid Altassan
- Specialist Department of General Surgery, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Assem S. A. Alzoman
- Consultant Anesthesia, King Salman Hospital, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
| | - Abdulaziz S. Alkhaldi
- Specialist Department of General Surgery, Riyadh First Central Health Cluster, Riyadh, Saudi Arabia
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12
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Frio GS, Russo LX, de Albuquerque CP, da Mota LMH, Barros-Areal AF, Oliveira APRA, Firmino-Machado J, da Silva EN. The disruption of elective procedures due to COVID-19 in Brazil in 2020. Sci Rep 2022; 12:10942. [PMID: 35768482 PMCID: PMC9243075 DOI: 10.1038/s41598-022-13746-5] [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: 09/28/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
Elective procedures were temporarily suspended several times over the course of the pandemic of COVID-19. Monthly data from the Unified Health System (SUS) were used for the period between January 2008 and December 2020 and the interrupted time series method was used to estimate the effect of the pandemic on the number of elective surgeries and elective procedures that were not performed. Considering a 9-month period, a reduction of 46% in the number of elective procedures carried out in the SUS could be attributed to COVID-19, corresponding to about 828,429 elective procedures cancelled, ranging from 549,921 to 1,106,936. To a full recovery of pre-pandemic performance, SUS would need to increase about 21,362 hospital beds, ranging from 12,370 to 36,392 hospital beds during a 6 month-period. This effort would represent an increase of 8.48% (ranging from 4.91 to 14.45%) in relation to the total number of SUS’s hospital beds in 2019. As a result, the pandemic will leave a large number of elective procedures to be carried out, which will require efforts by health agencies to meet this demand.
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Affiliation(s)
- Gustavo Saraiva Frio
- Graduate Program in Collective Health, Faculty of Health Science, University of Brasilia, Brasília, Brazil.,Catholic University of Pelotas, Pelotas, Brazil
| | - Letícia Xander Russo
- Department of Economics, Federal University of Grande Dourados, Dourados, Brazil.
| | - Cleandro Pires de Albuquerque
- Graduate Program in Medical Science, Faculty of Medicine, University Hospital of Brasília, University of Brasilia, Brasília, Brazil
| | | | - Adriana Ferreira Barros-Areal
- Graduate Program in Medical Science, Health Department of the Federal District (SES/DF), Faculty of Medicine, University of Brasilia, Brasília, Brazil
| | | | - João Firmino-Machado
- Faculty of Medicine, Institute of Public Health (ISPUP), University of Porto, Porto, Portugal
| | - Everton Nunes da Silva
- Graduate Program in Collective Health, Faculty of Health Science, Faculty of Ceilândia, University of Brasilia, Brasília, Brazil
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Hsu CH, Huang HT, Chen CH, Fu YC, Chou PH, Hsu NC. Global Impact of the COVID-19 Pandemic on Orthopedics and the Implications of Telemedicine: A Systematic Review of the Literature. J Clin Med 2022; 11:jcm11112983. [PMID: 35683371 PMCID: PMC9181233 DOI: 10.3390/jcm11112983] [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: 04/14/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to systematically review the literature on the impact of the coronavirus disease (COVID-19) pandemic on the orthopedics field by focusing on multiple aspects, including orthopedic training and application, performance, work loading, change of practice, research work, and other psychological factors. Published articles were searched using the PubMed database. Articles were selected in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 58 studies published between 1 January 2020 and 1 October 2021, 57 peer-reviewed original articles were included. Nearly 90% of students experienced an impact of the pandemic on application. The impact on training stemmed from redeployment rates of 20.9–23.1%. The rate of emergency or outpatient visits decreased from 18% to 58.6%. The rates of all surgeries or emergency surgeries decreased by 15.6–49.4%, while the rates of elective surgeries decreased by 43.5–100%. The rate of work loading ranged from 33% to 66%. Approximately 50–100% of surgeons had a change of practice. A total of 40.5% of orthopedic surgeons experienced mild psychological pressure. Approximately 64% had stopped research participant recruitment. Most of the included studies were conducted in Europe, followed by Asia and North America. It is suggested orthopedic surgeons prepare more sufficient, flexible, and reservable staffing measures, proper preventive strategies and surgical scheduling algorithms, and set up dedicated venues and equipment for routine telemedicine with staff training for virtual teaching or consultations in case of future impacts on orthopedics.
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Affiliation(s)
- Chia-Hao Hsu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan; (C.-H.H.); (C.-H.C.); (P.-H.C.)
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, No. 68, Jhonghua 3rd Rd., Cianjin District, Kaohsiung 80145, Taiwan;
- Department of Orthopedics, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd., Sanmin District, Kaohsiung 80756, Taiwan;
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan
| | - Hsuan-Ti Huang
- Department of Orthopedics, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd., Sanmin District, Kaohsiung 80756, Taiwan;
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan
| | - Chung-Hwan Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan; (C.-H.H.); (C.-H.C.); (P.-H.C.)
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, No. 68, Jhonghua 3rd Rd., Cianjin District, Kaohsiung 80145, Taiwan;
- Department of Orthopedics, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd., Sanmin District, Kaohsiung 80756, Taiwan;
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan
| | - Yin-Chih Fu
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, No. 68, Jhonghua 3rd Rd., Cianjin District, Kaohsiung 80145, Taiwan;
- Department of Orthopedics, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd., Sanmin District, Kaohsiung 80756, Taiwan;
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan
| | - Pei-Hsi Chou
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan; (C.-H.H.); (C.-H.C.); (P.-H.C.)
- Department of Orthopedics, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd., Sanmin District, Kaohsiung 80756, Taiwan;
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan
| | - Nin-Chieh Hsu
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng District, Taipei 10002, Taiwan
- Correspondence: ; Tel.: +886-2-23123456 (ext. 65130)
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14
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Vatsya P, Garika SS, Mittal S, Trikha V, Sharma V, Malhotra R. Lockdown imposition due to COVID-19 and its effect on orthopedic emergency department in level 1 trauma center in South Asia. J Clin Orthop Trauma 2022; 28:101826. [PMID: 35345869 PMCID: PMC8942879 DOI: 10.1016/j.jcot.2022.101826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The coronavirus pandemic brought the entire world to a standstill. One of the most stringent lockdowns in the world was implemented in India. With the entire healthcare system being stretched, emergency orthopaedic services also take a hit. We studied the trends in patient presentation, testing, management, and restructuring of doctors at a tertiary care orthopaedic centre and compared them with the data from the same time period the previous year (2019). METHOD Data was collected separately for all the 5 different phases of lockdown and unlock, as well as for the same duration of months in 2019, and was analysed for epidemiological trends. RESULTS A rapid fall in the total number of cases was seen during the lockdown, followed by a skewed rise during the unlock. Forearm, wrist, and hip fractures were the most common fractures. Once nucleic acid testing of all patients intended to be admitted was started, a steep rise in coronavirus positivity was seen. There was a reduction in the total number of cases compared to 2019, but it was not as significant as would have been expected due to the complete standstill of activity during the lockdown. CONCLUSION During a pandemic, with the healthcare system under a crisis of workforce and infrastructure, there needs to be a separate task force for catering to orthopaedic emergencies since all fractures cannot be managed conservatively and the numbers of trauma-related patients did not show a stark fall as compared to normal months of last year. LEVEL OF EVIDENCE Level 3 Retrospective Case Series.
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15
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Usman M, Tarar MY, Toe KKZ, Iqbal M, Kempanna V, Gill I. Evolving Practice in Management of Pelvic-Acetabular Trauma: COVID-19 Experience From a Tertiary Referral Centre in the UK. Cureus 2021; 13:e18778. [PMID: 34796067 PMCID: PMC8590463 DOI: 10.7759/cureus.18778] [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] [Accepted: 10/13/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The United Kingdom was one of the hardest-hit countries during the COVID-19 Pandemic. The UK government announced three national lockdowns to control the spread of the coronavirus and prevent the NHS from getting overburdened with COVID-19 related attendances. Two of the most significant peaks in terms of COVID-19 related hospitalizations and COVID-19 related deaths were in Summer 2020 (corresponding to lockdown 1, which was in effect from 26th March to 26th May 2020) and early 2021 (corresponding to lockdown 3, which was in effect 6th January to 8th March 2021). During this time, a significant proportion of NHS resources was being diverted towards the treatment of COVID-19 patients. Measures were being taken to prevent unnecessary hospitalizations and reduce patient contact. These included but were not limited to measures to reduce attendances to Emergency departments, introducing telemedicine clinics, and pausing elective services. Our hospital is a Major Trauma Centre providing Tertiary Pelvic trauma service to the Greater Manchester area and the North West of England. We conducted this retrospective comparative study to compare the trends in presentation and Management of Pelvic trauma and identify trends in how these changed throughout the pandemic. We want to share these insights with our readers. Methodology We conducted a retrospective comparative study by comparing two cohorts of patients, patients presenting to the Pelvic Trauma service during Lockdown 1 and Lockdown 3 in the UK, named Group A and Group B, respectively. Data on patient demographics, injuries, and their management was identified from the Electronic Patient Record System. The data analysis was carried out with the aid of Stata/IC version 16.1. using descriptive Statistics. Results Group A contained 19 patients, with a mean age of 66.9 years. Group B contained 23 patients with a mean age of 67.4 years. There was no statistically significant difference in these patients' population demographics, injury patterns, and management (operative vs conservative). However, there was an absolute reduction in the complication rate from Group A to Group B of 17.2% (26.3% vs 9.1%). The higher complication rate during Lockdown 1 can be explained by conservatively managing Pelvic and Acetabular Fractures that would have been eligible for fixation, had COVID-19 not been a factor. Conclusions Within the limitations of our study, it appears that operatively managing a carefully selected cohort of acute Pelvic Trauma patients with proper precautions was safe and effective. It is unclear whether there was an added benefit to having a higher threshold to operate and adopting the watch-and-wait policy in Lockdown 1. We recommend continuing to follow the current evidence and fix these fractures early.
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Affiliation(s)
- Muhammad Usman
- Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Manchester, GBR
| | | | - Ko Ko Zayar Toe
- Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Manchester, GBR
| | - Mohammad Iqbal
- Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Manchester, GBR
| | - Vijaya Kempanna
- Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Manchester, GBR
| | - Inder Gill
- Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Manchester, GBR
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16
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The effect of physical and social isolation due to the COVID-19 pandemic on the incidence of hip fractures among senior citizens. Geriatr Nurs 2021; 43:21-25. [PMID: 34798310 PMCID: PMC8531412 DOI: 10.1016/j.gerinurse.2021.10.018] [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: 08/25/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/04/2022]
Abstract
This study aimed to explore the effects of the lockdown due to the coronavirus disease 2019 pandemic on the incidence and characteristics of hip fracture in older adults. Data from the three-month lockdown period and the corresponding period in the previous year were obtained from the computerized medical records of a large acute-care hospital. No significant differences were observed in the absolute and relative numbers of hip fractures. There were no significant differences in terms of socio-demographic and clinical characteristics, which are considered risk factors for falls. Similarly, there was no difference in the length of time between admission and surgery and the mean length of hospital stay. Compared to the previous year, there was a significantly higher incidence of hip fractures in older adults living alone during the lockdown. Health policy should provide social support and monitoring of healthcare, particularly to older adults living alone.
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Dell'Isola A, Kiadaliri A, Turkiewicz A, Hughes V, Magnusson K, Runhaar J, Bierma-Zeinstra S, Englund M. The impact of first and second wave of COVID-19 on knee and hip surgeries in Sweden. J Exp Orthop 2021; 8:60. [PMID: 34389919 PMCID: PMC8363236 DOI: 10.1186/s40634-021-00382-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To investigate the impact of COVID-19 in Sweden on rates of knee and hip surgeries. METHODS We used healthcare data for the population of the southernmost region in Sweden (1.4 million inhabitants). We did an interrupted time-series analysis to estimate changes in rates and trends of joint replacements (JR), arthroscopies, and fracture surgeries for knee or hip in April-December 2020 compared to pre-COVID-19 levels adjusting for seasonal variations. RESULTS We found a drop of 54% (95% CI 42%; 68%) and 42% (95% CI 32%; 52%), respectively, in the rate of JRs and arthroscopies in April 2020 when compared to the counterfactual scenario. This was followed by an increase that brought the rates of JRs and arthroscopies back to their predicted levels also during the beginning of the second wave (November-December 2020). Acute fracture surgeries were largely unaffected, i.e. did not show any decrease as observed for the other surgeries. CONCLUSIONS In southern Sweden, we observed a marked decrease in elective knee and hip surgeries following the first wave of Covid-19. The rates remained close to normal during the beginning of the second wave suggesting that important elective surgeries for patients with end-stage osteoarthritis can still be offered despite an ongoing pandemic provided adequate routines and hospital resources.
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Affiliation(s)
- Andrea Dell'Isola
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden.
| | - Ali Kiadaliri
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden.,Centre for Economic Demography, Lund University, Lund, Sweden
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden
| | - Velocity Hughes
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden
| | - Karin Magnusson
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden.,Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sita Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden
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