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Bancsik K, Ilea CDN, Daina MD, Bancsik R, Șuteu CL, Bîrsan SD, Manole F, Daina LG. Patient-Perceived Quality Assessment in Orthopedics and Traumatology Departments during COVID-19 Pandemic. Healthcare (Basel) 2024; 12:879. [PMID: 38727436 PMCID: PMC11083493 DOI: 10.3390/healthcare12090879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
The COVID-19 pandemic has led to significant disruptions in various healthcare systems. In Romania, the elective procedures in the orthopedic and traumatology specialty were one of the most affected. The study aims to investigate the influence of the COVID-19 pandemic on patient perceptions of quality in these departments. Standardized assessment tools were used, which consist of satisfaction questionnaires addressed to patients in order to assess the quality of health services in orthopedics and traumatology departments. Thus, a retrospective study was conducted using satisfaction questionnaires addressed to patients admitted to the orthopedics and traumatology departments of the County Clinical Emergency Hospital Bihor between January 2019 and December 2022. Eight reports, based on 746 questionnaires conducted during the studied period, were evaluated. To gauge patient satisfaction, Likert scales featuring five response options were used. A total of 627 questionnaires were valid, the exclusion criteria being incomplete questionnaires (the patients did not respond on all questions, n = 119). Four domains were analyzed: demographic data, hotel conditions, quality of medical care, and overall satisfaction. Demographic data highlight that patients exhibited an equitable distribution across residences, with 50.2% hailing from urban locales, while 53.5% (n = 333) were female. Regarding the overall impression, in 2020, there was a decline in the top rating of 5 compared to 2019, dropping to just 45.10% from 53.45%. Scores of 4 increased to 41.83%, while scores of 3 stayed under 8.5%. Scores of 2 and 1 were negligible. In 2021 and 2022, we can observe a sustained increase in the number of patients who awarded 5 points for overall impression and a decrease in the number of patients who awarded 4 points compared to previous years. The maximum difference between 2020 and 2021 and the period before and after this period was 27.24% (p-value < 0.001). The results indicate that while overall impressions of the hospital remained positive throughout the studied period, there were notable fluctuations in satisfaction levels during the pandemic. Patient satisfaction with attending physicians dipped in 2020 from 86.70% to 77.78% but recovered by 2022. The same trend can be observed with nurses and caregivers, as well as hotel services, during this period. These findings underscore the importance of addressing patient concerns and improving the quality of care delivery, particularly during times of crisis.
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Affiliation(s)
- Karoly Bancsik
- Faculty of Medicine and Pharmacy, Doctoral School of Biomedical Sciences, University of Oradea, 1 December Sq., 410081 Oradea, Romania;
| | - Codrin Dan Nicolae Ilea
- Faculty of Medicine and Pharmacy, Doctoral School of Biomedical Sciences, University of Oradea, 1 December Sq., 410081 Oradea, Romania;
| | - Mădălina Diana Daina
- Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania
| | - Raluca Bancsik
- Clinical Emergency Hospital “Avram Iancu”, 410027 Oradea, Romania
| | - Corina Lacramioara Șuteu
- Department of Psycho-Neurosciences and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania
| | - Simona Daciana Bîrsan
- Department of Psycho-Neurosciences and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania
| | - Felicia Manole
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania;
| | - Lucia Georgeta Daina
- Department of Psycho-Neurosciences and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania
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Casella G, Beretta M, Costa F, Opizzi D, Pompini P, Posla S, Sanfratello R, Guasconi M, Merlini C. Experiences of newly hired nurses during the Covid-19 emergency: descriptive qualitative research. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023168. [PMID: 37326265 PMCID: PMC10308466 DOI: 10.23750/abm.v94i3.14343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIM OF THE WORK The Covid-19 pandemic led to an increased demand for healthcare professionals, particularly nurses. The Piacenza Local Health Service, Northern Italy, issued several calls for tenders in order to recruit nurses and the University anticipated graduation sessions, so several new graduates nurses found themselves facing their first work experience in the middle of the pandemic emergency. It is well known that being a first-time employee causes stress, but there are few studies yet investigating the perception of newly employed nurses during the pandemic. The aim of this research is therefore to describe the experience of these nurses. METHODS A descriptive qualitative study was conducted through interviews. The research was approved by the 'Area Vasta Emilia Nord Ethics Committee. RESULTS 14 nurses were interviewed and nine themes were found. Emotions, awareness, job opportunities, professional liability, organisational aspects and relationship with the other. CONCLUSIONS Our study shows how stress, anxiety and feelings of inadequacy characterise new nurses' entry into the workplace. Emotional support strategies, such as counselling and emergency preparedness training, could help early career professionals to cope with complex and emotionally charged clinical care situations with greater resilience. STUDY REGISTRATION ClinicalTrials.gov Identifier: NCT05110859.
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Affiliation(s)
- Giovanna Casella
- "Azienda Unità Sanitaria Locale" (Local Health Service) di Piacenza, Piacenza, Italy; University of Parma, Department of Medicine and Surgery, Parma, Italy; .
| | - Maurizio Beretta
- "Azienda Unità Sanitaria Locale" (Local Health Service) di Piacenza, Piacenza, Italy; University of Parma, Department of Medicine and Surgery, Parma, Italy;.
| | - Francesca Costa
- "Azienda Unità Sanitaria Locale" (Local Health Service) di Piacenza, Piacenza, Italy; University of Parma, Department of Medicine and Surgery, Parma, Italy; .
| | - Daniela Opizzi
- "Azienda Unità Sanitaria Locale" (Local Health Service) di Piacenza, Piacenza, Italy; University of Parma, Department of Medicine and Surgery, Parma, Italy; .
| | - Pierangela Pompini
- "Azienda Unità Sanitaria Locale" (Local Health Service) di Piacenza, Piacenza, Italy; University of Parma, Department of Medicine and Surgery, Parma, Italy; .
| | - Sara Posla
- "Azienda Unità Sanitaria Locale" (Local Health Service) di Piacenza, Piacenza, Italy; University of Parma, Department of Medicine and Surgery, Parma, Italy; .
| | - Rosaria Sanfratello
- "Azienda Unità Sanitaria Locale" (Local Health Service) di Piacenza, Piacenza, Italy; University of Parma, Department of Medicine and Surgery, Parma, Italy; .
| | - Massimo Guasconi
- "Azienda Unità Sanitaria Locale" (Local Health Service) di Piacenza, Piacenza, Italy; University of Parma, Department of Medicine and Surgery, Parma, Italy; .
| | - Cinzia Merlini
- "Azienda Unità Sanitaria Locale" (Local Health Service) di Piacenza, Piacenza, Italy; University of Parma, Department of Medicine and Surgery, Parma, Italy; .
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ALENCAR NETO JONATASBRITODE, OLIVEIRA ERICADAMASCENO, BRANCO MÁRCIOCARVALHOCASTELO, OZÓRIO RENANGALVÃO, SOUSA ANTÔNIOANDERSONFONSECADE, CAVALCANTE MARIALUZETECOSTA, ARAÚJO RAMILLELIMA. THE IMPACT OF COVID-19 ON THE EPIDEMIOLOGICAL PROFILE OF FRACTURES. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e252472. [PMID: 36451796 PMCID: PMC9670789 DOI: 10.1590/1413-785220223005e252472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/12/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To analyze the epidemiological transition of fractures in patients who were treated in a tertiary hospital which is reference in traumatology during the COVID-19 pandemic to assess the changes in trauma service. METHODS This is a retrospective and descriptive analysis of data on orthopedics lesions treated at Instituto Doutor Jose Frota between December 16, 2019 and June 16, 2020 (three months before and after the first case of COVID-19 in Ceará). RESULTS In total, we evaluated 913 patients, 28.5% of which were women and 71.5%, men. We found a significative reduction (p < 0.05) in the proportion of female patients operated in the analyzed time. We also observed an increase in patients' mean age, 35.4 years before the pandemic, and 38.48 (p = 0.04) during the consecutive period. Trauma mechanisms significantly changed (p < 0.05), with a proportional increase of high-energy traumas and reduction of instances of falling. We found a 11.9% reduction in orthopedic surgeries, from 655 to 577 at the time after the first case of COVID-19 (p = 0.071). Mean hospitalization length (p < 0.001) and time until surgeries decreased (p < 0.001). CONCLUSION We observed the impact of lockdown in this hospital of trauma especially via the decreased number of operated cases and the change in patients' profile and trauma mechanism. Level of Evidence III, Retrospective Comparative Study.
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Affiliation(s)
| | - ERICA DAMASCENO OLIVEIRA
- Hospital Geral de Fortaleza, Department of Orthopedic Surgery and Traumatology, Fortaleza, CE, Brazil
| | | | | | | | | | - RAMILLE LIMA ARAÚJO
- Centro Universitário Christus, Department of Odontology, Fortaleza, CE, Brazil
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From the Triage to the Intermediate Area: A Simple and Fast Model for COVID-19 in the Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138070. [PMID: 35805727 PMCID: PMC9266218 DOI: 10.3390/ijerph19138070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022]
Abstract
Introduction: The early identification of patients with SARS-CoV-2 infection is still a real challenge for emergency departments (ED). First, we aimed to develop a score, based on the use of the lung ultrasonography (LUS), in addition to the pre-triage interview, to correctly address patients; second, we aimed to prove the usefulness of a three-path organization (COVID-19, not-COVID-19 and intermediate) compared to a two-path organization (COVID-19, non-COVID-19). Methods: We retrospectively analysed 292 patients admitted to our ED from 10 April to 15 April 2020, with a definite diagnosis of positivity (93 COVID-19 patients) or negativity (179 not-COVID-19 patients) for SARS-COV-2 infection. Using a logistic regression, we found a set of predictors for infection selected from the pre-triage interview items and the LUS findings, which contribute with a different weight to the final score. Then, we compared the organization of two different pathways. Results: The most informative factors for classifying the patient are known nasopharyngeal swab positivity, close contact with a COVID-19 patient, fever associated with respiratory symptoms, respiratory failure, anosmia or dysgeusia, and the ultrasound criteria of diffuse alveolar interstitial syndrome, absence of B-lines and presence of pleural effusion. Their sensitivity, specificity, accuracy, and AUC-ROC are, respectively, 0.83, 0.81, 0.82 and 0.81. The most significant difference between the two pathways is the percentage of not-COVID-19 patients assigned to the COVID-19 area, that is, 10.6% (19/179) in the three-path organization, and 18.9% (34/179) in the two-path organization (p = 0.037). Conclusions: Our study suggests the possibility to use a score based on the pre-triage interview and the LUS findings to correctly manage the patients admitted to the ED, and the importance of an intermediate area to limit the spread of SARS-CoV-2 in the ED and, as a consequence, in the hospital.
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An analysis of the dynamic spatial spread of COVID-19 across South Korea. Sci Rep 2022; 12:9364. [PMID: 35672439 PMCID: PMC9171729 DOI: 10.1038/s41598-022-13301-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/23/2022] [Indexed: 11/08/2022] Open
Abstract
The first case of coronavirus disease 2019 (COVID-19) in South Korea was confirmed on January 20, 2020, approximately three weeks after the report of the first COVID-19 case in Wuhan, China. By September 15, 2021, the number of cases in South Korea had increased to 277,989. Thus, it is important to better understand geographical transmission and design effective local-level pandemic plans across the country over the long term. We conducted a spatiotemporal analysis of weekly COVID-19 cases in South Korea from February 1, 2020, to May 30, 2021, in each administrative region. For the spatial domain, we first covered the entire country and then focused on metropolitan areas, including Seoul, Gyeonggi-do, and Incheon. Moran's I and spatial scan statistics were used for spatial analysis. The temporal variation and dynamics of COVID-19 cases were investigated with various statistical visualization methods. We found time-varying clusters of COVID-19 in South Korea using a range of statistical methods. In the early stage, the spatial hotspots were focused in Daegu and Gyeongsangbuk-do. Then, metropolitan areas were detected as hotspots in December 2020. In our study, we conducted a time-varying spatial analysis of COVID-19 across the entirety of South Korea over a long-term period and found a powerful approach to demonstrating the current dynamics of spatial clustering and understanding the dynamic effects of policies on COVID-19 across South Korea. Additionally, the proposed spatiotemporal methods are very useful for understanding the spatial dynamics of COVID-19 in South Korea.
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Miranda I, Sangüesa-Nebot MJ, González A, Doménech J. Impact of strict population confinement on fracture incidence during the COVID-19 pandemic. Experience from a public Health Care Department in Spain. J Orthop Sci 2022; 27:677-680. [PMID: 33933326 PMCID: PMC8081314 DOI: 10.1016/j.jos.2021.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND the COVID-19 pandemic has led to drastic "stay-at-home" measures for the population. The aim of this study was to know the influence of the population strict confinement on the presentation of the different types of fracture as well as on the needs of hospital admission by the Orthopedic Surgery and Traumatology Service. METHODS a retrospective observational analytical descriptive study was carried out on the population attended in the Emergency Services of two general hospitals in a public Health Care Department in Spain. Data were studied from the two-months confinement period in 2020 and compared with the same period in 2018 and 2019. RESULTS A total of 56,332 emergency cases were included. There was a decrease in the total number of patients attended along the confinement period compared to the same period in the two previous years. Fracture cases decreased by 58,8% in the confinement period (330 in 2020; 715 in 2018 and 884 in 2019). Also there was a 37,6% reduction in fractures needing admission or surgery. The percentage distribution of the types of fractures that required admission resulted in a decrease in upper and lower limb fractures, whereas the number of vertebral and hip fractures remained unchanged. CONCLUSIONS both the reduction of fractures attended in the emergency department and the maintenance of the number of hip fractures must be taken into account when establishing contingency plans in the event of a pandemic situation in order to properly plan human resources and materials.
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Affiliation(s)
- Ignacio Miranda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova y Hospital de Liria, Valencia, Spain,Health Care Department Arnau-Lliria, Valencia, Spain,Corresponding author. Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, C/ Sant Climent 12, 46015 Valencia, Spain
| | - María José Sangüesa-Nebot
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova y Hospital de Liria, Valencia, Spain,Health Care Department Arnau-Lliria, Valencia, Spain
| | - Antonio González
- Health Care Department Arnau-Lliria, Valencia, Spain,Clinical Documentation Department, Hospital Arnau de Vilanova. Valencia, Spain
| | - Julio Doménech
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova y Hospital de Liria, Valencia, Spain,Health Care Department Arnau-Lliria, Valencia, Spain
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Changes in acute and trauma hand surgery in the first Covid-19 lockdown in a German trauma center: a retrospective analysis of 338 cases. Arch Orthop Trauma Surg 2022; 142:1289-1299. [PMID: 35179633 PMCID: PMC8854483 DOI: 10.1007/s00402-021-04319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/14/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Although Covid-19 and especially lockdown periods have affected our everyday live, its impact on hand traumatology is under investigated. MATERIALS AND METHODS We retrospectively analyzed all patients presenting at a FESSH accredited HTRC and level 1 trauma center in Germany during the Covid-19 lockdown period and an equivalent timeframe in 2019 regarding incidence of hand trauma, injury mechanism, type of injury and hand surgeries. RESULTS 338 patients presented at our department with acute hand injuries. A significant reduction of work-related accidents was found during lockdown contrary to an increase of do-it-yourself related trauma. Although the incidence of hand trauma decreased during lockdown by 18%, the rate of hand surgery increased in absolute and relative numbers. CONCLUSIONS Although Covid-19 has negatively impacting elective and semi-elective surgeries, acute hand surgery has gained in importance represented by a shift from work related to do-it-yourself trauma and an increased rate of surgical treatment. LEVEL OF EVIDENCE IV (therapeutic).
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Lugli G, Ottaviani MM, Botta A, Ascione G, Bruschi A, Cagnazzo F, Zammarchi L, Romagnani P, Portaluri T. The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review. Mediterr J Hematol Infect Dis 2022; 14:e2022012. [PMID: 35070219 PMCID: PMC8746940 DOI: 10.4084/mjhid.2022.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Italy has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy. METHODS A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19. RESULTS Of the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine. CONCLUSIONS Our work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.
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Affiliation(s)
- Gianmarco Lugli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Matteo Maria Ottaviani
- Department of Neurosurgery, University Politecnica delle Marche, Ancona, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Alessandro Bruschi
- Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Infectious and Tropical Disease, University Hospital Careggi, Florence, Italy
| | - Paola Romagnani
- Nephrology and Dialysis Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Tommaso Portaluri
- IN Srl, Udine, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
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Testa G, Sapienza M, Rabuazzo F, Culmone A, Valenti F, Vescio A, Pavone V. Comparative study between admission, orthopaedic surgery, and economic trends during Covid-19 and non-Covid-19 pandemic in an Italian tertiary hospital: a retrospective review. J Orthop Surg Res 2021; 16:601. [PMID: 34654447 PMCID: PMC8517555 DOI: 10.1186/s13018-021-02754-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/24/2021] [Indexed: 12/26/2022] Open
Abstract
Background The COVID-19 pandemic represents one of the most massive health emergencies in the last century and has caused millions of deaths worldwide and a massive economic and social burden. The aim of this study was to evaluate how the COVID-19 pandemic—during the Italian lockdown period between 8 March and 4 May 2020—influenced orthopaedic access for traumatic events to the Emergency Department (ER). Methods A retrospective review of the admission to the emergency room and the discharge of the trauma patients’ records was performed during the period between 8 March and 4 May 2020 (block in Italy), compared to the same period of the previous year (2019). Patients accesses, admissions, days of hospitalisation, frequency, fracture site, number and type of surgery, the time between admission and surgery, days of hospitalisation, and treatment cost according to the diagnosis-related group were collected. Chi-Square and ANOVA test were used to compare the groups. Results No significant statistical difference was found for the number of emergency room visits and orthopaedic hospitalisations (p < 0.53) between the year 2019 (9.5%) and 2020 (10.81%). The total number of surgeries in 2019 was 119, while in 2020, this was just 48 (p < 0.48). A significant decrease in the mean cost of orthopaedic hospitalisations was detected in 2020 compared (261.431 euros, equal to − 52.07%) relative to the same period in 2019 (p = 0.005). Although all the surgical performances have suffered a major decline, the most frequent surgery in 2020 was intramedullary femoral nailing. Conclusion We detected a decrease in traumatic occasions during the lockdown period, with a decrease in fractures in each district and a consequent decrease in the diagnosis-related group (DRG).
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Affiliation(s)
- Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Fabrizia Rabuazzo
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Annalisa Culmone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Fabiana Valenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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Lee Y, Kirubarajan A, Patro N, Soon MS, Doumouras AG, Hong D. Impact of hospital lockdown secondary to COVID-19 and past pandemics on surgical practice: A living rapid systematic review. Am J Surg 2021; 222:67-85. [PMID: 33218675 PMCID: PMC7657940 DOI: 10.1016/j.amjsurg.2020.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted surgical practice worldwide. There is widespread concern for surgeon and provider safety, and the implications of hospital lockdown on patient care during epidemics. METHODS Medline, EMBASE, CENTRAL, and PubMed were systematically searched from database inception to July 1, 2020 and ongoing monthly surveillance will be conducted. We included studies that assessed postoperative patient outcomes or protection measures for surgical personnel during epidemics. RESULTS We included 61 studies relevant to the COVID-19 pandemic and past epidemics. Lockdown measures were noted globally including cancellation of elective surgeries and outpatient clinics. The pooled postoperative complication rate during epidemics was 21.0% among 2095 surgeries. 31 studies followed the health of surgical workers with the majority noting no adverse outcomes with proper safety measures. CONCLUSIONS This review highlights postoperative patient outcomes during worldwide epidemics including the COVID-19 pandemic and identifies specific safety measures to minimize infection of healthcare workers.
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Affiliation(s)
- Yung Lee
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada,Centre for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
| | | | - Nivedh Patro
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada,Centre for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Sam Soon
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada,Centre for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes G. Doumouras
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada,Centre for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada,Centre for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada,Corresponding author. Division of General Surgery, St. Joseph’s Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
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Andreozzi V, Marzilli F, Muselli M, Previ L, Cantagalli MR, Princi G, Guzzini M, Ferretti A. The Effect of Shelter-In-Place on Orthopedic Trauma Volumes in Italy During the COVID-19 Pandemic. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021216. [PMID: 33988156 PMCID: PMC8182575 DOI: 10.23750/abm.v92i2.10827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 outbreak heavily attacked Italy, putting a strain for an extended time on the National healthcare system. Hospitals fastly rearranged the activity to cope with the crisis. This retrospective comparative study intended to investigate the impact of the lockdown imposed in Italy, in two different periods, during the COVID-19 outbreak on acute orthopedic trauma, in order to identify significant issues for improvement and future preparation. MATERIALS AND METHODS We obtained data on total trauma access to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during two periods of the COVID-19 pandemic lockdown in Italy: from March 9th, 2020 to May 4th, 2020(Phase 1), from May 10th, 2020 to June 30th, 2020(Phase 2) and then comparing them with the analogous period in 2019. We recorded demographic data; the characteristics of the lesion, including the anatomical area, fracture, sprain, dislocation, contusion, laceration, whether the lesion site was exposed or closed, where the trauma occurred and polytrauma. We also reported the waiting time in the emergency room and the mode of transport. RESULT The study sample was composed of 1655 patients, 894 (54%) males and 761 (46%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during Phase 1 and increased again to 456 during Phase 2. The average age of the Phase 1 group was 51.9 ± 24.8 years, significantly higher than that of the 2019 group (41.4 ± 25.7) and Phase 2 group (42.2 ± 22.5 years) (p<0.0001). In particular, elderly patients (>=65 years) were the most commonly involved in the Phase 1 group, while in the pre-COVID-19 period and in Phase 2 they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 66.2% of cases in the Phase 1 group, in 32.3% of cases in the Phase 2 group and in 32.3% of patients in the 2019 group. Concerning the injury type, in all groups, the most frequent injury was a fracture (45.1% in 2019; 62.7% in Phase 1; 50% Phase2) (p<0.0001). The most injured anatomical section during Phase 1 was the upper limb (43.1%), while in the pre-COVID-19 group and in Phase 2 group the most frequent injury location was the lower limb (48.3% and 40.8% respectively). CONCLUSION Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly people remained constant, indicating that not all trauma presentations would inevitably decrease during such circumstances.
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Affiliation(s)
- Valerio Andreozzi
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Fabio Marzilli
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Mario Muselli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Leonardo Previ
- 1Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Matteo Romano Cantagalli
- 1Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Giorgio Princi
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Matteo Guzzini
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Andrea Ferretti
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
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12
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Kalem M, Kocaoğlu H, Merter A, Karaca MO, Özbek EA, Kınık HH. Effects of COVID-19 pandemic curfew on orthopedic trauma in a tertiary care hospital in Turkey. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2021; 55:191-195. [PMID: 34100357 PMCID: PMC10566346 DOI: 10.5152/j.aott.2021.20263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to investigate whether various curfew practices affect trauma prevalence, epidemiological differences among the population admitted to hospital because of trauma, and treatment practices used after trauma. METHODS Patients who suffered from fractures or soft-tissue trauma between March 21, 2020, and June 1, 2020, (group pandemic) and during the same period in 2019 (control group) were included in our single-center retrospective study. Each group was also divided into 3 subgroups according to the age of patients (≤ 20 years, 21-64 years, and ≥ 65 years). Data including anatomical region subjected to trauma, place of admission, mechanism of trauma, location of trauma, mode of treatment, type of surgery (if performed), duration of hospitalization (if hospitalized), time elapsed until surgery, and duration of postoperative hospitalization were collected and compared between groups. RESULTS A total of 361 patients were admitted to the hospital with new trauma during the pandemic, and 708 patients had been admitted during the same period in 2019. The number of admissions decreased significantly by 50.9% (P < 0.001). The mechanism of trauma that occurred with low energy was significantly increased in the pandemic group (73.9%) compared with the control group (47.6%) (P < 0.001). Similarly, the distribution of trauma throughout the skeletal system, especially in the upper extremity, was significantly increased in the pandemic group (49.9% vs. 30.5%, P < 0.001). However, there was no significant decrease in individuals aged above 65 years (P = 0.115). Similar to the general outlook, the 3 groups differed in terms of the mechanism of trauma, location of trauma, and distribution of the anatomical region subjected to trauma (P < 0.001). Majority of the patients received inpatient treatment in all 3 groups (P < 0.001). CONCLUSION The results of this study showed that the pandemic dramatically reduced the number of hospital admissions related to orthopedic trauma. The rate of low energy, upper extremity traumas that occurred indoors increased during the pandemic period compared with that of the previous year. However, the rate of hospital admissions did not differ in the ≥65-year-old subgroup during the pandemic period compared with that of the previous year.
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Affiliation(s)
- Mahmut Kalem
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Hakan Kocaoğlu
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Abdullah Merter
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Mustafa Onur Karaca
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Emre Anıl Özbek
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Hüseyin Hakan Kınık
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
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13
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Oda Y, Shiraishi S, Shimada M, Kurai O. Clinical profiles and outcome of patients with COVID-19 in a specialized hospital in Japan. J Anesth 2021; 35:405-411. [PMID: 33661358 PMCID: PMC7929897 DOI: 10.1007/s00540-021-02912-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/22/2021] [Indexed: 12/02/2022]
Abstract
Purpose To characterize the clinical features and outcome of patients treated at a specialized hospital for coronavirus disease 2019 (COVID-19). Methods We retrospectively reviewed the symptoms on admission, treatment, and outcome of a total of 300 patients with mild (peripheral oxygen saturation (SpO2) ≥ 96%), moderate I (93% < SpO2 < 96%), moderate II (SpO2 ≤ 93%) and severe (requiring admission to the ICU or mechanical ventilation) COVID-19. Results Median age was 53 (interquartile range [IQR] 33–72) years and 57% was male. The number of patients with mild, moderate I, II and severe condition was 85, 138, 61 and 16, respectively. Common presenting symptoms were cough (n = 71), loss of taste (42), loss of smell (39), fever ≥ 37.5 °C (36). Dyspnea was observed only 21 cases; 57 reported no symptoms on admission. Favipiravir, ciclesonide, dexamethasone, and heparin were administered in 106, 168, 65, and 38 patients, respectively, but not remdesivir. The median duration of hospitalization was 10 (7–15) days. All patients with mild and moderate I severity were discharged. Among the 77 patients classified as moderate II or severe, 3 were transferred to tertiary hospitals for further treatment on the day of admission. The respiratory condition worsened in 21 patients; 18 required transfer to tertiary hospitals 3 (median) days after admission and 3 died. Conclusion Respiratory condition recovered in 92%; whereas it worsened in 7% and the mortality rate was 1%. The ratios of male patients, of patients with diabetes mellitus in those with the decreased respiratory condition, were significantly higher than recovered.
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Affiliation(s)
- Yutaka Oda
- Department of Anesthesiology, Osaka City Juso Hospital, 2-12-27 Nonaka-kita, Yodogawa-ku, Osaka, 532-0034 Japan
| | - Satoshi Shiraishi
- Department of Respiratory Medicine, Osaka City Juso Hospital, Osaka, Japan
| | - Motoko Shimada
- Department of Anesthesiology, Osaka City Juso Hospital, 2-12-27 Nonaka-kita, Yodogawa-ku, Osaka, 532-0034 Japan
| | - Osamu Kurai
- Department of Gastroenterology and Hepatology, Osaka City Juso Hospital, Osaka, Japan
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14
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Normando PG, Araujo-Filho JDA, Fonseca GDA, Rodrigues REF, Oliveira VA, Hajjar LA, Almeida ALC, Bocchi EA, Salemi VMC, Melo M. Reduction in Hospitalization and Increase in Mortality Due to Cardiovascular Diseases during the COVID-19 Pandemic in Brazil. Arq Bras Cardiol 2021; 116:371-380. [PMID: 33566937 PMCID: PMC8159562 DOI: 10.36660/abc.20200821] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the COVID-19 pandemic, the increase in the incidence of cardiovascular diseases (CVD) and mortality from them has been recognized worldwide. In Brazil, the impact of COVID-19 on CVD must be evaluated. OBJECTIVES To assess the impact of the current pandemic on the numbers of hospital admissions (HA), in-hospital deaths (ID), and in-hospital fatality (IF) from CVD by use of national epidemiological data from the Brazilian Unified Public Health System. METHODS Time-series observational study using comparative analysis of the HA, ID, and IF due to CVD recorded from January to May 2020, having as reference the values registered in the same period from 2016 to 2019 and the values projected by linear regression methods for 2020. The statistical significance level applied was 0.05. RESULTS Compared to the same period in 2019, there was a 15% decrease in the HA rate and a 9% decrease in the total ID due to CVD between March and May 2020, followed by a 9% increase in the IF rate due to CVD, especially among patients aged 20-59 years. The HA and IF rates registered in 2020 differed significantly from the projected trend for 2020 (p = 0.0005 and 0.0318, respectively). CONCLUSIONS During the first months of the pandemic, there were a decline in HA and an increase in IF due to CVD in Brazil. These data might have resulted from the inadequate planning of the CVD management during the pandemic. Thus, immediate actions are required to change this scenario. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0).
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Affiliation(s)
- Paulo Garcia Normando
- Universidade Federal da ParaíbaJoão PessoaPBBrasil Universidade Federal da Paraíba
,
João Pessoa
,
PB
-
Brasil
| | | | | | | | - Victor Agripino Oliveira
- Universidade Federal da ParaíbaJoão PessoaPBBrasil Universidade Federal da Paraíba
,
João Pessoa
,
PB
-
Brasil
| | - Ludhmila Abrahão Hajjar
- Instituto de Coração – CardiopneumologiaSão PauloSPBrasil Instituto de Coração – Cardiopneumologia
,
São Paulo
,
SP
-
Brasil
| | - André Luiz Cerqueira Almeida
- Santa Casa de Misericórdia de Feira de SantanaFeira de SantanaBABrasil Santa Casa de Misericórdia de Feira de Santana
– Cardiologia,
Feira de Santana
,
BA
-
Brasil
| | - Edimar Alcides Bocchi
- Universidade de São PauloInstituto do Coração - Centro de Diagnóstico por ImagemSão PauloSPBrasil Universidade de São Paulo
Instituto do Coração - Centro de Diagnóstico por Imagem
,
São Paulo
,
SP
-
Brasil
| | - Vera Maria Cury Salemi
- Universidade de São PauloInstituto do Coração - Centro de Diagnóstico por ImagemSão PauloSPBrasil Universidade de São Paulo
Instituto do Coração - Centro de Diagnóstico por Imagem
,
São Paulo
,
SP
-
Brasil
| | - Marcelo Melo
- Universidade Federal da ParaíbaJoão PessoaPBBrasil Universidade Federal da Paraíba
,
João Pessoa
,
PB
-
Brasil
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15
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Maniscalco P, Ciatti C, Gattoni S, Quattrini F, Puma Pagliarello C, Patane' AC, Capelli P, Banchini F, Rivera F, Sanna F, Nonne D, Di Maggio B, Scaravilli G. Proximal humerus fractures in COVID-19 lockdown: the experience of three orthopedics and traumatology departments in the first ten weeks of the Italian epidemic. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021104. [PMID: 33682805 PMCID: PMC7975920 DOI: 10.23750/abm.v92i1.11231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/30/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Coronavirus disease (CoVID-19) is causing millions of deaths worldwide and the crisis of the global healthcare system. Aim Of The Study: evaluate the preliminary impact of CoVID-19 in three Italian Orthopedics and Traumatology Departments in the first 10 weeks of the national lockdown. We focused on proximal humerus fractures, analyzing data and results in comparison with the same period of 2019. MATERIALS AND METHODS From February 22nd to May 3rd 2020, 55 patients were admitted to our departments for promixal humerus fractures. Our cohort of patients is composed by 13 males (23.6%) and 42 females (76.4%), with an average age of 73.8 ± 11.7 years (range 44 - 94). Trauma occurred at home in 43 cases (78.2%), by the roadside in 10 cases (18.2%), in a retirement home in 1 case (1.8%), and at work in 1 case (1.8%). We proposed surgical treatment in 15/55 cases, but 4 patients refused hospitalization, mainly because of the risk of contracting n-CoV19 infection. RESULTS We noticed a decrease in proximal humerus fractures compared to 2019 (-37.5%). Particularly, we observed a significant drop in traumas occurred on the road and at work respectively 23.9% and 3.4%% in 2019, and 18.2% and 1.8% in 2020, probably due to the consequences of the national lockdown. Sports traumas had a reset during the pandemic (6 cases in 2019, 0 in 2020). As consequence, surgical treatment had a decrease due to the reduction in number of fractures, indications and patient's consent. CONCLUSION The incidence of proximal humerus fractures had a significant reduction during CoVID-19 spread. We assume that the reasons of this reduction are to be found in the national lockdown (since March 10th, 2020) and Ministerial Decrees that limited the access to the E.R. only in case of severe traumas in order to avoid CoVID-19 spread.
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Affiliation(s)
- Pietro Maniscalco
- Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
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16
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Andreozzi V, Marzilli F, Muselli M, Previ L, Cantagalli MR, Princi G, Ferretti A. The impact of COVID-19 on orthopaedic trauma: A retrospective comparative study from a single university hospital in Italy. Orthop Rev (Pavia) 2021; 12:8941. [PMID: 33585026 PMCID: PMC7874950 DOI: 10.4081/or.2020.8941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 outbreak strongly affected Italy, putting a strain on the National healthcare system. Hospitals quickly reorganized the activity to cope with the emergency. This retrospective comparative study aimed to analyze the impact of the lockdown imposed in Italy during the COVID-19 outbreak on acute orthopedic trauma, in order to identify critical issues for improvement and future planning. We collected data on all the trauma admissions to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during the COVID- 19 pandemic lockdown in Italy, comparing them with the corresponding period in 2019. We reported demographic data; the characteristics of the injury, including the anatomical location, fracture, sprain, dislocation, contusion, laceration, whether the injury site was exposed or closed, where the injury occurred, and polytrauma. We also recorded the waiting time in the emergency room and mode of transportation. The study sample was composed of 1199 patients, 636 (53.04%) males and 563 (46.96%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during COVID-19 outbreak in 2020. The average age of the 2020 group was 51.9 ± 24.8 years, significantly higher than that of the 2019 group (41.4 ± 25.7) (p<0.0001). In particular, elderly patients (≥65 years) were the most commonly involved in the COVID-19 group, while in the pre- COVID-19 period they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 65.7% of cases in the 2020 group, and in 32.3% of patients in the 2019 group. Concerning the injury type, in both groups, the most common injury was a fracture (45.1% in 2019; 62.7% in 2020) (p<0.0001). The most injured anatomical location during COVID-19 lockdown was the hand (14.2%), while in the pre-COVID- 19 group the most frequent injury type was polytrauma (22.8%). Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly individuals remained stable, indicating that not all trauma presentations would necessarily decrease during such times.
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Affiliation(s)
- Valerio Andreozzi
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome
| | - Fabio Marzilli
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome
| | - Mario Muselli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - Leonardo Previ
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome
| | | | - Giorgio Princi
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome
| | - Andrea Ferretti
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome
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17
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Maniscalco P, Ciatti C, Gattoni S, Puma Pagliarello C, Moretti G, Cauteruccio M, Carpaneto D, Capelli P, Gurrieri L, Banchini F, Quattrini F. The impact of COVID-19 pandemic on the Emergency Room and Orthopedic Departments in Piacenza: a retrospective analysis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020028. [PMID: 33559619 PMCID: PMC7944696 DOI: 10.23750/abm.v91i14-s.11003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/18/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND AIM The Coronavirus pandemic represents one of the most massive health emergencies in the last century. Aim of the study is to evaluate the trend of E.R. accesses and orthopaedic events during the pandemic of Covid-19. MATERIALS AND METHODS we retrospectively analysed all data related to patients admitted to the E.R. Department of the Hospital of Piacenza from August 26th 2019 to August 23rd 2020, splitting this period on February 23rd 2020. RESULTS Our analysis shows a reduction of -18.0% in E.R. accesses. We calculated a growth of deaths in the E.R. equal to +220%. Our orthopaedic pathway recorded a drop of -26.8%. Traumas occurred at home increased (+19.1%). We note an actual drop only on proximal femur fractures (weighted average of -17.7%), while all the others underwent an increase. DISCUSSION The amount of E.R. accesses registered a drop -18.0%, while the pathway dedicated to emergency cases underwent an increase. The major complexity of clinical conditions influenced the number of hospitalizations and the fear of the infection increased hospitalization refusals. There has been a zeroing of school traumas, a reduction in sport, transfer home-work/work-home, work, roadside, injuries. Total amount of fractures strongly increase after the end of the lockdown. CONCLUSION our data confirmed the decrease of retirement houses, sports, works and roadsides traumas and a zeroing of schools ones, while those occurred inside domestic environment underwent a consistent raise. We noticed a reduction in femur fractures and significant spread of all fractures after the end of the lockdown.
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Affiliation(s)
- Pietro Maniscalco
- Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | | | | | | | | | | | | | | | | | - Filippo Banchini
- Surgery Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
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18
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Maniscalco P, Quattrini F, Ciatti C, Gattoni S, Puma Pagliarello C, Burgio V, Di Stefano G, Cauteruccio M, Giovanelli M, Magro A, Capelli P. The Italian Covid-19 Phase 2 in Piacenza: results of the first semester of 2020 and future prospective of new orthopedics surgical procedures. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020159. [PMID: 33525208 PMCID: PMC7927514 DOI: 10.23750/abm.v91i4.10377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 12/23/2022]
Abstract
Introduction: During the pandemic, Piacenza’s Orthopedic and Traumatology Department firstly dealt with the emergency with the complete closure of all the elective surgical and outpatient activities. As general population, also healthcare workers were affected by Coronavirus, increasing difficulties of epidemic management. The aim of our study is to evaluate the activity trend of the first six months of 2020 in our hospital. Data will be compared to the two semesters of 2019, in order to have two objective samples. Materials and Methods: We retrospectively analyzed all the orthopedics surgical procedures performed at Guglielmo da Saliceto Hospital (Piacenza, Emilia Romagna, Northern Italy) between January 1st and June 30th 2020. 2019 semesters (January 1st - June 30th 2020 and July 1st - December 31st 2020) have been used as control group to evaluate the activity trend of the first six months of 2020, compared to the two semesters of 2019. Results: We noticed a significant increase of domestic and retirement houses accidents, a consistent increase in one-month mortality rate of 2020 first semester and a decrease of mean hospitalization time. About surgical procedures, we detect a drop in the total number: in the first semester of 2020 we performed 499 (-39.9%) surgeries less than the first semester of 2019 and 337 (-30.9%) then the second one. Traumatology recorded a decrease of 27.6% than the first semester of 2019 (-204 surgeries) and of 26.3% than the second one (-191 surgeries). Concerning orthopedic procedures, in comparison to the first semester of 2019 we registered a reduction of 57.6% (-295 surgeries) and of 40.2% to the second semester (-146 surgeries) Discussion and conclusion: Covid-19 forced a reorganization of the Italian Health System that led to a clear reduction of surgical procedures performed in the orthopedic and traumatology department. The “Phase 2” can’t be consider the last step of the emergency. We surely will have to get used to live with this enemy, at least until we will find an effective cure or a vaccine. (www.actabiomedica.it)
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Affiliation(s)
- Pietro Maniscalco
- Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
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19
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Perazzo P, Giorgino R, Briguglio M, Zuffada M, Accetta R, Mangiavini L, Peretti GM. From Standard to Escalated Anticoagulant Prophylaxis in Fractured Older Adults With SARS-CoV-2 Undergoing Accelerated Orthopedic Surgery. Front Med (Lausanne) 2020; 7:566770. [PMID: 33178713 PMCID: PMC7593394 DOI: 10.3389/fmed.2020.566770] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022] Open
Abstract
Proximal femoral fractures in older adults are not uncommon and represent a great challenge for orthopedic surgeons because of the high risks of complications. In the COVID-19 panorama, fractures occurring in infected older adults become an even more intricate task because of concomitant metabolic derangements due to SARS-CoV-2. Multidisciplinary protocols are mandatory and pharmacological treatment in infected patients should be tailored. Regrettably, the spread of the virus in northern Italy, has been faster than scientific progress in characterizing the disease and many hospitals have had to manage the symptoms on a daily clinical bases. Our Italian hospital in the region of Lombardy, which has been the epicenter of the Italian pandemic, has admitted sixteen patients with fractured femurs in March and April 2020. The first seven patients were treated with the antithrombotic prophylaxis of a single daily dose of low-molecular-weight heparin, but we observed the highest prevalence of deaths from cardiovascular complications (four deaths). By doubling the daily dose of anticoagulants in the subsequent patients, we observed a reduction in the incidence of death (one death out of nine). Controversies exist about the surgical treatment of fractures in older adults during this pandemic. However, we have observed an increased survival after fall trauma in infected older adults if treated with high doses of anticoagulant. Although not being statistically significant, our results are in line with the current knowledge of the pathophysiology of SARS-CoV-2 infection, but more studies should be shared about the efficacy and dosage of anticoagulants in traumatic injuries of the elderly.
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Affiliation(s)
- Paolo Perazzo
- Intensive Care Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | | | | | - Martina Zuffada
- Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Riccardo Accetta
- Traumatology Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Laura Mangiavini
- Regenerative and Reconstructive Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe M Peretti
- Regenerative and Reconstructive Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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20
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Poggiali E, Vercelli A, Mazzoni S, Bastoni D, Iannicelli T, Demichele E, Ioannilli E, Magnacavallo A. COVID-19 pandemic, Piacenza calling. The survival strategy of an Italian Emergency Department. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91. [PMID: 32921738 PMCID: PMC7717017 DOI: 10.23750/abm.v91i3.9908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022]
Abstract
CoVID-19 is a global health emergency, which has paralyzed most of the worldwide health systems. Italy is struggling hard with CoVID-19 pandemic since the end of February 2020, to avoid the collapse of its health system. The number of CoVID-19 patients and deaths are increasing day by day. At time of writing, in Italy there are 102253 infected patients and 19899 deaths. Despite being a relatively small city, Piacenza is one of the epicentres of the Italian epidemic, and our own hospital - Guglielmo da Saliceto - has quickly become a "CoVID-19 hospital". Fully 80% of beds in our hospital are reserved for ill CoVID-19 patients and ICU has tripled the number of beds. All these changes have required a great effort for all the medical staff to avoid the collpase of the local health system. We struggled to maintain our normal standard of care for each patient, but the severity of the disease and the high number of critically ill patients frustrated our efforts. Here we report our experience and challenge with managing such a disaster. We hope it could be useful for other Emergency Departments trapped in this global pandemic.
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Affiliation(s)
| | - Andrea Vercelli
- Ospedale Guglielmo da Saliceto, Emergency Department, Piacenza, Italy.
| | - Silvana Mazzoni
- Ospedale Guglielmo da Saliceto, Emergency Department, Piacenza, Italy.
| | - Davide Bastoni
- Emergency Department, "Guglielmo da Saliceto" Hospital, Piacenza, Italy.
| | - Teresa Iannicelli
- Ospedale Guglielmo da Saliceto, Emergency Department, Piacenza, Italy.
| | - Elena Demichele
- Ospedale Guglielmo da Saliceto, Emergency Department, Piacenza, Italy.
| | - Eva Ioannilli
- Ospedale Guglielmo da Saliceto, Emergency Department, Piacenza, Italy.
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