1
|
Bormann M, Neidlein C, Keppler AM, Prall WC, Böcker W, Fürmetz J. [Influence of the COVID-19 pandemic on fracture epidemiology exemplified by tibial plateau fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:967-974. [PMID: 36576535 PMCID: PMC9795428 DOI: 10.1007/s00113-022-01263-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND During the COVID-19 pandemic interventions, such as contact restrictions, lockdowns and postponement of elective surgeries were taken to ease the burden on the healthcare system. Among the population, these interventions led to changes in recreational behavior as well as personal transportation. OBJECTIVE This paper examines the epidemiological data of tibial plateau fractures (TPF) before and during the pandemic and to what extent pandemic control measures had an impact. MATERIAL AND METHODS In this retrospective monocentric study of a German level 1 trauma center, the intra-articular tibial plateau fractures of the years 2019 and 2020 were compared regarding incidence, demographics, cause of the accident, and treatment strategy. Fracture classification was according to Schatzker, AO/OTA, and Moore. RESULTS Incidence showed a decrease of -8.5% as well as a shift in the age incidence curves. There was a decrease in incidence during lockdown periods but also an increase in late summer 2020 compared to 2019. Tripping accidents (+12.4%) and bicycle accidents (+6.6%) increased in the pandemic year, whereas motorized traffic accidents (-7%) and skiing accidents (-10%) decreased. In terms of fracture morphology, 2020 showed an increase in impression fractures and a decrease in complex fractures. The number of surgically treated patients decreased by 7.3%. CONCLUSION The 12 months of pandemic resulted in only a slight incidence decrease of intra-articular tibial plateau fractures. The pandemic control measures showed effects within the calendar year and led directly and indirectly to a change in incidence, cause of the accident, fracture entities and care strategy.
Collapse
Affiliation(s)
- Markus Bormann
- Muskuloskelettales Universitätszentrum München, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland
| | - Claas Neidlein
- Muskuloskelettales Universitätszentrum München, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland
| | - Alexander Martin Keppler
- Muskuloskelettales Universitätszentrum München, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland
| | - Wolf Christian Prall
- Muskuloskelettales Universitätszentrum München, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland
- Abteilung für Knie‑, Hüft‑, Schulter- und Ellenbogenchirurgie, Schön Klinik München, Harlachinger Str. 51, 81547, München, Deutschland
| | - Wolfgang Böcker
- Muskuloskelettales Universitätszentrum München, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland
| | - Julian Fürmetz
- Muskuloskelettales Universitätszentrum München, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland.
- Sporttraumatologie und Arthroskopische Chirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland.
| |
Collapse
|
2
|
Weichert V, Rosga C, Nohl A, Zeiger S, Ohmann T, Ben-Abdallah H, Steinhausen ES, Dudda M. [Polytrauma care in air rescue in times of the COVID-19 pandemic: impact and development of case numbers]. Notf Rett Med 2023; 26:284-291. [PMID: 37261334 PMCID: PMC10158709 DOI: 10.1007/s10049-023-01153-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 06/02/2023]
Abstract
Background Changes in patient care occurred as a result of the SARS-CoV‑2 virus, and both intrahospital and prehospital care were profoundly affected. Public shutdowns during lockdown periods were intended to prevent overstretching existing resources, resulting in noticeable changes in medical care for both elective treatments and emergency medicine. This study now considered the impact of the COVID 19 pandemic on air ambulance services at a central air ambulance site in 2020 compared to the previous 2 years. Methods A retrospective evaluation of all missions of the rescue helicopter Christoph 9 in the first COVID-19 pandemic year 2020 in comparison to the years 2018 and 2019 was performed. The mission logs were evaluated for the analysis. Results There was a 20% reduction in the number of missions in 2020, with primarily internal medicine missions affected. Despite the lockdown periods and reduction in social life, the proportion of trauma deployments remained nearly the same. As expected, the proportion of occupational accidents decreased, and recreational activities resulted in accidents more frequently. Injury or illness severity showed no significant differences. In terms of internal diseases, there was a reduction in alerts for acute coronary syndrome and respiratory emergencies. The proportion of suicide-related injuries remained constant over the years. Conclusion During the COVID-19 study period, a decrease in the number of deployments and aborted deployments was observed. However, no significant differences in deployment and injury characteristics were observed for trauma-related deployments. These results highlight the importance of air ambulance services to ensure patient care even during pandemic periods.
Collapse
Affiliation(s)
- Veronika Weichert
- Luftrettungszentrum Christoph 9, Duisburg, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Christina Rosga
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Deutschland
| | - André Nohl
- Luftrettungszentrum Christoph 9, Duisburg, Deutschland
- Zentrum für Notfallmedizin, BG Klinikum Duisburg, Duisburg, Deutschland
- Ärztliche Leitung Rettungsdienst, Feuerwehr Stadt Oberhausen, Oberhausen, Deutschland
| | - Sascha Zeiger
- Luftrettungszentrum Christoph 9, Duisburg, Deutschland
- Zentrum für Notfallmedizin, BG Klinikum Duisburg, Duisburg, Deutschland
- Ärztliche Leitung Rettungsdienst, Feuerwehr Stadt Duisburg, Duisburg, Deutschland
| | - Tobias Ohmann
- Forschungsabteilung, BG Klinikum Duisburg, Duisburg, Deutschland
| | | | - Eva Simone Steinhausen
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Marcel Dudda
- Luftrettungszentrum Christoph 9, Duisburg, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
- Ärztliche Leitung Rettungsdienst, Feuerwehr Stadt Essen, Essen, Deutschland
| |
Collapse
|
3
|
Carvalho AS, Brito Fernandes Ó, de Lange M, Lingsma H, Klazinga N, Kringos D. Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a scoping review. BMC Health Serv Res 2022; 22:786. [PMID: 35715795 PMCID: PMC9204363 DOI: 10.1186/s12913-022-08166-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/06/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer comprises a high burden on health systems. Performance indicators monitoring cancer outcomes are routinely used in OECD countries. However, the development of process and cancer-pathway based information is essential to guide health care delivery, allowing for better monitoring of changes in the quality of care provided. Assessing the changes in the quality of cancer care during the COVID-19 pandemic requires a structured approach considering the high volume of publications. This study aims to summarize performance indicators used in the literature to evaluate the impact of the COVID-19 pandemic on cancer care (January-June 2020) in OECD countries and to assess changes in the quality of care as reported via selected indicators. METHODS Search conducted in MEDLINE and Embase databases. Performance indicators and their trends were collated according to the cancer care pathway. RESULTS This study included 135 articles, from which 1013 indicators were retrieved. Indicators assessing the diagnostic process showed a decreasing trend: from 33 indicators reporting on screening, 30 (91%) signalled a decrease during the pandemic (n = 30 indicators, 91%). A reduction was also observed in the number of diagnostic procedures (n = 64, 58%) and diagnoses (n = 130, 89%). The proportion of diagnoses in the emergency setting and waiting times showed increasing trends (n = 8, 89% and n = 14, 56%, respectively). A decreasing trend in the proportion of earliest stage cancers was reported by 63% of indicators (n = 9), and 70% (n = 43) of indicators showed an increasing trend in the proportion of advanced-stage cancers. Indicators reflecting the treatment process signalled a reduction in the number of procedures: 79%(n = 82) of indicators concerning surgeries, 72%(n = 41) of indicators assessing radiotherapy, and 93%(n = 40) of indicators related to systemic therapies. Modifications in cancer treatment were frequently reported: 64%(n = 195) of indicators revealed changes in treatment. CONCLUSIONS This study provides a summary of performance indicators used in the literature to assess the cancer care pathway from January 2020 to June 2020 in OECD countries, and the changes in the quality of care signalled by these indicators. The trends reported inform on potential bottlenecks of the cancer care pathway. Monitoring this information closely could contribute to identifying moments for intervention during crises.
Collapse
Affiliation(s)
- Ana Sofia Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Mats de Lange
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hester Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Polan C, Meyer HL, Burggraf M, Herten M, Beck P, Braitsch H, Becker L, Vogel C, Dudda M, Kauther MD. Geriatric Proximal Femur Fractures During the Covid-19 Pandemic - Fewer Cases, But More Comorbidities. Geriatr Orthop Surg Rehabil 2021; 12:21514593211009657. [PMID: 34938592 PMCID: PMC8687435 DOI: 10.1177/21514593211009657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/26/2021] [Accepted: 03/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment. Methods: In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated. Results: The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased. Conclusions: Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.
Collapse
Affiliation(s)
- Christina Polan
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Heinz-Lothar Meyer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Manuel Burggraf
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Monika Herten
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Paula Beck
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Henrik Braitsch
- Central Department of Medical Controlling, University Hospital Essen, Essen, Germany
| | - Lars Becker
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Carsten Vogel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Marcel Dudda
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Max Daniel Kauther
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| |
Collapse
|
5
|
Impact and Strategies on Joint Surgery Centers without Lockdowns during the Peak of the COVID-19 Pandemic: A Multicenter Cross-Sectional Study. J Clin Med 2021; 10:jcm10225392. [PMID: 34830674 PMCID: PMC8618289 DOI: 10.3390/jcm10225392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/29/2022] Open
Abstract
The real psychological impact of COVID-19 remains difficult to quantify and may differ between hospital sizes and levels. Taiwan’s response to COVID-19 differed in that it successfully prevented its spread, without implementing any lockdowns before May 2021. Patients’ fear would be the major reason for the reduction of surgeries. The daily data for patients who underwent total knee arthroplasty (TKA), total hip arthroplasty, and hemiarthroplasty were collected from two major joint surgery centers of a university hospital and a community hospital in Taiwan. Compared with the previous year, the initial impact of the pandemic evidently reduced the total number of patients (outpatient: 20–29%; admission: 22–37%; surgery: 18–35%) in both hospitals. During the study period, the total number of TKAs decreased by 56–61% in both hospitals. The reduction in arthroplasty surgeries was attributable to patients’ fear. Even with confirmed COVID-19 cases, the university hospital experienced less impact than the community hospital. The TKA was the most affected of all surgery types. Even without local epidemics and restrictions in Taiwan, the worldwide pandemic inevitably led to a reduction of approximately 60% of the total TKA operation volume, especially for community hospitals. The surgery scheduling strategies helped maintain the routine arthroplasty services.
Collapse
|