Effect of COVID-19 Pandemic on Orthopedic Surgery in Three Centers from Romania

Patient-Perceived Quality Assessment in Orthopedics and Traumatology Departments during COVID-19 Pandemic

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.

An Investigation for Future Practice of Elective Hip and Knee Arthroplasties during COVID-19 in Romania

Background and Objectives: Elective arthroplasty in Romania has been severely affected by the COVID-19 pandemic, and its effects are not quantified so far. The aim of this paper is to determine the impact of COVID-19 on arthroplasty interventions and how they varied in Romania. Materials and Methods: We performed a national retrospective analysis of patients who underwent primary and revision elective hip and knee interventions at the 120 orthopedic-traumatology hospitals in Romania that are registered in the National Endoprosthesis Registry from 1 January 2019 to 1 September 2022. First, we examined the monthly trend in the number of surgeries for seven categories of arthroplasties. We calculated the percentage change in the average number of cases per month and compared them with other types of interventions. We then examined the percentage change in the average monthly number of arthroplasty cases, relative to the number of COVID-19 cases reported nationwide, the influence of the pandemic on length of hospital stay, and the percentage of patients discharged at home who no longer follow recovery protocols. Finally, we calculated the impact of the pandemic on hospital revenues. Results: There was an abrupt decrease in the volume of primary interventions in hip and knee patients by up to 69.14% with a low degree of patient care, while the average duration of scheduled hospitalizations increased. We found a 1-2-day decrease in length of hospital stays for explored arthroplasties. We saw an increasing trend of home discharge, which was higher for primary interventions compared to revision interventions. The total hospital revenues were 50.96% lower in 2020 compared to 2019, and are currently increasing, with the 2022 estimate being 81.46%. Conclusions: The conclusion of this study is that the COVID-19 pandemic severely affected the volume of arthroplasty of the 120 hospitals in Romania, which also had unfavorable financial implications. We proposed the development of new procedures and alternative clinical solutions, as well as personalized home recovery programs, to be activated if necessary, for possible future outbreaks.

Surgical treatment for fragility hip fractures during the COVID-19 pandemic resulted in lower short-term postoperative functional outcome and a higher complication rate compared to the pre-pandemic period

The COVID-19 pandemic adversely affected the functional outcomes of fragility hip fracture patients. This study revealed a higher in-hospital complication rate and lower postoperative function at 3 months among patients treated during the pandemic. Therefore, modified in-hospital and post-discharge protocols should be developed for implementation during pandemic crisis periods.

INTRODUCTION

This study aims to investigate the in-hospital complication rate and short-term postoperative functional outcomes of fragility hip fracture (FHF) patients compared between during the COVID-19 pandemic and the same 14-month time period 1 year prior to the pandemic.

METHODS

Using data from the Siriraj Fracture Liaison Service registry, FHF patients treated during the COVID-19 pandemic (1 March 2020 to 30 April 2021) were time-matched with FHF patients treated during the pre-pandemic period (1 March 2018 to 30 April 2019). We collected the rate of in-hospital postoperative complications and the postoperative functional outcomes at discharge and 3 months as measured by the Barthel Index (BI) and EuroQol visual analog scale (EQ-VAS). Functional outcome measures were compared between the pre-pandemic and pandemic periods.

RESULTS

There were 197 and 287 patients in the pre-pandemic and pandemic groups, respectively. At the 3-month postoperative follow-up, the mean postoperative BI score and change in BI score were both significantly lower in the pandemic group indicating poorer postoperative function. Moreover, FHF patients treated during the pandemic had significantly more in-hospital complications (36.6% vs. 22.8%, p = 0.002). There was no significant difference in the 3-month EQ-VAS or change in the EQ-VAS between groups.

CONCLUSION

The results of this study revealed a higher in-hospital complication rate and lower postoperative function at 3 months among FHF patients treated during the COVID-19 pandemic compared to the pre-pandemic period. Therefore, modified in-hospital and post-discharge protocols should be developed for implementation during pandemic crisis periods.

Impact of COVID-19 pandemic on Vascular Surgery Unit activity in Central Romania

The COVID-19 outbreak has placed substantial pressure on the medical systems worldwide. This study aimed to investigate the influence of the prepandemic vs. pandemic period on the activity of the Vascular Surgery Unit of a large emergency hospital in Eastern Europe. We performed a retrospective review of the vascular surgery cases admitted, comparing the statistics from the two time periods. We examined data of a total of 1,693 patients over the two periods. We report a 34.51% decrease in the surgical procedures performed during the pandemic period, with a disproportionate 80.6% decrease in the number of cases admitted with a diagnosis of venous insufficiency diagnosis and an increase of 67.21% in the number of patients admitted with acute arterial ischemia. Furthermore, individuals not classed as emergencies were delayed or denied surgical care. The number of nonurgent procedures conducted by our Vascular Surgery Unit decreased significantly, whereas the number of emergency surgeries increased. COVID-19′s effect is projected to have a long-term impact on how surgical treatments are provided in Romania.

Riding the Pandemic Waves—Lessons to Be Learned from the COVID-19 Crisis Management in Romania

In our analysis, we assessed how Romania dealt with the numerous challenges presented by the COVID-19 pandemic during 2021. In that year, the government had to deal with two waves of COVID-19 pandemics caused by the new variants, the low vaccination rate of the population, the overload of the healthcare system and political instability at the same time. Based on publicly available databases and international literature, we evaluated government measures aimed at reducing the spread of the pandemic and ensure the operation of the healthcare workforce and infrastructure. In addition, we evaluated measures to provide health services effectively and the government’s pandemic responses regarding excess mortality in 2021. In the absence of a complex monitoring system, limited information was available on the spread of the pandemic or the various risk factors at play. Due to incomplete and inadequate management systems, the government was unable to implement timely and adequate measures. Our analysis concludes that the management of a pandemic can only be successful if data are collected and evaluated using complex systems in a timely manner, and if members of society adhere to clearly communicated government measures due to high levels of trust in the government.

Negative Impact of the COVID-19 Pandemic on Kidney Disease Management-A Single-Center Experience in Romania

Background: The evolution of the COVID-19 pandemic affected healthcare systems worldwide. The patients with chronic kidney disease (CKD), diabetes, and cardiovascular disease were most affected and had an unfavorable outcome. Methods: We examined the activity of the Nephrology Department from Târgu-Mureș County Emergency Hospital retrospectively, comparing two periods: June 2020–November 2021 (COVID-19 period) and June 2018–November 2019 (non-COVID-19 period). Results: In the COVID-19 period, there were fewer one-day hospitalizations registered, 77.27% more dialysis catheters were installed, and 43.75% more arteriovenous fistulas were performed. An overall increase in the number of patients requiring dialysis during the pandemic was recorded, as of the number of dialysis sessions performed. Moreover, we observed a statistically significant increase in the number of dialysis sessions per patient and a statistically significant increase in the number of hospitalization days in the pandemic interval. Acute kidney injury (AKI) and urosepsis were the diagnoses that increased the most among in-patients during the pandemic, while all other nephrology diagnoses decreased. Conclusions: The COVID-19 pandemic accelerated kidney pathology and worsened the outcomes of nephrology patients in our center. The number of chronic and patient’s access to one-day hospitalization decreased in order to minimalize the exposure and the risk of infection. In contrast, the need for emergency dialysis increased significantly.

The Impact of the COVID-19 Pandemic on the Neck of the Femur and Hip Fracture Surgery Volumes in the Lazio Region

This study compares surgery volumes for fractures of the neck of the femur (FNF) and hip replacements during the COVID-19 pandemic compared with previous years. Historical (2018–2019) and pandemic (2020–2021) surgery rates for FNF and hip replacement in Lazio, adjusted for age and gender, were calculated per period and compared with a Poisson regression model. For hip replacement surgery, a comparison of different types of hospitals was also made. Before COVID-19’s spread, no difference was found in the volume of surgery of both interventions. From the lockdown to the end of 2021, a decrease in surgery volumes for FNF with stabilization between summer 2020 and summer 2021, as well as an additional decline beginning at the start of Omicron’s spread, were found. Hip replacement surgeries showed a greater decline during the lockdown period and increased during summer 2020 and during the Delta wave period. The increment in hip replacements, mainly observed in 2021, is due to private and religious hospitals. These results highlight that the pandemic emergency, caused by SARS-CoV-2, has had an important indirect effect on the population’s health assistance in the field of orthopedics.

An In Vivo Observational Histological Study of Peripheral Arterial Damage in Patients with Acute Limb Ischemia in SARS-CoV-2 Infection

Thromboembolic events, such as acute limb ischemia, were reported worldwide in patients with COVID-19, suggesting that SARS-CoV-2 infection acts like a redoubtable prothrombotic factor in these patients. The aim of the study was to summarize the histopathological changes found in the arterial wall, intraarterial thrombus, and adjacent skeletal muscles. Considering the lack of evidence from in vivo studies, we performed observational histological research of peripheral arterial damage in patients with acute limb ischemia and SARS-CoV-2 infection. We investigated 22 patients with acute limb ischemia and SARS and harvested histopathological samples from those who agreed to this procedure. We performed histologic tissue harvesting during the revascularization procedure from the thrombosed area of the common femoral artery. Morphologic analysis was made on the hematoxylin-eosin (HE) stain. Special stains were also used—Elastica van Gieson (EvG) and Alcian Blue—Periodic Acid—Schiff (AB-PAS) and primary antibodies—CD45 and CD61. Our patients had significant risk factors for thrombus formation, since all of them had arterial hypertension, 81% had dyslipidemia, 73% were obese, 63% suffered from diabetes mellitus, and 45% were active smokers. The histological findings using immunohistochemistry (CD45 and CD68 reactions) or special and usual stains underlined the mechanism for ischemia production in SARS-CoV-2 patients. The main histological findings in our study were endothelial destruction and inflammation that were found in all analyzed structures.

Impact and Strategies on Joint Surgery Centers without Lockdowns during the Peak of the COVID-19 Pandemic: A Multicenter Cross-Sectional Study

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.

COVID-19 Impact on Musculoskeletal Regenerative Medicine Research: Maintaining Lab Continuity

BACKGROUND

Research in the fields of musculoskeletal tissue engineering and regenerative medicine may suffer a slowdown during the ongoing COVID-19 pandemic emergency. This is likely to harm the development of new therapeutic strategies and their translation into the clinic in the long term. Recently, the need to maintain continuity in research activities in those fields has assumed even greater importance due to the accumulation of data concerning the effects of SARS-CoV-2 on the musculoskeletal system. This study is aimed at the identification of a series of safe handling practices against COVID-19 diffusion to apply in a research environment, thus allowing the maintenance of research lab activities.

METHODS

The control measures to apply to mitigate the COVID-19 risk were identified and categorized utilizing the Hierarchy of Controls. We also compared our analysis with that assessed before the pandemic to consider the additional risk of COVID-19.

RESULTS

Results highlighted that the most relevant implemented measures to control SARS-CoV-2 were based on protecting people through engineering (e.g., ventilation and social distancing), and administrative (e.g., hand sanitization, work shifts) measures or Personnel Protective Equipment, rather than eliminating hazards at the source (e.g., smart working).

CONCLUSIONS

Work continuity in research labs during the COVID-19 emergency should be guaranteed by ensuring the protection of researchers in the workplace and considering the physical environment, the type of operators and work activity, and the proven ability of workers to face biological risks. The increased knowledge and awareness on lab' risks should be useful to prevent and mitigate future viral outbreaks.