Careful return to elective orthopaedic surgery in an acute hospital during the COVID-19 pandemic shows no increase in morbidity or mortality

Aims: Elective orthopaedic surgery was cancelled early in the COVID-19 pandemic and is currently running at significantly reduced capacity in most institutions. This has resulted in a significant backlog to treatment, with some hospitals projecting that waiting times for arthroplasty is three times...

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Autores principales:	Monu Jabbal, Nathan Campbel, Terence Savaridas, Ali Raza
Formato:	article
Lenguaje:	EN
Publicado:	The British Editorial Society of Bone & Joint Surgery 2021
Materias:	arthroplasty covid-19 elective waiting times patient safety service development quality improvement tha tka morbidity covid-19 infection elective orthopaedic surgery arthroplasties elective arthroplasties anesthesiologists orthopaedic surgery clinicians bmi nosocomial covid-19 infection Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/19e3100cda534ed0be85f4885cbe4e96
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spelling	oai:doaj.org-article:19e3100cda534ed0be85f4885cbe4e962021-12-01T18:44:47ZCareful return to elective orthopaedic surgery in an acute hospital during the COVID-19 pandemic shows no increase in morbidity or mortality2633-146210.1302/2633-1462.211.BJO-2021-0114.R1https://doaj.org/article/19e3100cda534ed0be85f4885cbe4e962021-11-01T00:00:00Zhttps://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.211.BJO-2021-0114.R1https://doaj.org/toc/2633-1462Aims: Elective orthopaedic surgery was cancelled early in the COVID-19 pandemic and is currently running at significantly reduced capacity in most institutions. This has resulted in a significant backlog to treatment, with some hospitals projecting that waiting times for arthroplasty is three times the pre-COVID-19 duration. There is concern that the patient group requiring arthroplasty are often older and have more medical comorbidities—the same group of patients advised they are at higher risk of mortality from catching COVID-19. The aim of this study is to investigate the morbidity and mortality in elective patients operated on during the COVID-19 pandemic and compare this to a pre-pandemic cohort. Primary outcome was 30-day mortality. Secondary outcomes were perioperative complications, including nosocomial COVID-19 infection. These operations were performed in a district general hospital, with COVID-19 acute admissions in the same building. Methods: Our institution reinstated elective operations using a “Blue stream” pathway, which involves isolation before and after surgery, COVID-19 testing pre-admission, and separation of ward and theatre pathways for “blue” patients. A register of all arthroplasties was taken, and their clinical course and investigations recorded. Results: During a seven-month period, 340 elective arthroplasties were performed. There was zero mortality. One patient had a positive swab for COVID-19 while an inpatient, but remained asymptomatic. There were two readmissions within a 12-week period for hip dislocation. Patients had a mean age of 68 years (28 to 90), mean BMI of 30 kg/m2 (19.0 to 45.6), and mean American Society of Anesthesiologists grade of 2 (1 to 3). Conclusion: Results show no increased morbidity or mortality in this cohort of patients compared to the same hospital’s morbidity and mortality pre-COVID-19. The screened pathway for elective patients is effective in ensuring that patients can be safely operated on electively in an acute hospital. This study should reassure clinicians and patients that arthroplasties can be carried out safely when the appropriate precautions are in place. Cite this article: Bone Jt Open 2021;2(11):940–944.Monu JabbalNathan CampbelTerence SavaridasAli RazaThe British Editorial Society of Bone & Joint Surgeryarticlearthroplastycovid-19electivewaiting timespatient safetyservice developmentquality improvementthatkamorbiditycovid-19 infectionelective orthopaedic surgeryarthroplastieselective arthroplastiesanesthesiologistsorthopaedic surgerycliniciansbminosocomial covid-19 infectionOrthopedic surgeryRD701-811ENBone & Joint Open, Vol 2, Iss 11, Pp 940-944 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	arthroplasty covid-19 elective waiting times patient safety service development quality improvement tha tka morbidity covid-19 infection elective orthopaedic surgery arthroplasties elective arthroplasties anesthesiologists orthopaedic surgery clinicians bmi nosocomial covid-19 infection Orthopedic surgery RD701-811
spellingShingle	arthroplasty covid-19 elective waiting times patient safety service development quality improvement tha tka morbidity covid-19 infection elective orthopaedic surgery arthroplasties elective arthroplasties anesthesiologists orthopaedic surgery clinicians bmi nosocomial covid-19 infection Orthopedic surgery RD701-811 Monu Jabbal Nathan Campbel Terence Savaridas Ali Raza Careful return to elective orthopaedic surgery in an acute hospital during the COVID-19 pandemic shows no increase in morbidity or mortality
description	Aims: Elective orthopaedic surgery was cancelled early in the COVID-19 pandemic and is currently running at significantly reduced capacity in most institutions. This has resulted in a significant backlog to treatment, with some hospitals projecting that waiting times for arthroplasty is three times the pre-COVID-19 duration. There is concern that the patient group requiring arthroplasty are often older and have more medical comorbidities—the same group of patients advised they are at higher risk of mortality from catching COVID-19. The aim of this study is to investigate the morbidity and mortality in elective patients operated on during the COVID-19 pandemic and compare this to a pre-pandemic cohort. Primary outcome was 30-day mortality. Secondary outcomes were perioperative complications, including nosocomial COVID-19 infection. These operations were performed in a district general hospital, with COVID-19 acute admissions in the same building. Methods: Our institution reinstated elective operations using a “Blue stream” pathway, which involves isolation before and after surgery, COVID-19 testing pre-admission, and separation of ward and theatre pathways for “blue” patients. A register of all arthroplasties was taken, and their clinical course and investigations recorded. Results: During a seven-month period, 340 elective arthroplasties were performed. There was zero mortality. One patient had a positive swab for COVID-19 while an inpatient, but remained asymptomatic. There were two readmissions within a 12-week period for hip dislocation. Patients had a mean age of 68 years (28 to 90), mean BMI of 30 kg/m2 (19.0 to 45.6), and mean American Society of Anesthesiologists grade of 2 (1 to 3). Conclusion: Results show no increased morbidity or mortality in this cohort of patients compared to the same hospital’s morbidity and mortality pre-COVID-19. The screened pathway for elective patients is effective in ensuring that patients can be safely operated on electively in an acute hospital. This study should reassure clinicians and patients that arthroplasties can be carried out safely when the appropriate precautions are in place. Cite this article: Bone Jt Open 2021;2(11):940–944.
format	article
author	Monu Jabbal Nathan Campbel Terence Savaridas Ali Raza
author_facet	Monu Jabbal Nathan Campbel Terence Savaridas Ali Raza
author_sort	Monu Jabbal
title	Careful return to elective orthopaedic surgery in an acute hospital during the COVID-19 pandemic shows no increase in morbidity or mortality
title_short	Careful return to elective orthopaedic surgery in an acute hospital during the COVID-19 pandemic shows no increase in morbidity or mortality
title_full	Careful return to elective orthopaedic surgery in an acute hospital during the COVID-19 pandemic shows no increase in morbidity or mortality
title_fullStr	Careful return to elective orthopaedic surgery in an acute hospital during the COVID-19 pandemic shows no increase in morbidity or mortality
title_full_unstemmed	Careful return to elective orthopaedic surgery in an acute hospital during the COVID-19 pandemic shows no increase in morbidity or mortality
title_sort	careful return to elective orthopaedic surgery in an acute hospital during the covid-19 pandemic shows no increase in morbidity or mortality
publisher	The British Editorial Society of Bone & Joint Surgery
publishDate	2021
url	https://doaj.org/article/19e3100cda534ed0be85f4885cbe4e96
work_keys_str_mv	AT monujabbal carefulreturntoelectiveorthopaedicsurgeryinanacutehospitalduringthecovid19pandemicshowsnoincreaseinmorbidityormortality AT nathancampbel carefulreturntoelectiveorthopaedicsurgeryinanacutehospitalduringthecovid19pandemicshowsnoincreaseinmorbidityormortality AT terencesavaridas carefulreturntoelectiveorthopaedicsurgeryinanacutehospitalduringthecovid19pandemicshowsnoincreaseinmorbidityormortality AT aliraza carefulreturntoelectiveorthopaedicsurgeryinanacutehospitalduringthecovid19pandemicshowsnoincreaseinmorbidityormortality
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Careful return to elective orthopaedic surgery in an acute hospital during the COVID-19 pandemic shows no increase in morbidity or mortality

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