key: cord-324236-32sxqeko
authors: Hua, Wenbin; Zhang, Yukun; Wu, Xinghuo; Gao, Yong; Yang, Cao
title: Work Characteristics of Orthopaedic Surgeons During the COVID-19 Pandemic: A Single Center Analysis
date: 2020-08-13
journal: Perioper Care Oper Room Manag
DOI: 10.1016/j.pcorm.2020.100127
sha: 
doc_id: 324236
cord_uid: 32sxqeko

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in widespread cancellation of elective orthopaedic surgeries. During the pandemic period, many orthopaedic surgeons had been working at the front line to fight against COVID-19 in China, and the number of orthopaedic surgeries performed in our hospital decreased sharply. METHODS: The work characteristics of orthopaedic surgeons was evaluated by the workplaces of orthopaedic surgeons, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rate of orthopaedic surgeons and the number of orthopaedic surgeries performed. January 23–April 7 in 2020, January 23–April 8 in 2019, and April 8–June 22 in 2020 was defined as the pandemic period, non-pandemic period and the post-pandemic period, respectively. The number and types of orthopaedic surgeons during the pandemic period, non-pandemic period, and post-pandemic period was compared and summarized. RESULTS: During the pandemic period, 65.56% of the orthopaedic surgeons had been working at the front line to fight against COVID-19. The SARS-CoV-2 infection rate of the orthopaedic surgeons who worked at the front line in January and since February was 18.18% and 0.00%, respectively (P=0.003). The number of orthopaedic surgeries performed per day during the pandemic period decreased 95.74% compared with the same period in the past year (P<0.001). The number of orthopaedic surgeries performed during the post-pandemic period was 13.10 times that of the pandemic period (P<0.001), and 55.71% of the non-pandemic period (P<0.001). CONCLUSIONS: The work characteristics of orthopaedic surgeons greatly changed during the COVID-19 pandemic.

In December 2019, cases of the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), were first reported in Wuhan, People's Republic of China 1-4 . By July 23, 2020, more than 15,000,000 cases of COVID-19 had been reported around the world 5 .

During the COVID-19 pandemic, almost all the hospitals in Wuhan had been converted into infectious disease hospitals. There were about 42,000 doctors coming from different cities around China to fight against COVID-19. Moreover, due to the nosocomial transmission of COVID-19, orthopaedic surgeons were also redeployed to work in fever clinics or isolated wards.

In our hospital, a total of 1,866 beds were transformed from general beds to designated beds for patients with COVID-19, and 60% of the orthopaedic beds were converted into designated beds. About two thirds of the orthopaedic surgeons were 5 redeployed to work in the fever clinics or isolated wards to fight against COVID-19.

As a result, the work characteristics of orthopaedic surgeons in our hospital greatly changed.

Only emergency or urgent surgeries were performed during the COVID-19 pandemic; therefore, the number of surgeries performed decreased sharply. To evaluate the influence of the COVID-19 pandemic on orthopaedic surgeons, the work characteristics of orthopaedic surgeons in our hospital during the pandemic period have been collected and analyzed.

The work characteristics of orthopaedic surgeons in the department of Orthopaedics, Due to policy reasons, residents and postgraduates were asked to stay at home, and fellows were told to work in their own hospitals; therefore, all of them were not included in the study. Due to the exclusion of the residents, fellows and postgraduates, there were 90 surgeons in the department of orthopaedics of our hospital.

The study also evaluated the demographic characteristics and nosocomial transmission of COVID-19 in the orthopaedic surgeons.

All data are presented as mean ± standard deviation. SPSS 22.0 (IBM Corp., Armonk, NY, USA) was used to perform the statistical analyses. GraphPad Prism 6 (Graph Pad Software, Inc., San Diego, CA, USA) was applied to generate plots. Normal distribution of the data was assessed using the Kolmogorov-Smirnov test. The independent samples t test was used to compare the data regarding two groups with normal distribution. Nonparametric data were analyzed by Mann-Whitney U test. A p-value of less than 0.05 was considered as statistically significant. 

The workplaces of the orthopaedic surgeons during the pandemic period have been summarized in Table 1 . During the pandemic period, 65.56% of the orthopaedic surgeons had been working at the front line to fight against COVID-19. The average age of those who worked as Orthopaedic surgeons full time, and those who were at the front line was 51.22±7.94 years and 37.97±5.93 years, respectively (P＜0.001).

The average age of those who worked at the front line in January, and those who worked at the front line since February was 42.45±4.18 years and 36.94±5.82 years, respectively (P=0.002).

Two orthopaedic surgeons tested positive for SARS-CoV-2 at the outbreak of COVID-19, another two who worked at the front line in January also tested positive for SARS-CoV-2; however, none of the front-line orthopaedic surgeons who worked since February tested positive for SARS-CoV-2. The SARS-CoV-2 infection rate of the orthopaedic surgeons who worked at the front line in January and since February was 18.18% and 0.00%, respectively (P=0.003). 

The work characteristics of orthopaedic surgeons was greatly changed by the To prevent the nosocomial transmission of COVID-19, it is necessary to conduct rigorous screening of each patient before being admitted to our hospital at the outpatient department, emergency department, or fever clinics. The stringent screening procedures for general patients, and patients needing emergency surgeries have been shown in Figure 2 . All the patients confirmed with COVID-19 were sent to the isolation wards. All the patients who tested negative for COVID-19 were monitored in the buffer wards for at least three days, and then transferred to the safe wards subject to continuous negative results on COVID-19 tests. Disposable surgical caps and N95 (or FFP2) respirators should be used during surgeries for patients with negative results on COVID-19 tests. For emergency surgeries or for patients with COVID-19, the following materials ought to be used: disposable surgical caps, N95 (or FFP2) respirators, disposable surgical masks, surgical undergarments, disposable medical protective uniforms, disposable isolation clothing, disposable latex gloves, goggles, and waterproof surgical shoe covers 8 .

Even though all the 90 orthopaedic surgeons have been back to work, and the lockdown restrictions were removed during the post-pandemic period, the number of the orthopaedic surgeries was still much lower than that during the non-pandemic period. Several factors contributed to the slow increase in the number of orthopaedic surgeries performed during the post-pandemic period. First, most patients still had fears regarding COVID-19, and stayed at home unless they suffered from serious illness or trauma. Second, more than 80% of the patients were transferred from other cities during non-pandemic period, while only about 50% of the patients were transferred from other cities due to the COVID-19 pandemic. Third, the rigorous screening procedures for general patients reduced the number of admitted patients and the efficiency of admission preparation.

Even though the preliminary influence of the COVID-19 pandemic on the work characteristics of orthopaedic surgeons can be found in the present study, the work characteristics of orthopaedic surgeons in different countries or districts may vary due 12 to the differences in the severity of the COVID-19 pandemic.

The 

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A novel coronavirus from patients with pneumonia in china

Coronavirus disease 2019 (covid-19) situation report -185

Clinical characteristics of coronavirus disease 2019 in china

Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in wuhan, china

Perioperative management of patients infected with the novel coronavirus: Recommendation from the joint task force of the chinese society of anesthesiology and the chinese association of anesthesiologists

 Table 3 Types