key: cord-0932223-ox7k0a3a
authors: Bockmann, Benjamin; Venjakob, Arne Johannes; Holschen, Malte; Nebelung, Wolfgang; Schulte, Tobias Ludger
title: Elective shoulder surgery during the COVID-19 pandemic in Germany: the patients‘ perspective
date: 2021-03-10
journal: JSES Int
DOI: 10.1016/j.jseint.2020.12.021
sha: 09343687b7484976d840d5f0a3c3847c78edead6
doc_id: 932223
cord_uid: ox7k0a3a

INTRODUCTION: The coronavirus disease 2019 (COVID19)- pandemic impeded the treatment of elective shoulder patients all over the world. Due to the constraints in personnel and operation theatre capacities, many patients who should undergo planned surgeries could not receive medical care. In our study, we examined the status quo of elective shoulder arthroscopy during the pandemic in Germany. METHODS: Using a non-profit database, the 40 shoulder units that performed the most arthroscopic rotator cuff repairs in Germany in 2018 were identified. Following a standardized protocol, the webpages of these units were screened and their strategy for elective procedures during the COVID19- pandemic was analyzed. Special emphasis was put on the use of new digital technologies. RESULTS: At the time of the study, no unit had stopped scheduling appointments for elective shoulder patients due to the pandemic. Almost all units (97.5%) offered explicit information about COVID19 and their strategies towards it. The possibilities of visiting patients in shoulder units varied due to local restrictions. Two units (5%) offered digital consultations. CONCLUSION: At the time of the study, elective shoulder procedures could be planned and carried out at the largest centers in Germany. Local restrictions had a great influence on the organization of the procedure and hospital stay during the COVID19-pandemic. Digital consultations were not available in every unit.

The coronavirus disease 2019 (COVID19)-pandemic impeded the treatment of elective 2 shoulder patients all over the world. Due to the constraints in personnel and operation 3 theatre capacities, many patients who should undergo planned surgeries could not receive 4 medical care. In our study, we examined the status quo of elective shoulder arthroscopy 5 during the pandemic in Germany. 6

Methods 7

Using a non-profit database, the 40 shoulder units that performed the most arthroscopic 8 rotator cuff repairs in Germany in 2018 were identified. Following a standardized protocol, 9 the webpages of these units were screened and their strategy for elective procedures during 10 the COVID19-pandemic was analyzed. Special emphasis was put on the use of new digital 11 technologies. 12

At the time of the study, no unit had stopped scheduling appointments for elective shoulder 14 patients due to the pandemic. Almost all units (97.5%) offered explicit information about 15 COVID19 and their strategies towards it. The possibilities of visiting patients in shoulder units 16 varied due to local restrictions. Two units (5%) offered digital consultations.

The coronavirus disease 2019 (COVID19)-pandemic is a challenge for health professionals all 26 over the world 1 . With more than 42 million cases worldwide as of October 25 th 2020, it 27 poses a substantial threat on the capacity of numerous global healthcare systems 5 . In order 28 to provide as many critical care beds as possible, elective procedures of all specialties were 29 postponed in spring 2020 in many countries 2 . As the pandemic stretches over more than 30

half a year without a definite end in sight and the number of infected individuals climaxes for 31 a second time, many hospitals that depend on elective procedures are developing strategies 32 to return to regular schedules while maintaining high safety standards for their patients. In the vast majority of hospitals (n=39, 97.5%), it was possible to make an appointment in 83 order to plan an elective arthroscopy of the shoulder. Only one hospital (2.5%) was unable 84 to schedule appointments, which was associated with a hospital shutdown and not directly 85 associated with the COVID19-pandemic. Of note, one hospital clearly stated that it was not 86 allowed to treat patients from 'risk areas' with a high incidence of COVID-infections. 87

Of all hospitals (n=40), 3 (7.5%) were located in the east, 9 (22.5%) in the southeast, 8 (20%) 88 in the southwest and 20 (50%) in the northeast of Germany. 89

The ownership was mostly private with 21 units (52.5%), followed by 10 confessional 90 hospitals (25%) and 9 (22.5%) public hospitals. 91

Only one hospital (2.5%) did not provide explicit information about the COVID19-pandemic 92 and how it is handled in the respective unit, while all other webpages have arranged special 93 sections on their webpages (s. Fig. 1 ). 94 28 webpages (70%) explicitly advised patients to wear a facemask, and in 19 cases (47.5%) 95 surgery, and in 5 cases (12.5%) patients were warned about a measurement of the body 98 temperature when the hospital is entered. 99

The possibility of visits varied from hospital to hospital. In total, 18 units (45%) did not allow 100 any external visitors (s. Fig. 2) . In 21 hospitals (52.5%), hospital visits were allowed under 101 certain restrictions. As mentioned above, one hospital (2.5%) went out of business and did 102 not provide information concerning visits. The permission of visits did not correlate with a 103 certain region in Germany (p = 0.915). 104

Of note, two hospitals (5%) offered digital consultations with orthopedic surgeons. 105 

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