key: cord-0974222-x93eybaw
authors: De, Chiranjit; Kainth, Nimrath; Harbham, Pratap Karavadra; Brooks, Margaret; Agarwal, Sujit
title: Review of orthopaedic trauma surgery during the peak of COVID-19 pandemic – An observational cohort study in the UK
date: 2021-04-21
journal: J Clin Orthop Trauma
DOI: 10.1016/j.jcot.2021.04.018
sha: 615a0c0feb6e25c4d69b5d11115d016decad9c2f
doc_id: 974222
cord_uid: x93eybaw

AIM: This study aims to estimate the risk of acquiring medical complication or death from COVID-19 infection in patients who were admitted for orthopaedic trauma surgery during the peak and plateau of pandemic. Unlike other recently published studies, where patient-cohort included a more morbid group and cancer surgeries, we report on a group of patients who had limb surgery and were more akin to elective orthopaedic surgery. METHODS: The study included 214 patients who underwent orthopaedic trauma surgeries in the hospital between 12th March and 12th May-2020 when the pandemic was on the rise in the United Kingdom. Data was collected on demographic profile including comorbidities, ASA grade, COVID-19 testing, type of procedures and any readmissions, complications or mortality due to COVID-19. RESULTS: There were 7.9% readmissions and 52.9% of it was for respiratory complications. Only one patient had positive COVID-19 test during readmission. 30-day mortality for trauma surgeries was 0% if hip fractures were excluded and 2.8% in all patients. All the mortalities were for proximal femur fracture surgeries and between ASA Grade 3 and 4 or in patients above the age of 70 years. CONCLUSION: This study suggests that presence of COVID-19 virus in the community and hospital did not adversely affect the outcome of orthopaedic trauma surgeries or lead to excess mortality or readmissions in patients undergoing limb trauma surgery. The findings also support resumption of elective orthopaedic surgeries with appropriate risk stratification, patient optimization and with adequate infrastructural support amidst the recovery phase of the pandemic.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was declared a pandemic 30 on March 11, 2020 by the World Health Organization and very soon it spread to most parts of 31 the world 1 . In the UK, there have been over 1,706,000 confirmed cases of SARS-CoV-2, with 32 almost 61,000 related deaths till date. The pandemic has tested the resilience of health-care 33 systems, including hospitals, which were largely unprepared for the scale of the pandemic 2 . 34 Patients having surgery are a vulnerable group at risk of SARS-CoV-2(COVID-19) exposure 35 in hospital and might be particularly susceptible to subsequent post-operative complications, 36 due to the pro-inflammatory cytokine and immunosuppressive responses to surgery 3,4 . Some 37 early publications 5 have shown a remarkably high post-operative mortality due to infection. This has led to an overly cautious approach for orthopaedic surgeries and 39 reinstitution of elective orthopaedic services have been very protracted. However, those 40 publications report outcome of surgery in a more moribund group of patients leading to an 41 inherent bias and more evidence is needed to assess whether this reported high peri-operative was post-operative 30- 

Of the 214 orthopaedic trauma surgeries carried out during the first surge of the pandemic, 106 there were 6 deaths (2.8%). Table-1 shows the distribution of the patients with respect to 107 different demographic parameters and corresponding mortality. There were no significant 108 differences based on gender or associated comorbidities. This table shows a statistically 109 significant difference in mortality based on the 'Red' or 'Blue' ward and 'COVID' and 110 'Clean' (Non-COVID) theatres but in our view, this is more of an association than causal.

Patients on the 'Red ward' were usually the ones who presented with chest symptoms and 112 they were often frail elderly and presented with hip fractures.

Table-2 shows that all the mortalities were in those aged 70 years and above and they were in All the deaths that occurred were in the hip fracture patients with their characteristics 131 summarised in the table below (Table No-3) . In our study group, all the mortalities were in the age group of 70 years and above.

COVIDSurg collaborative 12 also reported highest mortality in the same age group. In our 209 study, there were no mortalities following upper limb surgery. As we observed all the deaths 

al Prevalence of comorbidities and its 387 effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis

Incidence, clinical characteristics and 391 prognostic factor of patients with COVID-19: a systemic review and meta-analysis

Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-396

Confirmed Coronavirus Disease 2019 -COVID-NET, 14 States

DOI

Review of orthopaedic trauma surgery during the peak of COVID-19 Pandemic -An observational cohort study in the UK