key: cord-0976958-a7yvizzq
authors: Sobti, A.; Memon, K.; Pala Bhaskar, R. R.; Unnithan, A.; Khaleel, A.
title: Analysis Of Mortality Following Trauma And Orthopaedic Surgery At The Peak Of COVID‐19 Pandemic
date: 2020-08-18
journal: Br J Surg
DOI: 10.1002/bjs.11929
sha: 466d2ba90139d5bef8e6350bb746f3482931e243
doc_id: 976958
cord_uid: a7yvizzq

nan

The 2019 novel coronavirus or the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) as it is now called is highly contagious. Asymptomatic Table 1 Characteristics and laboratory finding of the nine patients that had mortality during the peak of the pandemic Public Health England (PHE). There has been a noticeable reduction in Accident and Emergency presentations and overall Trauma admissions 2 . Multicenter studies, conducted over many countries have reported high postoperative pulmonary complications and an alarming rate of mortality in patients with perioperative SARS-CoV-2 infection 1,3 . During the same period our unit has maintained a prospective database of Trauma and Orthopaedic surgical activity. We performed 206 trauma and orthopaedics surgical procedures during the peak of the pandemic (01/03/2020-31/05/2020).

These procedures were considered urgent and essential following a multi disciplinary team (MDT) discussion. Our data on mortality following surgical procedures is presented in Table 1 . Nine patients died following surgery. Three patients were COVID-19 positive, post operatively. One patient did not have any symptoms at time of presentation and surgery hence was not tested; five patients who died were COVID-19 negative on testing.

We have some concerns about the published data on the outcomes of surgery during this period, in literature. Firstly the clinical diagnosis of COVID-19 patients was not standardized. The guidance and criteria for testing suspected patients with COVID-19 continued to evolve during the entire period. There is diagnostic uncertainty regarding false negative reverse transcription polymerase chain reaction in detection of SARS-CoV-2 from nasopharyngeal specimens 4 . Finally there is the concern of COVID-19 infection being transmitted by asymptomatic carriers during the incubation period 5 , especially as some are not being tested.

Comparing mortality of patients that tested positive or negative may not be entirely accurate. This may lead to spuriously high and alarming mortality rates. This however has not been our experience. We suggest it is more useful to compare and evaluate a single centres practice.

When hospitals resume routine surgery, it is likely to be in environments that remain exposed to SARS-CoV-2 1,2 . With an aim and drive to normalize services and practice, we suggest it might be helpful to share mortality rate of the centre in totality, rather based on testing alone. This will prove useful in preparation of an imminent second wave. 

Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection

Global guidance for surgical care during the COVID-19 pandemic

Mortality rates of patients with proximal femoral fracture in a worldwide pandemic: preliminary results of the Spanish HIP-COVID observational study

COVID-19 testing: the threat of false-negative results

Presumed asymptomatic carrier transmission of COVID-19