|
1
|
Di J, Ma X, Wu T, Qiao E, Salouti M, Zhong Y, Xia Q, Kong D, Hao M, Xie Q, Ge Z, Liu D, Feng J, Zheng X. Association of COVID-19 with thyroid dysfunction and autoimmune thyroid disease: A retrospective cohort study. J Transl Autoimmun 2024; 9:100255. [PMID: 39524116 PMCID: PMC11550720 DOI: 10.1016/j.jtauto.2024.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/18/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024] Open
Abstract
Background Since the end of the COVID-19 pandemic, the potential roles of thyroid-inflammatory derangements in driving or being associated with the prognosis of COVID-19 remain controversial. We aimed to clarify the association between COVID-19 infection and thyroid dysfunction, and highlight the impacts of subsequent autoimmune thyroid disease (AITD) on the prognosis of COVID-19. Methods The retrospective, multicenter, cohort study enrolled 2,339 participants with COVID-19 from three hospitals located in the north, middle, and south regions of Shaan Xi Province, China, between December 2022 and July 2023. 464 non-COVID-19 patients within the same period were supplemented, divided into groups with and without AITD. At hospital admission (baseline), 3- and 6-month follow-ups, we presented a dynamic description and correlation analysis of thyroid-inflammatory-autoimmune derangements in patients with AITD. Results A total of 2,082 COVID-19 patients diagnosed with AITD and 257 cases without AITD were included in the study, and 464 non-COVID-19 patients were supplemented, dividing into 14 AITD and 450 non-AITD cases. We found that COVID-19 infection was closely associated with thyroid dysfunction (χ 2 = 1518.129, p = 0.000). AITD patients with COVID-19 showed a higher prevalence of symptoms and comorbidities and longer hospital stays at baseline than non-AITD patients with COVID-19 (p = 0.000, p = 0.000, and p = 0.000). The baseline free triiodothyronine (FT3), free thyroxine, and radioactive iodine uptake at 24 h in AITD cases significantly decreased (p = 0.000, p = 0.000, and p = 0.000), while thyroid stimulating hormone, thyroglobulin, reverse triiodothyronine (rT3), and thyroid antibodies varying elevated from the baseline to the follow-up (baseline: p = 0.000, p = 0.000, p = 0.000, p = 0.000, p = 0.000, and p = 0.000; 3-month follow-up: p = 0.000, p = 0.000, p = 0.000, p = 0.000, p = 0.030, and p = 0.000). C-reactive protein, calcitonin, interleukin-6, -8, -10, and tumor necrosis factor-α rose significantly at baseline (p = 0.000, p = 0.000, p = 0.000, p = 0.000, p = 0.000, and p = 0.000) in AITD. Interferon-α and interferon-γ at baseline showed a significant decrease (p = 0.000 and p = 0.000), and remained at low levels after 6 months (p = 0.000 and p = 0.000). FT3 and rT3 were positively and negatively correlated with hospitalization, respectively (r = -0.208 and 0.231; p = 0.000 and p = 0.000). ROC curves showed that FT3 and rT3 had better robustness in predicting severe COVID-19 prognosis (AUC = 0.801 and 0.705). Ordered logistic regression revealed that ORs were 0.370, 0.048, and 0.021 for AITD [(subacute thyroiditis, Grave's disease, and Hashimoto's thyroiditis compared to non-thyroidal illness syndrome (NTIS)] with COVID-19 risk, indicating that NTIS was the predominant risk factor for the severity of COVID-19. Conclusions A robust association has been identified, wherein COVID-19 infection is closely associated with thyroid dysfunction, and the subsequent AITD may aggravate the poor prognosis of COVID-19.
Collapse
Affiliation(s)
- Jia Di
- Department of Nuclear Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi Province, 710004, China
| | - Xiaodong Ma
- Department of Nuclear Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi Province, 710004, China
| | - Tao Wu
- Department of Nuclear Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi Province, 710004, China
| | - Eryue Qiao
- Department of Nuclear Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi Province, 710004, China
| | - Mojtaba Salouti
- Department of Microbiology, Islamic Azad University, Zanjan, 45156-58145, Iran
| | - Yu Zhong
- Department of Laboratory Medicine, Yulin Zizhou County Hospital, Yulin, Shaan Xi Province, 718499, China
| | - Qian Xia
- Department of Physical Examination, Hanzhong Mian County Hospital, Hanzhong, Shaan Xi Province, 724299, China
| | - Danfeng Kong
- Department of Nuclear Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi Province, 710004, China
| | - Min Hao
- Department of Nuclear Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi Province, 710004, China
| | - Qingwei Xie
- Department of Nuclear Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi Province, 710004, China
| | - Zhuang Ge
- Department of Nuclear Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi Province, 710004, China
| | - Dongzheng Liu
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Juanyi Feng
- Department of Nuclear Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi Province, 710004, China
| | - Xianghong Zheng
- Department of Nuclear Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi Province, 710004, China
| |
Collapse
|
|
2
|
Zhang YS, Ma R, Liu B, Zhang Q, Hai Y. Occupational exposure protection and perioperative management of sudden infectious diseases from the perspective of COVID-19. J Int Med Res 2024; 52:3000605241266234. [PMID: 39301802 PMCID: PMC11418532 DOI: 10.1177/03000605241266234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 06/18/2024] [Indexed: 09/22/2024] Open
Abstract
The coronavirus disease (COVID-19) SARS-CoV-2 virus epidemic continues to exhibit a sporadic onset trend due to the continuous variation of the novel coronavirus. However, the psychological impact of the pandemic persists. It is crucial to reflect on our experiences to better prepare for future large-scale infectious diseases. During outbreaks of infectious diseases, patients may still require orthopaedic surgery. It is crucial to prioritize the safety of medical staff and establish procedures to ensure their protection. However, with the implementation of a series of standardized operational protection procedures, orthopaedic surgeons can safely perform their duties without the risk of contracting COVID-19. There is no doubt that the orthopaedic occupational exposure protection process and perioperative management plan for global infectious diseases, such as COVID-19, require a standardized summarization process and a narrative review.
Collapse
Affiliation(s)
- Yao-Shen Zhang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Rui Ma
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Bo Liu
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qiang Zhang
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
|
3
|
Karna ST, Ahmad Z, Thaware P, Trivedi S, Gouroumourty R, Singh P, Waindeskar V, Sharma JP, Kaushal A, Saigal S. Postoperative Outcomes After Emergency Surgery in COVID-19 Patients: An Ambispective Matched Cohort Study. Cureus 2024; 16:e55845. [PMID: 38590490 PMCID: PMC11001162 DOI: 10.7759/cureus.55845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose There is limited data from the Indian subcontinent regarding the surgical outcomes of coronavirus disease (COVID-19) patients. In this observational study, we aimed to evaluate the postoperative outcomes after emergency surgery in COVID-19 patients compared to concurrent age and gender-matched controls. We also sought to analyze the possible predictors of postoperative mortality in COVID-19 patients. Methods This matched cohort study was conducted in a tertiary care teaching hospital in central India, between 1st July 2021 and 30th June 2022. COVID-19-positive patients undergoing emergency surgery under anesthesia were recruited as cases. Age and gender-matched COVID-19-negative patients undergoing a similar nature of surgery in the same period served as concurrent controls. The cases and controls were compared for the 30-day mortality and perioperative complications. Results The COVID-19-positive surgical cohort had a 12.3 times greater 30-day postoperative overall mortality risk as compared to a matched cohort of patients with a negative COVID-19 test. A positive COVID-19 status was associated with more postoperative complications of acute respiratory distress syndrome (ARDS), sepsis, shock, and persistent hyperglycemia. On analysis of predictors of mortality, the presence of preoperative dyspnea, ARDS, American Society of Anesthesiologists Physical Status (ASA-PS) Class IIIE/IVE, increase in sequential organ failure assessment (SOFA) score, Quick SOFA>1, higher creatinine, bilirubin, and lower albumin were observed to be associated with increased mortality. Conclusions Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients undergoing emergency surgery is significantly associated with higher postoperative complications and increased 30-day postoperative mortality.
Collapse
Affiliation(s)
- Sunaina T Karna
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Zainab Ahmad
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Pooja Thaware
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Saurabh Trivedi
- Anesthesiology, Chirayu Medical College and Hospital, Bhopal, IND
| | - Revadi Gouroumourty
- Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Pooja Singh
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Vaishali Waindeskar
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Jai Prakash Sharma
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ashutosh Kaushal
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Saurabh Saigal
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| |
Collapse
|
|
4
|
Chauhan GS, Kaur J, Habeebullah A, Dewan V, Pemmaraju G. The Impact of the COVID-19 Pandemic on Orthopaedic Trauma Surgery in a District General Hospital in the United Kingdom. Cureus 2024; 16:e53928. [PMID: 38465094 PMCID: PMC10924859 DOI: 10.7759/cureus.53928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction The 2020 COVID-19 pandemic led to a national lockdown and a major reorganization of healthcare services in the United Kingdom. The center where the study was done was one of the worst affected hospitals in the United Kingdom at the outset of the pandemic. Our study evaluates the impact of the pandemic and national lockdown on the outcomes for patients undergoing orthopedic trauma surgery. Methods We prospectively identified all patients undergoing orthopedic trauma surgery in the unit from 1st March 2020 to 31st May 2020. We recorded demographics, diagnoses, COVID-19 infection status, length of stay, and mortality. This was compared with a comparative group in the same period in 2018 and 2019. Results There was a significant reduction in the number of orthopedic trauma surgery cases (318) performed in 2020 compared to 2019 (423 cases, p<0.001) and 2018 (444 cases, p<0.001). The mean time from injury to presentation was 3.6 days, with 40 patients (12.6%) presenting more than one week after injury. The 30-day mortality was 8.2%, and the six-month mortality was 15.1%, with both significantly higher than in 2018 (p<0.001) and 2019 (p<0.001). COVID-19 testing was positive in 39% of patients, with 30-day mortality in this group at 37%, rising to a 53% six-month mortality. No patients under the age of 50 years old died. The majority of admissions (51%) were due to falls at home. The second most common mechanism was Do-It-Yourself (DIY) injuries. Road traffic accidents accounted for 2%. Conclusion There were significantly fewer cases of orthopedic trauma surgery during the first wave of the COVID-19 pandemic compared to the same period in previous years. The type of trauma also showed low numbers of high-energy and sporting injuries as a result of the national lockdown. Patients undergoing orthopedic trauma surgery who tested positive for COVID-19 had significantly higher 30-day mortality than those without COVID-19, and this increased mortality persisted to six months post-operatively. However, patients under 50 years old appear to be at low risk of death.
Collapse
Affiliation(s)
- Govind S Chauhan
- Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, GBR
| | - Jasprit Kaur
- Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, GBR
| | | | - Varun Dewan
- Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, GBR
| | | |
Collapse
|
|
5
|
Levitt EB, Patch DA, Hess MC, Terrero A, Jaeger B, Haendel MA, Chute CG, Yeager MT, Ponce BA, Theiss SM, Spitler CA, Johnson JP. Outcomes of SARS-CoV-2 infection among patients with orthopaedic fracture surgery in the National COVID Cohort Collaborative (N3C). Injury 2023; 54:111092. [PMID: 37871347 DOI: 10.1016/j.injury.2023.111092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND The objective of this study was to investigate the outcomes of COVID-19-positive patients undergoing orthopaedic fracture surgery using data from a national database of U.S. adults with a COVID-19 test for SARS-CoV-2. METHODS This is a retrospective cohort study using data from a national database to compare orthopaedic fracture surgery outcomes between COVID-19-positive and COVID-19-negative patients in the United States. Participants aged 18-99 with orthopaedic fracture surgery between March and December 2020 were included. The main exposure was COVID-19 status. Outcomes included perioperative complications, 30-day all-cause mortality, and overall all-cause mortality. Multivariable adjusted models were fitted to determine the association of COVID-positivity with all-cause mortality. RESULTS The total population of 6.5 million patient records was queried, identifying 76,697 participants with a fracture. There were 7,628 participants in the National COVID Cohort who had a fracture and operative management. The Charlson Comorbidity Index was higher in the COVID-19-positive group (n = 476, 6.2 %) than the COVID-19-negative group (n = 7,152, 93.8 %) (2.2 vs 1.4, p<0.001). The COVID-19-positive group had higher mortality (13.2 % vs 5.2 %, p<0.001) than the COVID-19-negative group with higher odds of death in the fully adjusted model (Odds Ratio=1.59; 95 % Confidence Interval: 1.16-2.18). CONCLUSION COVID-19-positive participants with a fracture requiring surgery had higher mortality and perioperative complications than COVID-19-negative patients in this national cohort of U.S. adults tested for COVID-19. The risks associated with COVID-19 can guide potential treatment options and counseling of patients and their families. Future studies can be conducted as data accumulates. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Eli B Levitt
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA; Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - David A Patch
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Matthew C Hess
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Alfredo Terrero
- Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA; Department of Translational Medicine, School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Byron Jaeger
- Department of Epidemiology, University of Alabama, Birmingham, AL, USA
| | - Melissa A Haendel
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew T Yeager
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | | | - Steven M Theiss
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Joey P Johnson
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA.
| |
Collapse
|
|
6
|
Tsui KHM, Chau WW, Liu WH, Tam CY, Yee DKH, Tso CY, Zhang N, Cheung WH, Tang N, Wong RMY. COVID-19 hip fracture outcomes: The role of Ct values and D-dimer levels? J Orthop Translat 2023; 43:14-20. [PMID: 37920546 PMCID: PMC10618614 DOI: 10.1016/j.jot.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/11/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction The COVID-19 pandemic has caused high mortality rates in hip fracture patients, but data for Asian patients are lacking. Whilst Cycle threshold (Ct) values and D-dimer have been reported as predictors of mortality in COVID-19 patients, their prognostic roles in those with concomitant hip fracture remain unknown. The objectives of this study were to i) assess the clinical outcomes of COVID-19 hip fractures patients in the Chinese population, ii) identify risk factors of mortality and complications, and iii) determine the prognostic roles of Ct values and D-dimer levels. Methodology This cohort study was conducted during the 5th wave of the COVID-19 pandemic. Inclusion criteria were 1) hip fracture 2) ≥ 60 years old 3) low-energy trauma. Outcomes were 90-day all-cause mortality, complications, length of stay, discharge destination and mobility status. Logistic regression analysis was performed to identify risk factors for mortality and complications. Subgroup analysis was performed for patients with Ct < 30 and Ct > 30, comparing their outcomes of operations performed within 48 h vs beyond 48 h. Results 159 hip fracture patients were included, 42 patients were COVID-19 positive. COVID-19 group had significantly higher 90-day mortality rates (21.4% vs 9.4%), complication rates (45.2% vs 28.2%) and longer length of stay (17.06 vs 10.84 nights). COVID-19 was an independent risk factor for mortality and complications. Amongst the COVID-19 group, risk factors for poor outcomes were advanced age, steroids use, conservative treatment and American Society of Anaesthesiologists (ASA) score ≥ 3. Conservative treatment was associated with higher mortality (OR = 16.00; p = 0.025) in COVID-19 hip fracture patients. There was no significant difference between Ct values < 30 and >30 regarding mortality and complication rate. D-dimer and timing to operation did not affect outcomes. Conclusions Patients with concomitant COVID-19 and hip fracture are at high risk of mortality and complications. Ct values and D-dimer levels have no prognostic roles for hip fracture outcomes. Early operative treatment is recommended as soon as patients are medically fit.
Collapse
Affiliation(s)
- Kwan Hung Moya Tsui
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Wai Wang Chau
- Department of Orthopaedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong SAR, China
| | - Wing Hong Liu
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Cheuk Yin Tam
- Department of Orthopaedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong SAR, China
| | - Dennis King Hang Yee
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Yin Tso
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Ning Zhang
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wing-Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ning Tang
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
|
7
|
Dankl L, Crepaz-Eger U, Arora R, Schneider F. Retrospective Analysis of Nosocomial SARS-CoV-2 Infections in Orthopedic and Traumatological Inpatients. Healthcare (Basel) 2023; 11:2765. [PMID: 37893839 PMCID: PMC10606212 DOI: 10.3390/healthcare11202765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/29/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
SARS-CoV-2 has had a measurable impact on the field of orthopedic and traumatological surgery. To date, scarce data on intramural SARS-CoV-2 infections in orthopedic and traumatological patients have been reported. Therefore, the aim of our study was to investigate the effect of nosocomial SARS-CoV-2 infections in orthopedic and traumatological inpatients regarding symptoms of infection, mortality, duration of hospitalization, and other relevant patient-dependent factors. Patients admitted to hospital for an orthopedic or traumatological indication were screened retrospectively for nosocomial SARS-CoV-2 infections and included in this study. An age-, sex-, and ICD 10-matched control group was assigned and demographic data, clinical symptoms of a SARS-CoV-2 infection as well as mortality, length of hospital stays, time to surgery, pre-existing conditions, LKF-points representing the financial effort, and the Charlson Comorbidity Index were collected. A significantly higher length of stay was observed in the SARS-CoV-2 group (25 days; 4-60; SD 12.5) when compared to the control group (11 days; 2-36; SD 7; p < 0.05). LKF points were significantly higher in the SARS-CoV-2 group (13,939 points vs. 8542 points). No significant difference in mortality could be observed. An infection with SARS-CoV-2 in inpatients significantly increases length of hospital stay and cost of treatment. Although no significant difference in mortality was found, care should be taken to avoid intramural SARS-CoV-2 infections, resulting in prolonged hospitalization, higher costs, and potentially further individual risks.
Collapse
Affiliation(s)
| | | | | | - Friedemann Schneider
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (L.D.)
| |
Collapse
|
|
8
|
Tabu IA, Araneta KTS, Alpuerto BB, Delgado GD, Lai JGL, San Juan JAG, Ho A, Reyes MRB, De Vera J, Syquia JFC, Manalastas REC, Tablante AJC, Brabante AMT, Dimayuga CCD, Pacheco DM, Baclig PY, Co AST, Yap JAD. Improving fragility hip fracture care through data: a multicentre experience from a country with an emerging economy during the COVID-19 pandemic. BMJ Open Qual 2023; 12:e002299. [PMID: 37783523 PMCID: PMC10565130 DOI: 10.1136/bmjoq-2023-002299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/12/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION In low-to-middle-income countries (LMIC), the orthogeriatric model of care is still in its early stages of development. This study describes the initial results of the first online fragility hip fracture database to be setup in the Philippines using a modified minimum common dataset to generate outcomes data based on current hospital practices. METHODS A multicentre prospective cohort study among 12 Philippine hospitals was conducted from June 2020 to February 2021. Thirty-day mortality, morbidity and mobility were measured. Significant factors associated with mortality were determined. RESULTS 158 elderly patients with fragility hip fractures were included in the study. Nine patients (5.7%) were confirmed or suspected to have COVID-19 infection. Median time of injury to admission was at least 3 days (IQR: 1.0-13.7). Overall, 80% of patients underwent surgical intervention with a median time from admission to surgery of at least 5 days (IQR: 2.5-13.6). Thirty-day mortality and morbidity rates for acute fragility fractures were 3.7%. Factors significantly associated with early mortality were poor prefracture mobility, COVID-19 infection, radiograph of the abnormal chest and conservative treatment. Non-surgical patients had no functional mobility or were wheelchair users and had a significantly higher morbidity rate than surgically treated patients (13.6% vs 1.8%; p=0.031). CONCLUSION Despite treatment delays unique to an LMIC, short-term outcomes remain favourable for non-COVID-19 fragility hip fracture patients treated with surgery. Prompt admission and multidisciplinary care for elderly hip fracture patients while maintaining protective measures for COVID-19 infection control are recommended. The quality of data collected illustrates how this online database can provide a framework for a sustainable audit or registry as well as provide a platform for the introduction of orthogeriatric concepts at a multiregional scale.
Collapse
Affiliation(s)
- Irewin A Tabu
- Department of Orthopedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
- Institute on Aging, National Institutes of Health, UP Manila, Philippines
| | | | - Bernardino B Alpuerto
- Department of Orthopedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Giorgio D Delgado
- Department of Orthopedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Joseph Garvy L Lai
- Department of Orthopedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
- Department of Orthopedics, Cardinal Santos Medical Center, San Juan, Philippines
| | | | - Alexander Ho
- Department of Orthopedics, Chong Hua Hospital, Cebu City, Philippines
| | - Ma Ramona B Reyes
- Department of Orthopedics, Davao Doctors Hospital, Davao City, Philippines
| | - Jose De Vera
- Department of Orthopedics, De Los Santos Medical Center, Quezon City, Philippines
| | | | | | | | | | - Cesar Cipriano D Dimayuga
- Department of Orthopedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
- Department of Orthopedics, The Medical City, Pasig City, Philippines
| | - Deejay M Pacheco
- Department of Orthopedics, Veterans Memorial Medical Center, Quezon City, Philippines
| | - Phillipe Y Baclig
- Department of Orthopedics, Vicente Sotto Memorial Medical Center, Cebu City, Philippines
| | - Andrew Steven T Co
- Department of Orthopedics, Vicente Sotto Memorial Medical Center, Cebu City, Philippines
| | - John Alfred D Yap
- Department of Orthopedics, West Visayas State University Medical Center, Iloilo City, Philippines
| |
Collapse
|
|
9
|
James CL, Wolterink TD, Fathima B, Burdick GB, Wager SG, Haan JW, Hegde YD, Muh S. Effects of the COVID-19 Pandemic on Humeral Shaft Fracture Management and Its Outcomes. Cureus 2023; 15:e43433. [PMID: 37706149 PMCID: PMC10497303 DOI: 10.7759/cureus.43433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/15/2023] Open
Abstract
Background and objective The coronavirus disease 2019 (COVID-19) pandemic necessitated a sudden and drastic shift in patient management throughout the healthcare system, to curb the spread of the disease and deal with resource limitations. Many surgical cases were canceled or delayed with only the most urgent and emergent cases taken up for treatment. It is unknown if and how these alterations affected patient outcomes. The purpose of this study was to compare time to fracture care and outcomes between patients treated for humeral shaft fractures prior to the COVID-19 pandemic and those treated during the pandemic. We hypothesized that the pandemic cohort would have a prolonged time to fracture care and worse outcomes than the pre-pandemic cohort. Materials and methods This was a retrospective cohort study performed within a single healthcare system. All humeral shaft fractures treated from March to June 2019 (pre-pandemic cohort) and March to June 2020 (pandemic cohort) were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and ICD-10-CM codes as well as Current Procedural Terminology (CPT) codes. Data on demographics, fracture characteristics, treatment, and outcomes were collected via chart and radiograph review. Outcomes analyzed included time to being made weight-bearing as tolerated (WBAT), radiographic union, and final follow-up; range of motion (ROM) at radiographic union and final follow-up; and rate of complications. Results The pre-pandemic cohort (n=19) was significantly younger with a mean age of 29 years than the pandemic cohort (n=17) with a mean age of 49 years (p=0.010). There were no other significant differences in demographics, fracture characteristics, or treatment type between the groups. Time to fracture care was not significantly different in the pre-pandemic cohort (five days) versus the pandemic cohort (four days). Time to being made WBAT, radiographic union, and final follow-up were not significantly different between the pre-pandemic (86, 113, and 98 days) and the pandemic cohorts (77, 106, and 89.5 days). ROM measurements in abduction at radiographic union were significantly different between the cohorts: in the pre-pandemic cohort, 100% of patients reached greater than 160 degrees; in the pandemic cohort, only 16.7% of patients reached greater than 160 degrees (p=0.048). There was a non-significant decrease in the proportion of patients who achieved the maximal category of ROM measurements in forward elevation and extension at radiographic union and abduction, forward elevation, and extension at final follow-up, as well as a non-significant increase in visual analog scale (VAS) pain scores at final follow-up between cohorts. There were no significant differences in the rate of complications. Conclusions Despite limited resources, reduced operating room availability, and increased utilization of virtual visits due to the COVID-19 pandemic, patients with humeral shaft fractures may not have faced delays in fracture care or worse outcomes compared to the pre-pandemic period. The pandemic cohort may have experienced significantly decreased ROM compared to the pre-pandemic cohort, which may reflect the decreased availability of physical therapy services and overall decreased activity levels due to the quarantine orders. However, we could not identify any other significant differences in the type of treatment, pain, complications, or time to union.
Collapse
Affiliation(s)
- Chrystina L James
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA
| | - Trevor D Wolterink
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, USA
| | - Bushra Fathima
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, USA
| | - Gabriel B Burdick
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, USA
| | - Susan G Wager
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, USA
| | - Jager W Haan
- Department of Orthopaedic Surgery, Michigan State University College of Human Medicine, East Lansing, USA
| | - Yash D Hegde
- Department of Orthopaedic Surgery, Michigan State University College of Human Medicine, East Lansing, USA
| | - Stephanie Muh
- Department of Orthopaedic Surgery, Henry Ford Health System, West Bloomfield, USA
| |
Collapse
|
|
10
|
Bangani O, English R, Dramowski A. Intensive care unit nurses' knowledge, attitudes and practices of COVID-19 infection prevention and control. S Afr J Infect Dis 2023; 38:478. [PMID: 37435115 PMCID: PMC10318607 DOI: 10.4102/sajid.v38i1.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/13/2023] [Indexed: 07/13/2023] Open
Abstract
Background Intensive care units (ICUs) had to rapidly adapt infection prevention and control (IPC) practices during the coronavirus disease 2019 (COVID-19) pandemic. Objectives To determine ICU nurses' COVID-19 IPC-related knowledge, attitudes, practices, and perceptions. Method A mixed-methods study was conducted at the Groote Schuur Hospital ICU, Cape Town, South Africa (20 April 2021 and 30 May 2021). Participants completed anonymous, self-administered, knowledge, attitudes and practices (KAP) questionnaires. Individual interviews were conducted regarding nurses' lived experiences and perceptions of COVID-19 IPC in critical care. Results In total, 116 ICU nurses participated (93.5% response rate) including 57 professional nurses (49%), 34 enrolled nurses (29%) and 25 enrolled nursing assistants (22%); young females (31-49 years) predominating (n = 99; 85.3%). Nurses' overall COVID-19 IPC knowledge scores were moderately good (78%); professional nurses had greater knowledge of COVID-19 transmission (p < 0.001). Intensive care unit nurses' attitude scores towards COVID-19 IPC were low (55%), influenced by limited IPC training, insufficient time to implement IPC and shortages of personal protective equipment (PPE). Respondents' scores for self-reported COVID-19 IPC practices were moderate (65%); highest compliance rates were for hand hygiene after touching patient surroundings (68%). Only 47% ICU nurses underwent N95 respirator fit-testing despite working in a COVID-19 ICU. Conclusion Regular COVID-19 IPC training is needed to equip ICU nurses with the knowledge and skills to prevent healthcare-associated COVID-19 transmission. Enhanced IPC training and consistent PPE availability may support more favourable attitudes and better IPC practices. Comprehensive IPC and occupational health support should be offered to ensure ICU nurses' wellbeing during pandemics. Contribution Enhanced IPC training and consistent PPE availability may support better attitudes and IPC practices.
Collapse
Affiliation(s)
- Onga Bangani
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - René English
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
|
11
|
Hossain B, Malik F, Khan A, Abidi M, Marhaba A, Oranu A, Shumeyko M, Hila A, Banks L, Patel OA, Nawaz M, Shaikh S, Nadeem H, Qazi S. Prevalence and Impact of Gastrointestinal Manifestations in COVID-19 Patients: A Systematic Review. J Community Hosp Intern Med Perspect 2023; 13:39-54. [PMID: 37877065 PMCID: PMC10593163 DOI: 10.55729/2000-9666.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 10/26/2023] Open
Abstract
Background and objective The aim of this study is to systematically analyze and summarize the implications of COVID-19 on the digestive system by quantitatively evaluating the prevalence of gastrointestinal symptoms such as nausea, vomiting, abdominal pain, constipation, diarrhea, anorexia. reported in COVID-19 cases. We simultaneously investigated other variables to determine the association of such symptoms in COVID-19 patients which can potentially influence the disease prognosis and outcome. This systematic review presents an updated literature on the issue as it requires more scientific discussion in order to better inform the medical community and authorities so that appropriate measures can be taken to control the virus outbreak. Methods MEDLINE database was searched to identify relevant articles. Data was analyzed and synthesized from the 16 eligible studies which exclusively reported GI symptoms in COVID-19 patients along with the disease prognosis. A meta-analysis of studies having adequate information regarding the prevalence of specific GI symptoms in association with other relevant independent variables was performed. Results From the search strategy, we identified 16 articles which fit our eligibility criteria comprising of 10 cross-sectional studies, 2 cohort study, 1 RCT and 3 observational studies. From these pooled studies, 6 articles exclusively talked about COVID-19 patients in which GI symptoms were reported and adequately discussed. In a total of 3646 patients, GI symptoms were documented in (16.2%-10.1%) patients. The most prevalent GI symptom was diarrhea (47%) but the most common clinical manifestation reported was fever (77.4%). Among the adult patients, hypertension (11.6%) was the most frequently reported comorbidity. Presence of viral RNA in stool sample was noted in 16.7% patients with GI symptom. In patients who complained of having GI symptoms, an abnormal liver function was largely observed, with an elevated ALT level in (10.9%) and an elevated AST in (8.8%) of the patients. Evidence of vertical transmission (14.2%) was reported in one study which highlights the extent and mode of viral transmission. It was observed that a great majority of the patients in the 6 studies reporting specifically on patients with GI symptoms were on antiviral therapy (68.6%) as the standard disease management protocol but the eventual disease outcome as in this case died (8.4%), discharged (45.6%) was not linked to just one therapeutic factor but other indicators of disease severity such as positive chest CT findings (87.82%) have led to a poor disease prognosis which was noted in (28.9%) severe patients with GI symptoms compared to (71.1%) non-severe COVID-19 patients with GI symptom. Conclusion Presence of GI symptoms in COVID-19 patients has shown to have a positive association with the poor disease prognosis likely as a result of direct viral toxicity. It is important for the physicians to recognize digestive symptoms as an important characteristic in COVID-19 patients. Hence, precise and targeted documentation of GI symptoms and viral stool sample investigations should be performed in order to understand the rapidly evolving disease symptomology.
Collapse
Affiliation(s)
- Bassam Hossain
- Gastroenterology, UHS Wilson Hospital, Johnson City, NY,
USA
| | - Fahad Malik
- Gastroenterology, UHS Wilson Hospital, Johnson City, NY,
USA
| | - Ali Khan
- Gastroenterology, UHS Wilson Hospital, Johnson City, NY,
USA
| | - Mohammad Abidi
- Gastroenterology, UHS Wilson Hospital, Johnson City, NY,
USA
| | - Ali Marhaba
- Gastroenterology, UHS Wilson Hospital, Johnson City, NY,
USA
| | - Amanke Oranu
- Gastroenterology, UHS Wilson Hospital, Johnson City, NY,
USA
| | - Mark Shumeyko
- Gastroenterology, UHS Wilson Hospital, Johnson City, NY,
USA
| | - Amine Hila
- Gastroenterology, UHS Wilson Hospital, Johnson City, NY,
USA
| | - Lesli Banks
- Gastroenterology, UHS Wilson Hospital, Johnson City, NY,
USA
| | - Owais A. Patel
- Internal Medicine, Dow University of Health Sciences, Karachi,
Pakistan
| | - Marrium Nawaz
- Internal Medicine, Dow University of Health Sciences, Karachi,
Pakistan
| | - Shehryar Shaikh
- Internal Medicine, Dow University of Health Sciences, Karachi,
Pakistan
| | - Hafsa Nadeem
- Internal Medicine, Dow University of Health Sciences, Karachi,
Pakistan
| | - Shoreh Qazi
- Internal Medicine, Dow University of Health Sciences, Karachi,
Pakistan
| |
Collapse
|
|
12
|
Prost S, Carissimi M, McCausland AM, Tropiano P, Argenson JN, Blondel B. [The proximal femur fracture epidemic continued during the COVID-19 pandemic: Results of an observational study]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET TRAUMATOLOGIQUE 2023; 109:19-23. [PMID: 34786032 PMCID: PMC8585587 DOI: 10.1016/j.rcot.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/08/2021] [Indexed: 02/08/2023]
Abstract
Introduction L’objectif de cette étude était de comparer le volume et les caractéristiques des chirurgies urgentes traumatologiques réalisées dans notre institution entre le 20 mars et le 20 avril 2020, correspondant au premier mois de confinement, et de les comparer aux données de la période équivalente de 2019. Notre hypothèse de travail reposait sur le fait qu’il existe une part de traumatologie non évitable pour laquelle des mesures de prévention spécifique pourraient être nécessaires. Méthodes Il s’agit d’une étude continue mono-centrique observationnelle. Tous les patients ayant nécessités une prise en charge chirurgicale traumatologique entre le 20 mars et le 20 avril 2020 ont été inclus, et les données de la même période de 2019 étaient récupérées. L’ensemble des chirurgies était réalisé dans notre institution qui est un centre de traumatologie de niveau 2 de notre région. Résultats Pendant le premier mois de confinement, 70 patients ont été pris en charge chirurgicalement pour une urgence traumatologique, contre 109 patients sur la période de 2019, représentant une baisse d’activité globale de 36 %. Sur l’ensemble des patients, l’âge moyen était significativement plus élevé en 2020 (68,4 SD = 22 vs 60,3 SD = 24 p = 0,0210). Les accidents de loisirs et les accidents de la circulation étaient moins nombreux en 2020 (34 vs. 10), ainsi que les accidents liés au travail (7vs. 2) alors que les accidents domestiques restaient globalement stables (65 vs. 55). Conclusion En période d’urgence sanitaire, la poursuite des activités de traumatologie est essentielle, même si elle nécessite une organisation spécifique pour la prise en charge des patients. La période de confinement et les modifications de comportements associées ont changé le spectre global de la traumatologie. La réduction majeure de la traumatologie routière, de loisirs et celle liée au travail constitue une part évitable de cette activité chirurgicale justifiant d’une prévention spécifique en période crise sanitaire. À l’inverse, les traumatismes gériatriques et notamment les fractures de l’extrémité proximale du fémur n’étaient globalement que peu modifiées traduisant la nécessité de mesures de prévention supplémentaires pour ces patients. Niveau de preuve V ; étude observationnelle.
Collapse
|
|
13
|
Prost S, Carissimi M, McCausland AM, Tropiano P, Argenson JN, Blondel B. The proximal femur fracture epidemic continued during the COVID-19 pandemic: Results of an observational study. Orthop Traumatol Surg Res 2023; 109:103143. [PMID: 34768004 PMCID: PMC8577050 DOI: 10.1016/j.otsr.2021.103143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of this study was to compare the volume and characteristics of emergency trauma surgery procedures done at our hospital between March 20 and April 20, 2020 (the first month of the national lockdown in France) and to compare these data to the same period in 2019. We hypothesized that a portion of fractures are unavoidable, thus specific preventative measures will be needed to reduce their incidence. METHODS This was a continuous, observational and single center study. All patients who required urgent surgery for a fracture between March 20 and April 20, 2020, were included. Data for the same period in 2019 was retrieved. All the procedures were done at our hospital, which is a regional level II trauma center. RESULTS During the first month of the lockdown, 70 patients underwent emergency surgery because of a fracture, versus 109 patients in the same period in 2019, thus an overall 36% drop. The mean age of the patients was higher in 2020 (68.4 years SD=22) than in 2019 (60.3 years SD=24, p=0.0210). There were fewer recreational and motor vehicle accidents in 2020 (34 vs. 10) and fewer work-related accidents (7 vs. 2) although the number of accidents at home were similar (65 vs. 55). CONCLUSION During a public health emergency, it is vital to continue doing trauma surgery procedures, even though it requires a specific care pathway. The lockdown and associated behavioral changes have altered the spectrum of trauma surgery. A major decrease in motor vehicle, recreation and work-related accidents is the avoidable portion of this surgical activity, justifying specific preventative measures during a public health crisis. Conversely, the incidence of geriatric fractures - particularly of the proximal femur - did not change much overall, thus there is need for additional preventative measures in these patients. LEVEL OF EVIDENCE V, observational study.
Collapse
|
|
14
|
Kalogeropoulos A, Savvidou OD, Bissias C, Sarafis P, Savvidis M, Tanos A, Pikoulis E, Papagelopoulos PJ, Exadaktylos A, Eggli S. Milder impact of the COVID-19 pandemic on the practice of orthopaedic surgery in Greece and Cyprus than other European countries. Knee Surg Sports Traumatol Arthrosc 2023; 31:110-120. [PMID: 36114340 PMCID: PMC9483367 DOI: 10.1007/s00167-022-07159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this study was to highlight the impact of the COVID-19 pandemic on the practice of orthopaedics in Greece and Cyprus. METHODS The survey used the online questionnaire from AGA (Gesellschaft für Arthroskopie und Gelenkchirurgie; Society for Arthroscopy and Joint Surgery) to facilitate the comparison between different European countries. The questionnaire was distributed online to members of the HAOST (Hellenic Association of Orthopaedic Surgery and Trauma), the ΟΤΑΜΑΤ (Orthopaedic and Trauma Association of Macedonia and Thrace) and the CAOST (Cypriot Association of Orthopaedic Surgery and Trauma). The questionnaire consisted of 29 questions, which included demographic data, questions on the impact of the pandemic on the practice of orthopaedic surgery and questions on the impact on the personal and family life of orthopaedic surgeons. RESULTS The questionnaire was sent to 1350 orthopaedic surgeons in Greece and Cyprus, 303 of whom responded (response rate 22.44%). 11.2% of the participants reported cancellation of overall orthopaedic procedures. According to 35.6-49.8% of the participants, arthroscopic procedures were continued. As regards elective primary arthroplasties, 35.3% of the participants reported that these continued to be performed at their hospitals. Post-operative follow-ups as well as physiotherapy were affected by the pandemic, and changes were also observed in the habits of orthopaedic surgeons in their personal and family lives. CONCLUSION The orthopaedic service in Greece and Cyprus decreased during the first wave of the COVID-19 pandemic. Arthroscopic procedures and total joint replacements decreased significantly, but not to the same extent as in other countries. Health systems were not fully prepared for the first wave of the pandemic and the various countries took social measures at different times and to different extents. Thus, studying the impact of the pandemic on the practice of orthopaedic surgery in different countries can help health systems to better prepare for future pandemics; public health can then be shielded and hospitals can continue to provide high-quality orthopaedic care. LEVEL OF EVIDENCE Level V.
Collapse
Affiliation(s)
| | - Olga D. Savvidou
- 1st Department of Orthopedic Surgery, National and Kapodistrian University of Athens, ATTIKON” University General Hospital, Athens, Greece
| | | | - Pavlos Sarafis
- Department of Nursing, University of Thessaly, Volos, Greece
| | | | | | - Emmanouil Pikoulis
- 3rd Department of General Surgery, National and Kapodistrian University of Athens, ATTIKON” University General Hospital, Athens, Greece
| | - Panayiotis J. Papagelopoulos
- 1st Department of Orthopedic Surgery, National and Kapodistrian University of Athens, ATTIKON” University General Hospital, Athens, Greece
| | | | - Stefan Eggli
- Orthopädie Und Traumatologie, Sonnenhofspital, Buchserstrasse 30, 3006 Bern, Switzerland
| |
Collapse
|
|
15
|
Jun C, Cho YJ, Quinn PM, Song SK. Acute respiratory distress syndrome after treating ipsilateral femoral shaft and neck fracture with reamed intramedullary nailing in an asymptomatic COVID-19 patient. SAGE Open Med Case Rep 2023; 11:2050313X231168290. [PMID: 37113390 PMCID: PMC10119647 DOI: 10.1177/2050313x231168290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Currently, it is quite difficult to determine the best timeframe of operative treatment, as well as conduct surgery on asymptomatic COVID-19 patients due to misunderstandings and unawareness of the patient's inflammation state. Caution needs to be taken in specific patient cohorts, particularly those with femoral shaft fractures, who are more likely to develop diseases like acute respiratory distress syndrome after a procedure like intramedullary nailing. In this case report, a 36-year-old patient suffered a motorcycle accident in which he suffered an ipsilateral femoral shaft and neck fracture of the hip. The patient's screening test for COVID-19 was positive before admission. Because the patient did not display any COVID-19-related symptoms upon arrival to the hospital, surgical fixation with a reamed intramedullary femoral nail was performed. Despite having a successful post-surgical outcome, the patient was diagnosed with acute respiratory distress syndrome 36 h after surgery, recovering fully after about 2 weeks. To prevent subsequent complications such as acute respiratory distress syndrome in a high inflammatory state patient like COVID-19, the respiratory status and the degree of systemic inflammation should be considered precisely when determining the surgical timing and method.
Collapse
Affiliation(s)
- Chungmu Jun
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - Young-Jae Cho
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - Patrick Michael Quinn
- Department of Orthopaedic Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Suk-Kyoon Song
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
- Suk-Kyoon Song, Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea.
| |
Collapse
|
|
16
|
Jawad MU, Delman CM, Campbell ST, Fitzpatrick EP, Soles GLS, Lee MA, Randall RL, Thorpe SW. Traumatic Proximal Femoral Fractures during COVID-19 Pandemic in the US: An ACS NSQIP ® Analysis. J Clin Med 2022; 11:jcm11226778. [PMID: 36431255 PMCID: PMC9697726 DOI: 10.3390/jcm11226778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/06/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022] Open
Abstract
In order to determine the impact of COVID-19 on the treatment and outcomes in patients with proximal femoral fracture’s (PFF), we analyzed a national US sample. This is a retrospective review of American College of Surgery’s (ACS) National Surgical Quality Improvement Program (NSQIP) for patients with proximal femoral fractures. A total of 26,830 and 26,300 patients sustaining PFF and undergoing surgical treatment were sampled during 2019 and 2020, respectively. On multivariable logistic regression, patients were less likely to have ‘presence of non-healing wound’ (p < 0.001), functional status ‘independent’ (p = 0.012), undergo surgical procedures of ‘hemiarthroplasty’(p = 0.002) and ‘ORIF IT, Peritroch, Subtroch with plates and screws’ (p < 0.001) and to be ‘alive at 30-days post-op’ (p = 0.001) in 2020 as compared to 2019. Patients were more likely to have a case status ‘emergent’, ‘loss of ≥10% body weight’, discharge destination of ‘home’ (p < 0.001 for each) or ‘leaving against medical advice’ (p = 0.026), postoperative ‘acute renal failure (ARF)’ (p = 0.011), ‘myocardial infarction (MI)’ (p = 0.006), ‘pulmonary embolism (PE)’ (p = 0.047), and ‘deep venous thrombosis (DVT)’ (p = 0.049) in 2020 as compared to 2019. Patients sustaining PFF and undergoing surgical treatment during pandemic year 2020 differed significantly in preoperative characteristics and 30-day postoperative complications when compared to patients from the previous year.
Collapse
Affiliation(s)
- Muhammad Umar Jawad
- Department of Orthopedic Surgery, Good Samaritan Regional Medical Center, Corvallis, OR 97330, USA
| | - Connor M. Delman
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Sean T. Campbell
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Ellen P. Fitzpatrick
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Gillian L. S. Soles
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Mark A. Lee
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - R. Lor Randall
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Steven W. Thorpe
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
- Correspondence:
| |
Collapse
|
|
17
|
Faggiani M, Risitano S, Aprato A, Conforti L, Massè A. Management of Femur Fractures during COVID-19 Pandemic Period: The Influence of Vaccination and Nosocomial COVID-19 Infection. J Clin Med 2022; 11:jcm11226605. [PMID: 36431081 PMCID: PMC9699064 DOI: 10.3390/jcm11226605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
The COVID-19 pandemic management has led to a significant change in orthopedic surgical activity. During the pandemic, femur fractures in patients over 65 years of age have maintained a constant incidence. Our study will focus on this fragile population, analyzing the incidence of SARS-CoV-2 infection during hospital stays and the clinical and radiographic orthopedic outcomes. We also evaluated the va\riation of COVID-19 infection after health professionals' vaccinations, and the influence of inter-hospital transfers caused by logistical and organizational aspects of the pandemic. Material and Methods: This is a descriptive and prospective study from 13 October 2020 to 15 March 2021. Participants were patients over 65 years of age with diagnoses of proximal femoral fractures with r surgical treatments indicated. We compared the SARS-CoV-2 infected patients during the stay with non-infected cases. A second evaluation was carried out dividing the patients into those who underwent inter-hospital transfers and a group without transfers. We subdivided the study period into two, according to the percentage of healthcare workers vaccinated against SARS-CoV-2. The reported clinical variables included the Parker and Palmer Score, the Nottingham Hip Fracture Score, the Harris Hip Score, mortality, the Rush Score, and evaluation of reduction in radio-lucent lines in prosthetic implants. Results: Ninety-three patients were studied. The whole positive COVID cohort (11.83%) was hospitalized during the period when less than 80% of health workers were vaccinated (p = 0.02). The COVID cohort and the patients transferred before surgery had longer stays in the Emergency Room (p = 0.019; p = 0.00007) and longer lengths of stay compared to the other patients (p = 0.00001; p = 0.001). Mortality was higher both in the infected group and in the patients who underwent a transfer before the surgical procedure (18.18% vs. 1.22 %; p = 0.003. 25% vs. 6.85%; p = 0.02). In terms of orthopedic outcomes measured through the third month of follow-up, we found worse score results in functional and radiographic outcomes in the COVID positive cohort and in the transferred patients' cohort. Conclusions: The impact of the COVID-19 pandemic on patients treated for proximal femur fracture was statistically significant. Patients with Coronavirus during hospitalization obtained poor short-term radiographic and functional results and increased peri-operative mortality. The incidence of intra-hospital infection was high during the period in which health professionals were not yet covered by the anti-COVID vaccination cycle. Patients who were transferred between two hospitals due to pandemic-related management issues also achieved reduced outcomes compared to non-transferred cases, with increased mortality.
Collapse
Affiliation(s)
- Marianna Faggiani
- ASL TORINO 5, Department of Orthopaedic Surgery and Traumatology, 10024 Turin, Italy
- Correspondence:
| | - Salvatore Risitano
- Città della Salute e della Scienza di Torino, Department of Orthopaedic Surgery and Traumatology, 10126 Turin, Italy
| | - Alessandro Aprato
- Città della Salute e della Scienza di Torino, Department of Orthopaedic Surgery and Traumatology, 10126 Turin, Italy
| | - Luigi Conforti
- ASL TORINO 5, Department of Orthopaedic Surgery and Traumatology, 10024 Turin, Italy
| | - Alessandro Massè
- Città della Salute e della Scienza di Torino, Department of Orthopaedic Surgery and Traumatology, 10126 Turin, Italy
| |
Collapse
|
|
18
|
Freitas T, Ibrahim A, Lourenço A, Chen-Xu J. Mortality in COVID-19 patients after proximal femur fracture surgery: a systematic review and meta-analysis. Hip Int 2022:11207000221116764. [PMID: 35959769 DOI: 10.1177/11207000221116764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND COVID-19 infection first emerged in December 2019 in China and has since rapidly spread to become a worldwide pandemic. Orthopaedic surgery suffered a significant decline in the volume of surgical cases, while the orthopaedic trauma services maintained or increased the activity. Emergency operations for proximal femur fractures (PFF) in the elderly population assumed levels comparable to before the pandemic, with the 1-year mortality rate ranging from 14% to 36%. AIMS To determine whether patients with PFF affected by COVID-19 have a higher risk of postoperative mortality through a systematic review and meta-analysis. METHODS PubMed, Web of Science, Scopus and BMC were searched from January 2020 to January 2021 to identify original studies reporting the mortality in COVID-19 patients after PFF surgery. Study and participants' characteristics, mortality rate and odds ratio (OR) were extracted. Risk of bias assessment was carried, and visual inspection of the funnel plot was used to assess publication bias. A random-effects model for meta-analysis was adopted. RESULTS Among 656 articles that came from the search query and hand-search, 10 articles were eligible after applying inclusion and exclusion criteria. Overall, the sum of the study participants was 1882, with 351 COVID-19 positive patients (18.7%) and a total number of 117 deaths, with an overall mortality rate of 33.3%. The mortality rate of COVID-19 positive patients varied from 14.8% to 60% and was higher than of those without COVID-19, with OR ranging from 2.424 to 72.00. The inverse variance method showed an OR = 3.652. All studies showed a statistically significant p-value. CONCLUSIONS The postoperative mortality in hip fracture patients with concomitant COVID-19 was 3.65 times higher than the mortality in non-COVID patients. The currently available literature demonstrates that COVID-19 infection represents a substantial risk factor for postoperative mortality in the already susceptible hip fracture population.
Collapse
Affiliation(s)
- Tânia Freitas
- Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Public Health of University of Porto (ISPUP), Porto, Portugal
| | - Abdulrazak Ibrahim
- Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Public Health of University of Porto (ISPUP), Porto, Portugal.,National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal
| | - António Lourenço
- Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Public Health of University of Porto (ISPUP), Porto, Portugal.,National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal
| | - José Chen-Xu
- Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Public Health of University of Porto (ISPUP), Porto, Portugal.,National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal
| |
Collapse
|
|
19
|
Korres G, Kitsos DK, Kaski D, Tsogka A, Giannopoulos S, Giannopapas V, Sideris G, Tyrellis G, Voumvourakis K. The Prevalence of Dizziness and Vertigo in COVID-19 Patients: A Systematic Review. Brain Sci 2022; 12:brainsci12070948. [PMID: 35884754 PMCID: PMC9313303 DOI: 10.3390/brainsci12070948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022] Open
Abstract
Clinical manifestations of COVID-19 include symptoms of vertigo and dizziness, which is rather unsurprising, since SARS-CoV-2 neurotropism may inflict a broad spectrum of neuropathic effects. The widespread nature of central and peripheral audiovestibular pathways suggests that there may be several probable pathophysiological mechanisms. The cytokine storm, CNS infiltration of the virus through ACE 2 receptors, and other systemic factors can be responsible for the significant number of COVID-19 patients reported to experience symptoms of vertigo and dizziness. In this paper, we present a systematic review of clinical studies reporting the detection of dizziness and vertigo as clinical manifestations of COVID-19 and discuss their etiopathogenesis.
Collapse
Affiliation(s)
- George Korres
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece; (G.S.); (G.T.)
- Correspondence:
| | - Dimitrios K. Kitsos
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neuroscience, Department of Clinical and Movement Neurosciences, University College London, 33 Queen Square, London WC1N 3BG, UK;
| | - Anthi Tsogka
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
| | - Sotirios Giannopoulos
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
| | - Vasileios Giannopapas
- 2nd Department of Neurology, Laboratory of Neuromuscular & Cardiovascular Study of Motion (LANECASM), Attikon University Hospital, 124 62 Athens, Greece;
| | - Giorgos Sideris
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece; (G.S.); (G.T.)
| | - Giorgos Tyrellis
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece; (G.S.); (G.T.)
| | - Konstantine Voumvourakis
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
| |
Collapse
|
|
20
|
Jiménez-Telleria I, Urra I, Fernández-Gutiérrez L, Aragon E, Aguirre U, Foruria X, Moreta J. [Artículo traducido] Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco). Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T251-T259. [PMID: 35487483 PMCID: PMC9042409 DOI: 10.1016/j.recot.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/27/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. DESIGN Retrospective comparative study. SETTING Three university hospitals in Biscay province (Basque Country, Spain). PATIENTS 77 patients over 65 years-old with PFF (AO 31-A and 31-B). INTERVENTION Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. MAIN OUTCOME MEASUREMENTS 30-Day mortality rate and risk factors for mortality. RESULTS Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. CONCLUSIONS SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality. LEVEL OF EVIDENCE Level III study.
Collapse
Affiliation(s)
- I Jiménez-Telleria
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Galdakao-Usansolo, Bizkaia, España.
| | - I Urra
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Galdakao-Usansolo, Bizkaia, España
| | - L Fernández-Gutiérrez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Basurto, Bizkaia, España
| | - E Aragon
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Cruces, Bizkaia, España
| | - U Aguirre
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Unidad de Investigación Barrualde-Galdakao IHO, Galdakao, España
| | - X Foruria
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Galdakao-Usansolo, Bizkaia, España; Grupo de Reconstrucción de Extremidad Inferior, Instituto de Investigación en Salud de Bizkaia Biocruces, Hospital Galdakao-Usansolo, Osakidetza, Bizkaia, España
| | - J Moreta
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Galdakao-Usansolo, Bizkaia, España; Grupo de Reconstrucción de Extremidad Inferior, Instituto de Investigación en Salud de Bizkaia Biocruces, Hospital Galdakao-Usansolo, Osakidetza, Bizkaia, España
| |
Collapse
|
|
21
|
Qin HC, He Z, Luo ZW, Zhu YL. Management of hip fracture in COVID-19 infected patients. World J Orthop 2022; 13:544-554. [PMID: 35949705 PMCID: PMC9244961 DOI: 10.5312/wjo.v13.i6.544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/07/2022] [Accepted: 04/25/2022] [Indexed: 02/06/2023] Open
Abstract
Given that the global population of elderly individuals is expanding and the difficulty of recovery, hip fractures will be a huge challenge and a critical health issue for all of humanity. Although people have spent more time at home during the coronavirus disease 2019 (COVID-19) pandemic, hip fractures show no sign of abating. Extensive studies have shown that patients with hip fracture and COVID-19 have a multifold increase in mortality compared to those uninfected and a more complex clinical condition. At present, no detailed research has systematically analyzed the relationship between these two conditions and proposed a comprehensive solution. This article aims to systematically review the impact of COVID-19 on hip fracture and provide practical suggestions. We found that hip fracture patients with COVID-19 have higher mortality rates and more complicated clinical outcomes. Indirectly, COVID-19 prevents hip fracture patients from receiving regular medical treatment. With regard to the problems we encounter, we provide clinical recommendations based on existing research evidence and a clinical flowchart for the management of hip fracture patients who are COVID-19 positive. Our study will help clinicians adequately prepare in advance when dealing with such patients and optimize treatment decisions.
Collapse
Affiliation(s)
- Hao-Cheng Qin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhong He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu-Lian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| |
Collapse
|
|
22
|
Guran O, Ozmanevra R, Kuyumcu M, Cakmakci A, Aman T. The management of orthopedic trauma surgery during the COVID-19 pandemic in Turkey. Acta Orthop Belg 2022; 88:269-274. [DOI: 10.52628/88.2.7857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
COVID-19 has now alarmed the whole world, putting many countries’ health systems in trouble. We aimed to evaluate the affect of the new treatment strategy that shortens hospital stay in orthopedic trauma patients in pandemic.Trauma patients who underwent surgical treatment between March 15th-May 1st 2019 and 2020 were examined about time interval from admission to surgery, period from surgery to discharge and total hospital stay time. This cohort was compared to a retrospective cohort of patients admitted for the same reasons in the same period of the previous year. During COVID pandemia, 51 trauma patients operated with the mean period from admission to operation 1.45 days, faster than the previous year’s same period (3.76 days). From operation day to discharge time was 1.6 days in pandemic period and 4.3 days last year. The total hospitalization period (3,05 days) was significantly shorter in pandemic than the same period of the last year (8,06 days). (p<0.05). No complications and mortality were observed in any of our patients with faster trauma treatment strategy in pandemic. The operation of orthopedic trauma patients requiring surgery during a pandemic in a shorter time than normal time will not increase the complication and mortality, but will also help to use the bed more effectively by reducing the hospital stay.
Collapse
|
|
23
|
Muhammad M, Ayton S, Hejmadi S, Minhas JS, Morgan N, Peek AC. Single vs Dual-site service reconfiguration during Covid-19 pandemic - A tertiary care centre experience in hip fractures and a Scoping review. J Clin Orthop Trauma 2022; 29:101890. [PMID: 35540794 PMCID: PMC9072772 DOI: 10.1016/j.jcot.2022.101890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Aims and objectives The Covid-19 pandemic has had an unprecedented effect on surgical practice and healthcare delivery globally. We compared the impact of the care pathways which segregate Covid-19 Positive and Negative patients into two geographically separate sites, on hip fracture patients in our high-volume trauma center in 3 distinct eras - the pre-pandemic period, against the first Covid-19 wave with dual-site service design, as well as the subsequent surge with single-site service delivery. In addition, we sought to invoke similar experiences of centres worldwide through a scoping literature review on the current evidence on "Dual site" reconfigurations in response to Covid-19 pandemic. Methods We prospectively reviewed our hip fracture patients throughout the two peaks of the pandemic, with different service designs for each, and compared the outcomes with a historic service provision. Further, a comprehensive literature search was conducted using several databases for articles discussing Dual-site service redesign. Results In our in-house study, there was no statistically significant difference in mortality of hip fracture patients between the 3 periods, as well as their discharge destinations. With dual-site reconfiguration, patients took longer to reach theatre. However, there was much more nosocomial transmission with single-site service, and patients stayed in the hospital longer. 24 articles pertaining to the topic were selected for the scoping review. Most studies favour dual-site service reorganization, and reported beneficial outcomes from the detached care pathways. Conclusion It is safe to continue urgent as well as non-emergency surgery during the Covid-19 pandemic in a separate, geographically isolated site.
Collapse
Affiliation(s)
- Milan Muhammad
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Sarah Ayton
- Department of Elderly Medicine, University Hospitals of Leicester, Leicester, UK
| | - Shruthi Hejmadi
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - Jatinder S. Minhas
- Department of Elderly Medicine, Leicester University Hospitals, Leicester, UK
| | - Nicolette Morgan
- Department of Elderly Medicine, Leicester University Hospitals, Leicester, UK
| | - Anna C. Peek
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| |
Collapse
|
|
24
|
Noll J, Reichert M, Dietrich M, Riedel JG, Hecker M, Padberg W, Weigand MA, Hecker A. When to operate after SARS-CoV-2 infection? A review on the recent consensus recommendation of the DGC/BDC and the DGAI/BDA. Langenbecks Arch Surg 2022; 407:1315-1332. [PMID: 35307746 PMCID: PMC8934603 DOI: 10.1007/s00423-022-02495-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023]
Abstract
Since the eruption of the worldwide SARS-CoV-2 pandemic in late 2019/early 2020, multiple elective surgical interventions were postponed. Through pandemic measures, elective operation capacities were reduced in favour of intensive care treatment for critically ill SARS-CoV-2 patients. Although intermittent low-incidence infection rates allowed an increase in elective surgery, surgeons have to include long-term pulmonary and extrapulmonary complications of SARS-CoV-2 infections (especially "Long Covid") in their perioperative management considerations and risk assessment procedures. This review summarizes recent consensus statements and recommendations regarding the timepoint for surgical intervention after SARS-CoV-2 infection released by respective German societies and professional representatives including DGC/BDC (Germany Society of Surgery/Professional Association of German Surgeons e.V.) and DGAI/BDA (Germany Society of Anesthesiology and Intensive Care Medicine/Professional Association of German Anesthesiologists e.V.) within the scope of the recent literature. The current literature reveals that patients with pre- and perioperative SARS-CoV-2 infection have a dramatically deteriorated postoperative outcome. Thereby, perioperative mortality is mainly caused by pulmonary and thromboembolic complications. Notably, perioperative mortality decreases to normal values over time depending on the duration of SARS-CoV-2 infection.
Collapse
Affiliation(s)
- J Noll
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M Reichert
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M Dietrich
- Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - J G Riedel
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M Hecker
- Medical Clinic II, University Hospital of Giessen, Giessen, Germany
| | - W Padberg
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M A Weigand
- Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - A Hecker
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany.
| |
Collapse
|
|
25
|
Mastan S, Hodhody G, Sajid M, Malik R, Charalambous CP. COVID-19 Is Associated With a 4 Fold Increase in 30-day Mortality Risk in Hip Fracture Patients in the United Kingdom: A Systematic Review and Meta-analysis. Geriatr Orthop Surg Rehabil 2022; 13:21514593221099375. [PMID: 35546966 PMCID: PMC9081021 DOI: 10.1177/21514593221099375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Hip fracture in elderly patients is associated with a significant mortality which may be worsened by COVID-19 infection. Objective To undertake a systematic review and meta-analysis of studies assessing the effect of COVID-19 infection and mortality rates in hip fracture patients in the United Kingdom (UK) during the first surge of the pandemic. Design A systematic literature search of 9 online databases was undertaken independently by 2 reviewers using the Cochrane methodology for systematic reviews. Eligibility criteria were any study of an adult population with a hip fracture that assessed the relationship between COVID-19 infection and 30-day mortality in the UK. Meta-analysis was conducted using a random-effects model. Results Out of 309 identified articles, 10 studies reporting on 2448 hip fracture patients met the inclusion criteria. Meta-analysis showed that the estimated mortality rate in patients with laboratory confirmed COVID-19 infection was 32.5% (95% CI= 28.3 to 37.0) compared to 8.6% (95% CI= 6.3 to 11.6) in COVID-19 negative patients. Meta-analysis of 9 comparative studies showed a significantly higher mortality in patients with laboratory confirmed COVID-19 infection as compared to patients without (RR=3.937, 95% CI= 2.867 to 5.406, P<.001). Similar findings were obtained when comparing mortality in COVID-19 laboratory confirmed or clinically suspected infected vs non-infected patients (RR=4.576, 95% CI = 3.589 to 5.835, P <.001). Conclusions COVID-19 infection is associated with a 4-fold increase in mortality risk in hip fracture patients. Every effort should be made to avoid COVID-19 infection and nosocomial exposure in this highly vulnerable patient group.
Collapse
Affiliation(s)
| | | | | | - Rayaz Malik
- Weill Cornell Medicine-Qatar, Qatar.,University of Manchester, UK
| | | |
Collapse
|
|
26
|
Nakai T, Iwasaki H, Nishikawa T, Higuchi R, Sakata K, Matsuoka H, Iwata H, Sogo E, Nanno K, Nakamura S, Kuroda S, Hayashi J, Nakata S. Challenges and responses of elective orthopaedic surgery during the second wave of COVID-19. J Orthop Sci 2022; 27:713-716. [PMID: 33902971 PMCID: PMC8052470 DOI: 10.1016/j.jos.2021.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/17/2021] [Accepted: 02/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Elective orthopaedic surgery has been severely curtailed because of coronavirus disease, 2019. There is scant scientific evidence to guide surgeons in assessing the protocols that must be implemented before resuming elective orthopaedic surgery safely after the second wave of the coronavirus disease, 2019. METHODS A retrospective review of elective orthopaedic surgeries performed between May 15, 2020, and November 20, 2020, was conducted. A screening questionnaire was used, and reverse transcription-polymerase chain reaction and severe acute respiratory syndrome coronavirus-2 immunoglobulin G and IgM antibodies testing were assessed in all admitted patients. Screening and testing data for coronavirus disease was reviewed for all patients. RESULTS Of 592 patients tested for severe acute respiratory syndrome coronavirus-2 during the study period, 21 (3.5%) tested positive. There were 2 patients (0.3%) with positive reverse transcription-polymerase chain reaction tests, 3 (0.5%) with positive IgG and IgM antibodies, 13 (2.2%) with positive IgG antibodies, and 10 (1.7%) with positive IgM antibodies. Among these 21 patients, 20 (95.2%) were asymptomatic. CONCLUSIONS Our findings suggest that most elective orthopaedic surgery patients with severe acute respiratory syndrome coronavirus-2 are asymptomatic. In the second wave of coronavirus disease, 2019, universal testing of all patients should be strongly considered as an important measure to prevent clusters of in-hospital transmission of the disease.
Collapse
Affiliation(s)
- Tsuyoshi Nakai
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan,Corresponding author. Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, 664-8540, Japan. Fax: +81 72 777 8277
| | - Haruaki Iwasaki
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan
| | - Tomoya Nishikawa
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan
| | - Ryo Higuchi
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan
| | - Kosuke Sakata
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan
| | - Hozo Matsuoka
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan
| | - Hirokazu Iwata
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan
| | - Eiji Sogo
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan
| | - Katsuhiko Nanno
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan
| | - Shigeko Nakamura
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan
| | - Sanae Kuroda
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan
| | - Junzo Hayashi
- Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan
| | | |
Collapse
|
|
27
|
Diekmann PR, O’Neill OR, Floyd ER, Meinke LC, Lehman-Lane J, Uzlik RM, Stone McGaver R. Orthopedic Surgery in Ambulatory Surgery Centers During the COVID-19 Pandemic: Low Incidence of Infection Among Patients, Surgeons, and Staff. Cureus 2022; 14:e24247. [PMID: 35602796 PMCID: PMC9116689 DOI: 10.7759/cureus.24247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective The coronavirus disease 2019 (COVID-19) pandemic has presented tremendous challenges to the healthcare systems worldwide. Consequently, ambulatory surgery centers (ASCs) have been forced to find new and innovative ways to function safely and maintain operations. We conducted a study at a large United States (US) private orthopedic surgery practice, where a universal screening policy and testing protocol for COVID-19 was implemented for patients and ASC personnel including surgeons, in order to examine the incidence of COVID-19 in patients scheduled for orthopedic surgery in ASC settings as well as the incidence among the surgeons and ASC personnel. Methods The universal screening protocol was implemented in the ASCs of the facility during the early stage of the pandemic for an eight-month period from April 28, 2020, to December 31, 2020. All ASC personnel including surgeons had their symptoms tracked daily and were rapid-tested every two weeks. All patients were screened and tested before they entered the ASC. Results A total of 70 out of 12,115 patients and 41 out of 642 ASC personnel tested positive for COVID-19, resulting in infection rates of 0.6% and 6.4%, respectively. Individual symptoms, age, the American Society of Anesthesiologists (ASA) scores, and comorbidities were documented, and no single factor was found to be common among positive (+) tests. Conclusions The implementation of universal screening and symptom-reporting procedures was associated with a very low rate of infections among ASC patients, staff, and surgeons, and it offers a reproducible framework for other facilities to continue to provide orthopedic outpatient operations in ASC settings during the ongoing iterations of the COVID-19 pandemic.
Collapse
|
|
28
|
Fadulelmola A, Gregory R, Gordon G, Smith F, Jennings A. The impact of COVID-19 infection on hip fracture 30-day mortality. TRAUMA-ENGLAND 2022; 24:109-114. [PMID: 38603144 PMCID: PMC8689093 DOI: 10.1177/1460408620949725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65-98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0-22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% (n = 6) contracted the COVID-19 infection in the community, and 70% (n = 14) developed symptoms after hospital admission. Conclusion Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.
Collapse
Affiliation(s)
- Ahmed Fadulelmola
- University Hospital of North Durham,
County
Durham & Darlington NHSF, Newcastle
upon Tyne, UK
| | - Rob Gregory
- University Hospital of North Durham,
County
Durham & Darlington NHSF, Newcastle
upon Tyne, UK
| | - Gavin Gordon
- University Hospital of North Durham,
County
Durham & Darlington NHSF, Newcastle
upon Tyne, UK
| | - Fiona Smith
- University Hospital of North Durham,
County
Durham & Darlington NHSF, Newcastle
upon Tyne, UK
| | - Andrew Jennings
- University Hospital of North Durham,
County
Durham & Darlington NHSF, Newcastle
upon Tyne, UK
| |
Collapse
|
|
29
|
Pandey R, Rai D, Tahir MW, Wahab A, Bandyopadhyay D, Lesho E, Laguio-Vila M, Fentanes E, Tariq R, Naidu SS, Aronow WS. Prevalence of comorbidities and symptoms stratified by severity of illness amongst adult patients with COVID-19: a systematic review. Arch Med Sci Atheroscler Dis 2022; 7:e5-e23. [PMID: 35582712 PMCID: PMC9081912 DOI: 10.5114/amsad.2022.115008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction We performed a systematic review of comorbidities and symptoms of adult patients with coronavirus disease 2019 (COVID-19) to evaluate comorbidities, symptoms, and severity. Material and methods We searched databases and extracted comorbidities and symptoms from the included studies. We stratified the similar signs and symptoms in groups and on the basis of severity and compared them with stratified analysis. Individual case reports and case series with < 5 patients were excluded. Results A total of 163 studies with 43,187 patients were included. Mean age was 54.6 years. There were significantly fewer women in the study (43.9% vs. 56.1%, p < 0.0001). Prevalent cardiovascular comorbidities were hypertension (31.9%), obesity (27.9%), hyperlipidemia (26.4%), smoking (18.9%), diabetes mellitus (17.2%), atherosclerotic disease (9.2%) and arrhythmia (5.0%). The most frequently reported constitutional symptoms of COVID-19 were fever (73.9%), fatigue (33.4%), malaise (29.9%), myalgia and/or arthralgia (19.2%), generalized weakness (19.0%), and chills (11.3%). For the cardiovascular system, chest pain and/or tightness were most often reported (19.6%), followed by palpitations (5.2%). Hypertension and diabetes were common in severe disease. Obesity and congestive heart failure were not observed in any non-severe cases. Severe cases compared to non-severe cases more frequently had fever (87.8% vs. 58.5%, p < 0.001), shortness of breath (47.4% vs. 20.6%, p < 0.001), cough (66.8% vs. 62.9%, p < 0.001), sputum production (35.4% vs. 26.5%, p < 0.001) and rhinorrhea (32.2% vs. 7.3%, p < 0.001). Conclusions Hypertension, diabetes, and atherosclerotic diseases are common comorbidities across the world, with obesity as the second most common in the US and more common in men.
Collapse
Affiliation(s)
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, USA
| | | | - Abdul Wahab
- Department of Internal Medicine, University of Iowa, IA, USA
| | | | - Emil Lesho
- Department of Infectious Disease, Rochester General Hospital, Rochester, NY, USA
| | - Maryrose Laguio-Vila
- Department of Infectious Disease, Rochester General Hospital, Rochester, NY, USA
| | - Emilio Fentanes
- Department of Cardiology, Brigham and Women’s Hospital, MA, USA
| | - Raseen Tariq
- Department of Internal Medicine, Rochester General Hospital, USA
| | - Srihari S. Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Wilbert S. Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| |
Collapse
|
|
30
|
Faizi Z, Kim DW, Humayun A, Batool A, Ratnasekera A. A Rare Case of Fat Embolism Syndrome Masquerading as COVID-19 Pneumonia. Cureus 2022; 14:e23384. [PMID: 35475082 PMCID: PMC9022393 DOI: 10.7759/cureus.23384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/05/2022] Open
|
|
31
|
Mastri P, Di Petrillo F, Cerone A, Muselli M, Saracco M, Logroscino G, Calvisi V. Reduction in the Duration of Postoperative Fever during the COVID-19 Pandemic in Orthopedic and Traumatic Surgery Due to PPE and Cautions. J Clin Med 2022; 11:1635. [PMID: 35329961 PMCID: PMC8953353 DOI: 10.3390/jcm11061635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023] Open
Abstract
The Italian government on the 8th of march in response to the increased global prevalenceof severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stated a national quarantine. In this period the absence of rapid and sure screening tests for COVID-19 made necessary more attention for presence of fever in hospitalized patients, like continuous use of surgical, FFP2, and FFP3 masks (PPE) by nurses, physicians, and patients; moreover, patients visits were restricted. In this period, during the daily activities in our orthopedic department we observed an empirical decreased incidence of post-operative fever in patients admitted for trauma surgery. The aim of this study is to compare the prevalence of post-operative fever in this period with the same period in 2019. We analyzed the presence of post-operative fever in 110 patients admitted in 2020 and 129 admitted in 2019. The results show a significant decrease of the prevalence and duration of post-operative fever in patients admitted in 2020. This study evidenced that the use of PPE and limitation in external access to the hospital decrease postoperative fever in hospitalized patients undergone surgery for fracture.
Collapse
Affiliation(s)
- Pierluigi Mastri
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.D.P.); (A.C.); (M.M.); (G.L.); (V.C.)
| | - Francesco Di Petrillo
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.D.P.); (A.C.); (M.M.); (G.L.); (V.C.)
| | - Alessandro Cerone
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.D.P.); (A.C.); (M.M.); (G.L.); (V.C.)
| | - Mario Muselli
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.D.P.); (A.C.); (M.M.); (G.L.); (V.C.)
| | - Michela Saracco
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giandomenico Logroscino
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.D.P.); (A.C.); (M.M.); (G.L.); (V.C.)
| | - Vittorio Calvisi
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.D.P.); (A.C.); (M.M.); (G.L.); (V.C.)
| |
Collapse
|
|
32
|
|
|
33
|
Salvio G, Gianfelice C, Firmani F, Lunetti S, Ferroni R, Balercia G, Giacchetti G. Remote management of osteoporosis in the first wave of the COVID-19 pandemic. Arch Osteoporos 2022; 17:37. [PMID: 35235056 PMCID: PMC8889057 DOI: 10.1007/s11657-022-01069-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/21/2022] [Indexed: 02/03/2023]
Abstract
We conducted a survey during the first pandemic wave of coronavirus disease 2019 (COVID-19) on a large group of osteoporotic patients to evaluate the general conditions of osteoporotic patients and the impact of the pandemic on the management of osteoporosis, finding high compliance to treatments and low COVID-19 lethality. INTRODUCTION During the first pandemic wave of coronavirus disease 2019 (COVID-19), 209,254 cases were diagnosed in Italy; fatalities were 26,892 and were overwhelmingly older patients. The high prevalence of osteoporosis in this age group suggests a potential relationship between SARS-CoV-2 infection and bone metabolism. METHODS In a telephone survey conducted from April to May 2020, patients from the Osteoporosis Center, Clinic of Endocrinology and Metabolic Diseases of Umberto I Hospital (Ancona, Italy), were interviewed to evaluate the general clinical conditions of osteoporotic patients, compliance with osteoporosis medications, COVID-19 prevalence, hospitalization rate, COVID-19 mortality, and lethality. RESULTS Among the 892 patients interviewed, 77.9% were taking osteoporosis treatment and 94.6% vitamin D supplementation as prescribed at the last visit. COVID-19-like symptoms were reported by 5.1%, whereas confirmed cases were 1.2%. A total number of 33 patients had been in hospital and the hospitalization rate of those who had not discontinued vitamin D supplementation was less than 4%. There were eight deaths, two with a concomitant COVID-19 diagnosis. The prevalence of severe osteoporosis was 50% in total COVID-19 patients and 87.5% in deceased COVID-19 patients. The overall COVID-19 mortality was 0.2%; lethality was 20%, lower than the national rate of the same age group. CONCLUSIONS This large group of osteoporotic patients showed high compliance and lower COVID-19 lethality compared to patients of the same age. Novel approaches such as telemedicine can provide critical support for the remote follow-up of patients with chronic diseases also in the setting of routine care.
Collapse
Affiliation(s)
- Gianmaria Salvio
- Department of Clinical and Molecular Sciences, Division of Endocrinology, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126, Ancona, Italy
| | - Claudio Gianfelice
- Department of Clinical and Molecular Sciences, Division of Endocrinology, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126, Ancona, Italy
| | - Francesca Firmani
- Department of Clinical and Molecular Sciences, Division of Endocrinology, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126, Ancona, Italy
| | - Stefano Lunetti
- Department of Clinical and Molecular Sciences, Division of Endocrinology, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126, Ancona, Italy
| | - Rossella Ferroni
- Department of Clinical and Molecular Sciences, Division of Endocrinology, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126, Ancona, Italy
| | - Giancarlo Balercia
- Department of Clinical and Molecular Sciences, Division of Endocrinology, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126, Ancona, Italy
| | - Gilberta Giacchetti
- Department of Clinical and Molecular Sciences, Division of Endocrinology, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126, Ancona, Italy.
| |
Collapse
|
|
34
|
Jagadeesh N, Kapadi S, Deva V, Channabasappa D, Shaw D. COVID-19 Infection Increases Mortality and Complications in Patients With Neck of Femur Fracture. Cureus 2022; 14:e22264. [PMID: 35350493 PMCID: PMC8933182 DOI: 10.7759/cureus.22264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/05/2022] Open
|
|
35
|
Leulseged TW, Abebe KG, Hassen IS, Maru EH, Zewde WC, Chamiso NW, Yegele KT, Bayisa AB, Siyoum DF, Edo MG, Mesfin EG, Derejie MN, Shiferaw HK. COVID-19 disease severity and associated factors among Ethiopian patients: A study of the millennium COVID-19 care center. PLoS One 2022; 17:e0262896. [PMID: 35085338 PMCID: PMC8794201 DOI: 10.1371/journal.pone.0262896] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 01/07/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic started a little later in Ethiopia than the rest of the world and most of the initial cases were reported to have a milder disease course and a favorable outcome. This changed as the disease spread into the population and the more vulnerable began to develop severe disease. Understanding the risk factors for severe disease in Ethiopia was needed to provide optimal health care services in a resource limited setting. OBJECTIVE The study assessed COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia for characteristics associated with COVID-19 disease severity. METHODS A cross-sectional study was conducted from June to August 2020 among 686 randomly selected patients. Chi-square test was used to detect the presence of a statistically significant difference in the characteristics of the patients based on disease severity (Mild vs Moderate vs Severe). A multinomial logistic regression model was used to identify factors associated with COVID-19 disease severity where Adjusted Odds ratio (AOR), 95% CIs for AOR and P-values were used for significance testing. RESULTS Having moderate as compared with mild disease was significantly associated with having hypertension (AOR = 2.30, 95%CI = 1.27,4.18), diabetes mellitus (AOR = 2.61, 95%CI = 1.31,5.19for diabetes mellitus), fever (AOR = 6.12, 95%CI = 2.94,12.72) and headache (AOR = 2.69, 95%CI = 1.39,5.22). Similarly, having severe disease as compared with mild disease was associated with age group (AOR = 4.43, 95%CI = 2.49,7.85 for 40-59 years and AOR = 18.07, 95%CI = 9.29,35.14for ≥ 60 years), sex (AOR = 1.84, 95%CI = 1.12,3.03), hypertension (AOR = 1.97, 95%CI = 1.08,3.59), diabetes mellitus (AOR = 3.93, 95%CI = 1.96,7.85), fever (AOR = 13.22, 95%CI = 6.11, 28.60) and headache (AOR = 4.82, 95%CI = 2.32, 9.98). In addition, risk factors of severe disease as compared with moderate disease were found to be significantly associated with age group (AOR = 4.87, 95%CI = 2.85, 8.32 for 40-59 years and AOR = 18.91, 95%CI = 9.84,36.331 for ≥ 60 years), fever (AOR = 2.16, 95%CI = 1.29,3.63) and headache (AOR = 1.79, 95%CI = 1.03, 3.11). CONCLUSIONS Significant factors associated with severe COVID-19 in Ethiopia are being older than 60 years old, male, a diagnosis of hypertension, diabetes mellitus, and the presence of fever and headache. This is consistent with severity indicators identified by WHO and suggests the initial finding of milder disease in Ethiopia may have been because the first people to get COVID-19 in the country were the relatively younger with fewer health problems.
Collapse
Affiliation(s)
- Tigist W. Leulseged
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kindalem G. Abebe
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ishmael S. Hassen
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Endalkachew H. Maru
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wuletaw C. Zewde
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Negat W. Chamiso
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kalkidan T. Yegele
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abdi B. Bayisa
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dagne F. Siyoum
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mesay G. Edo
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Edmialem G. Mesfin
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Meskerem N. Derejie
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Helina K. Shiferaw
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
|
36
|
Fouladseresht H, Ghamar Talepoor A, Eskandari N, Norouzian M, Ghezelbash B, Beyranvand MR, Nejadghaderi SA, Carson-Chahhoud K, Kolahi AA, Safiri S. Potential Immune Indicators for Predicting the Prognosis of COVID-19 and Trauma: Similarities and Disparities. Front Immunol 2022; 12:785946. [PMID: 35126355 PMCID: PMC8815083 DOI: 10.3389/fimmu.2021.785946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
Although cellular and molecular mediators of the immune system have the potential to be prognostic indicators of disease outcomes, temporal interference between diseases might affect the immune mediators, and make them difficult to predict disease complications. Today one of the most important challenges is predicting the prognosis of COVID-19 in the context of other inflammatory diseases such as traumatic injuries. Many diseases with inflammatory properties are usually polyphasic and the kinetics of inflammatory mediators in various inflammatory diseases might be different. To find the most appropriate evaluation time of immune mediators to accurately predict COVID-19 prognosis in the trauma environment, researchers must investigate and compare cellular and molecular alterations based on their kinetics after the start of COVID-19 symptoms and traumatic injuries. The current review aimed to investigate the similarities and differences of common inflammatory mediators (C-reactive protein, procalcitonin, ferritin, and serum amyloid A), cytokine/chemokine levels (IFNs, IL-1, IL-6, TNF-α, IL-10, and IL-4), and immune cell subtypes (neutrophil, monocyte, Th1, Th2, Th17, Treg and CTL) based on the kinetics between patients with COVID-19 and trauma. The mediators may help us to accurately predict the severity of COVID-19 complications and follow up subsequent clinical interventions. These findings could potentially help in a better understanding of COVID-19 and trauma pathogenesis.
Collapse
Affiliation(s)
- Hamed Fouladseresht
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefe Ghamar Talepoor
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Eskandari
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Norouzian
- Department of Laboratory Sciences, School of Allied Medical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Behrooz Ghezelbash
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Beyranvand
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Aria Nejadghaderi
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Kristin Carson-Chahhoud
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Safiri
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
|
37
|
Mercier MR, Galivanche AR, Brand JP, Pathak N, Medvecky MJ, Varthi AG, Rubin LE, Grauer JN. COVID-positive ankle fracture patients are at increased odds of perioperative surgical complications following open reduction internal fixation surgery. PLoS One 2021; 16:e0262115. [PMID: 34972190 PMCID: PMC8719674 DOI: 10.1371/journal.pone.0262115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Ankle fractures have continued to occur through the COVID pandemic and, regardless of patient COVID status, often need operative intervention for optimizing long-term outcomes. For healthcare optimization, patient counseling, and care planning, understanding if COVID-positive patients undergoing ankle fracture surgery are at increased risk for perioperative adverse outcomes is of interest. METHODS The COVID-19 Research Database contains recent United States aggregated insurance claims. Patients who underwent ankle fracture surgery from April 1st, 2020 to June 15th, 2020 were identified. COVID status was identified by ICD coding. Demographics, comorbidities, and postoperative complications were extracted based on administrative data. COVID-positive versus negative patients were compared with univariate analyses. Propensity-score matching was done on the basis of age, sex, and comorbidities. Multivariate regression was then performed to identify risk factors independently associated with the occurrence of 30-day postoperative adverse events. RESULTS In total, 9,835 patients undergoing ankle fracture surgery were identified, of which 57 (0.58%) were COVID-positive. COVID-positive ankle fracture patients demonstrated a higher prevalence of comorbidities, including: chronic kidney disease, diabetes, hypertension, and obesity (p<0.05 for each). After propensity matching and controlling for all preoperative variables, multivariate analysis found that COVID-positive patients were at increased risk of any adverse event (odds ratio [OR] = 3.89, p = 0.002), a serious adverse event (OR = 5.48, p = 0.002), and a minor adverse event (OR = 3.10, p = 0.021). DISCUSSION COVID-positive patients will continue to present with ankle fractures requiring operative intervention. Even after propensity matching and controlling for patient factors, COVID-positive patients were found to be at increased risk of 30-day perioperative adverse events. Not only do treatment teams need to be protected from the transmission of COVID in such situations, but the increased incidence of perioperative adverse events needs to be considered.
Collapse
Affiliation(s)
- Michael R. Mercier
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Anoop R. Galivanche
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jordan P. Brand
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Neil Pathak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Michael J. Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Arya G. Varthi
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Lee E. Rubin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| |
Collapse
|
|
38
|
Outcomes of orthopaedic trauma surgery in COVID-19 positive patients. OTA Int 2021; 4:e129. [PMID: 34746661 PMCID: PMC8568410 DOI: 10.1097/oi9.0000000000000129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 03/07/2021] [Indexed: 01/03/2023]
Abstract
Objectives: To investigate outcomes for operative orthopaedic trauma in patients who tested positive for coronavirus disease 2019 (COVID-19) during the height of the COVID-19 pandemic in New York. Design: Retrospective case series. Setting: Urban Level-1 academic trauma center. Patients/participants: Thirteen patients diagnosed with COVID-19 who underwent surgical management for orthopaedic trauma between January 21, 2020 and May 11, 2020. Intervention: Does not apply to this study. Main outcome measurements: Complications including death, coma lasting more than 24 hours, prolonged mechanical ventilation, unplanned intubation, blood transfusion, postoperative pneumonia, cerebrovascular event, thromboembolic event, myocardial infarction, urinary tract infection, acute renal failure, septic shock, return to the operating room, wound dehiscence, surgical site infection, graft/prosthesis/flap failure, and peripheral nerve injury. Results: Two (18%) patients had symptoms of COVID-19 (cough, shortness of breath, fevers, chills, nausea/vomiting, diarrhea, abdominal cramps/pains) on admission. Average length of stay (standard deviation) was 6.6 (4.31) days. Average time to follow up was 29 (10.77) days. Three (27%) patients developed pneumonia postoperatively and 1 (9%) underwent unplanned intubation. One (9%) patient was intubated for greater than 48 hours. Two (18%) patients developed postoperative deep venous thromboembolism. Three (27%) patients developed acute renal failure postoperatively. Six (55%) patients underwent blood transfusion intraoperatively or postoperatively. Two (18%) patients died postoperatively. Conclusion: In this small series surgical management in Coronavirus-19 positive patients with skeletal injuries was successfully accomplished with patient anticoagulation, hematologic, and pulmonary status in mind. Therapeutic anticoagulation and patient hematologic status were optimized prior to the operating room to minimize development of venous thromboembolism and avoid blood transfusion. Level of evidence: Level IV prognostic
Collapse
|
|
39
|
Beaven A, Piper D, Plant C, Sharma A, Agrawal Y, Cooper G. Thirty-Day Mortality for Proximal Femoral Fractures Treated at a U.K. Elective Center with a Site-Streaming Policy During the COVID-19 Pandemic. JB JS Open Access 2021; 6:JBJSOA-D-21-00009. [PMID: 34703966 PMCID: PMC8542172 DOI: 10.2106/jbjs.oa.21.00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
COVID-19 led to the reconfiguration of U.K. orthopaedic trauma services because surgical capacity was threatened in acute centers. We report the 30-day mortality of proximal femoral fractures in older adults treated at an elective orthopaedic center.
Collapse
Affiliation(s)
- A Beaven
- The Royal Orthopaedic Hospital Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
| | - D Piper
- The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - C Plant
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - A Sharma
- The Royal Orthopaedic Hospital Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
| | - Y Agrawal
- The Royal Orthopaedic Hospital Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
| | - G Cooper
- The Royal Orthopaedic Hospital Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
|
40
|
Mills S, Ibarzábal-Gil A, Martínez-Diez JM, Pallarés-Sanmartín J, Kalbakdij-Sánchez C, Rubio-Suárez JC, Losantos-García I, Rodríguez-Merchán EC. SARS-CoV-2 outbreak impact on a trauma unit. World J Orthop 2021; 12:751-759. [PMID: 34754831 PMCID: PMC8554347 DOI: 10.5312/wjo.v12.i10.751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/17/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND From February 2020 onwards, our country has been hit by the coronavirus severe acute respiratory syndrome-2 (SARS-CoV-2) infection. At a glance, hospitals became overrun and had to reformulate all the assistance guidelines, focusing on the coronavirus disease 2019. One year after the start of the pandemic, we present the results of a morbimortality study. AIM To analyze how our department was affected by the outbreak in terms of morbimortality, and to analyze demographic data, admission to hospital-related data, and subgroups analyses for patients with hip fractures and polytrauma. METHODS We designed a study comparing data from patients who were admitted to our unit due to a lower limb fracture or a high energy trauma during the pandemic (from March to April 2020) to those admitted during the same period in 2019 before the pandemic. during the pandemic situation. Both cohorts completed a minimum of 6 mo of follow-up. RESULTS The number of patients admitted to hospital in 2020 was nearly half of those in 2019. Hip fractures in the elderly represented 52 out of 73 of the admitted patients. Twenty patients had a positive test result for SARS-CoV-2 infection. Patients with SARS-CoV-2 infection were admitted to the hospital for a longer time than the non-infected (P < 0.001), and had a higher mortality rate during hospitalization and follow-up (P = 0.02). Patients with a hip fracture associated with a severe respiratory syndrome were mostly selected for conservative treatment (P = 0.03). CONCLUSION Mortality and readmission rates were higher in the 2020 cohort and during follow-up, in comparison with the cohort in 2019.
Collapse
Affiliation(s)
- Sarah Mills
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
| | | | | | | | | | | | | | - E Carlos Rodríguez-Merchán
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
| |
Collapse
|
|
41
|
Clinical Characteristics and Perioperative Complication Profiles of COVID-19-Positive Patients Undergoing Hip Fracture Surgery. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202110000-00012. [PMID: 34653097 PMCID: PMC8522872 DOI: 10.5435/jaaosglobal-d-21-00104] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The coronavirus 2019 (COVID-19) pandemic disease has imposed an unprecedented degree of stress on healthcare systems. This study aimed to understand whether COVID-19 positivity is associated with an increased risk of adverse outcomes after geriatric hip fracture surgery. METHODS From a national administrative claims data set, patients who underwent hip fracture surgery from April 1, 2020, to December 1, 2020 were selected for analysis. COVID-19-positive status was assessed by the emergency International Classification of Diagnoses, 10th Revision, COVID-19 code within 2 weeks before the surgery. Demographic, comorbidity, and 30-day postoperative adverse event information were extracted. Logistic regression before and after 10:1 propensity matching was performed to identify patient risk factors associated with the occurrence of postoperative adverse events. RESULTS Of 42,002 patients who underwent hip fracture surgery, 678 (1.61%) were identified to be positive for COVID-19 infection. No significant differences in age, sex, and procedure type were found between COVID-19-positive and COVID-19-negative groups, but the COVID-19-positive patients demonstrated a higher incidence of several comorbidities. These differences were no longer significant after matching. After matching, the COVID-19-positive group had a higher incidence of any, serious, and minor adverse events (P < 0.001 for all). Controlling for preoperative variables, COVID-19 positivity was associated with an increased risk of experiencing any adverse events (odds ratio [OR] = 1.62, 95% confidence interval [95% CI] = [1.37 to 1.92], P < 0.001), serious adverse events (OR = 1.66, 95% CI = [1.31 to 2.07], P < 0.001), and minor adverse events (OR = 1.59, 95% CI = [1.34 to 1.89], P < 0.001). DISCUSSION After matching and controlling for confounding variables, COVID-19-positive hip fracture patients had increased odds of multiple postoperative events. Clinicians caring for this vulnerable geriatric population should be mindful of this risk to improve the care for these patients during the ongoing global pandemic.
Collapse
|
|
42
|
[Quantitative and qualitative analysis of the influence of confinement by COVID-19 in fracture patients entered in a traumatology service at a third level hospital]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:374-381. [PMID: 34630777 PMCID: PMC7836961 DOI: 10.1016/j.recot.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022] Open
Abstract
Introducción La pandemia por COVID-19 ha supuesto el confinamiento de aproximadamente un tercio de la población mundial, provocando un cambio drástico en las actividades de la vida diaria con enorme impacto sanitario, económico y social. Objetivos El objetivo de este trabajo es presentar las variaciones epidemiológicas en la producción de fracturas en el período de confinamiento obligatorio en nuestra población de referencia. Material y métodos Estudio analítico retrospectivo comparativo de dos grupos de pacientes: Grupo A: personas ingresadas antes del estado de alarma que obligó al confinamiento en el período del 13 enero al 13 de marzo vs. Grupo B: individuos atendidos durante los dos meses de confinamiento, hasta que comenzó la desescalada, período del 13 marzo al 13 mayo. Se registraron variables epidemiológicas, incluyendo edad, antecedentes personales, tipo de fractura, mecanismo de lesión, porcentaje de ambulatorización y estancia hospitalaria. Resultados Se incluyeron un total de 190 pacientes. En el período de pre-confinamiento 112 y en el confinamiento 78 (disminución del 30%). La edad media (p = 0,007) y las caídas en domicilio (p<0,001) fueron mayores en este último grupo. La estancia hospitalaria postoperatoria (p = 0,006) y global (p < 0,001) resultaron significativamente menores en el mismo grupo. No se encontraron diferencias en la localización anatómica de la lesión, el sexo, las comorbilidades, el mecanismo de lesión, la tasa de ambulatorización ni el éxitus. Conclusiones Con base en los resultados de nuestro estudio, el período de confinamiento forzoso por la pandemia de COVID-19 ha producido una drástica disminución del número total de fracturas ingresadas en el servicio de traumatología de un hospital de tercer nivel. Por otro lado, las fracturas osteoporóticas de cadera que requirieron tratamiento quirúrgico no variaron en número y se ha constatado un decremento de la estancia media postoperatoria y global.
Collapse
|
|
43
|
White PB, Partan M, Iturriaga C, Katsigiorgis M, Katsigiorgis G, Cohn RM, Bitterman A. Epidemiology and Clinical Outcomes of Foot and Ankle Trauma During the First Wave of the COVID-19 Pandemic in the New York Metropolitan Area. Orthopedics 2021; 44:313-319. [PMID: 34590956 DOI: 10.3928/01477447-20210819-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel respiratory virus that has rapidly changed the practice of medicine. The authors sought to evaluate the clinical presentation and clinical outcomes of patients presenting with foot and ankle (F&A) trauma to the emergency department during the first wave of the pandemic. The authors retrospectively studied all patients who presented to an emergency department within their multicenter institution during the first wave of the pandemic in their region from March 1 to June 30, 2020, with F&A trauma. They compared this cohort with a matched control group of patients who presented the prior year. Demographics, perioperative factors, coronavirus disease 2019 (COVID-19) polymerase chain reaction testing/positivity rates, 30-day readmissions, and 30-day mortalities were collected and analyzed. During the pandemic, the authors saw a 62.0% decrease in the total number of patients presenting with F&A trauma. Patients who presented during the pandemic were significantly older and a greater proportion were male. There was a greater proportion of ankle fractures, fewer ankle sprains, and more open fractures presenting during the pandemic. A greater proportion of patients presenting to the emergency department were admitted (18.2% vs 12.5%). The 30-day readmission (n=13 [5.8%] vs n=38 [9.3%]) and mortality (n=4 [1.8%] vs n=3 [0.7%]) rates for admitted patients were similar (P=.114 and P=.232, respectively). The authors found that 9.6% of patients who presented had a positive COVID-19 polymerase chain reaction test result and that these patients had 20% mortality and readmission rates. [Orthopedics. 2021;44(5):313-319.].
Collapse
|
|
44
|
Fadulelmola A, Gregory R, Gordon G, Smith F, Jennings A. The impact of COVID-19 infection on hip fractures 30-day mortality. TRAUMA-ENGLAND 2021; 23:295-300. [PMID: 38603069 PMCID: PMC7457007 DOI: 10.1177/1460408620951352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction A novel virus, SARS-CoV-2 has caused a fatal global pandemic which particularly affects the elderly and those with co-morbidities. Hip fractures affect elderly populations, necessitate hospital admissions, and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method Data related to seventy-five adult hip fractures admitted to two units during March and April 2020 was reviewed. The mean age was 83.5 years (range 65-98 years) and most (53, 70.7%) were females. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in COVID-19 positive group (10/20, 50%) compared to COVID-19 negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval 17.0-22.5). The mean time from admission to surgery was 43.1 hours and 38.3 hours, in COVID-19 positive and COVID-19 negative groups, respectively. All COVID-19 positive patients had shown symptoms of fever and cough, and all ten cases who died were from hypoxia. Seven (35%) cases had radiological lung findings consistent with viral pneumonitis which resulted in mortality (70% of mortality). 30% (n = 6) contracted the COVID-19 infection in the community and 70% (n = 14) developed symptoms after hospital admission. Conclusion Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest x-ray for patients presenting with hip fractures, helps in early planning of high-risk surgeries and allows counselling of the patients and family using realistic prognosis.
Collapse
Affiliation(s)
- Ahmed Fadulelmola
- University Hospital of North Durham, County Durham & Darlington NHSF, Newcastle upon Tyne, UK
| | - Rob Gregory
- University Hospital of North Durham, County Durham & Darlington NHSF, Newcastle upon Tyne, UK
| | - Gavin Gordon
- University Hospital of North Durham, County Durham & Darlington NHSF, Newcastle upon Tyne, UK
| | - Fiona Smith
- University Hospital of North Durham, County Durham & Darlington NHSF, Newcastle upon Tyne, UK
| | - Andrew Jennings
- University Hospital of North Durham, County Durham & Darlington NHSF, Newcastle upon Tyne, UK
| |
Collapse
|
|
45
|
Fisher ND, Bi AS, Aggarwal V, Leucht P, Tejwani NC, McLaurin TM. A Level 1 Trauma Center's response to the COVID-19 pandemic in New York City: a qualitative and quantitative story. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2021; 31:1451-1456. [PMID: 33616766 PMCID: PMC7897731 DOI: 10.1007/s00590-021-02902-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/08/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND The purpose of this study is to describe a Level 1 Trauma Center's orthopedic response to the COVID-19 pandemic, and to compare outcomes of acute fracture patients pre-COVID versus during the COVID-19 pandemic. METHODS All inpatient fracture cases performed over a 5-month period were identified and retrospective chart review performed. Patients were divided into pre- and COVID-era groups based on when surgery was performed relative to March 16, 2020 (the date elective operations were ceased), and groups were statistically compared. Patients with a COVID test result were further sub-divided into COVID negative and positive groups, and statistically compared. Statistical analysis was performed using independent t-test for continuous variables and chi-square analysis for categorical variables. RESULTS One hundred and nineteen patients were identified, 38% females with average age of 58 years. Average length of stay was 7 days with average time from injury to surgery of 3 days and average time from admission to surgery of 1.3 days. Overall in-hospital complication rate was 29.4%, and 30-day mortality and readmission rates were 2.5% and 5%, respectively. Sixty-nine patients comprised the pre-COVID group, and 50 in the COVID-era group. There was no significant difference with respect to length of stay, time from injury to surgery, time from admission to surgery, need for post-operative ICU stay, in-hospital complication rate, 30-day mortality rate and 30-day readmission rate. Thirty-four patients had COVID testing, with 24 negative and 10 positive. COVID-positive patients had longer time from injury to surgery (8.5 days vs. 2 days, p = 0.003) and longer time from admission to surgery (2.7 days vs. 1.2 days, p = 0.034). While more COVID-positive patients required ICU admission post-operatively (60% vs. 21%, p = 0.036), there was no difference in overall complication rate. CONCLUSIONS Orthopedic care of acute fracture patients was not affected by a global pandemic. The response of our Level 1 Trauma Center's orthopedic department can guide other hospitals if and when new surges in COVID cases arise, in order to prevent compromising appropriate orthopedic care. LEVEL OF EVIDENCE Prognostic III.
Collapse
Affiliation(s)
- Nina D Fisher
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.
| | - Andrew S Bi
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Vinay Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
- Department of Orthopedic Surgery, Health and Hospitals, Bellevue, New York, NY, USA
| | - Philipp Leucht
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
- Department of Orthopedic Surgery, Health and Hospitals, Bellevue, New York, NY, USA
| | - Nirmal C Tejwani
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
- Department of Orthopedic Surgery, Health and Hospitals, Bellevue, New York, NY, USA
| | - Toni M McLaurin
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
- Department of Orthopedic Surgery, Health and Hospitals, Bellevue, New York, NY, USA
| |
Collapse
|
|
46
|
LeBrun DG, Konnaris MA, Ghahramani GC, Premkumar A, DeFrancesco CJ, Gruskay JA, Dvorzhinskiy A, Sandhu MS, Goldwyn EM, Mendias CL, Ricci WM. Increased Comorbidity Burden Among Hip Fracture Patients During the COVID-19 Pandemic in New York City. Geriatr Orthop Surg Rehabil 2021; 12:21514593211040611. [PMID: 34522445 PMCID: PMC8436002 DOI: 10.1177/21514593211040611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
Background The coronavirus disease 19 (COVID-19) pandemic had a devastating effect on New York City in the spring of 2020. Several global reports suggested worse early outcomes among COVID-positive patients with hip fractures. However, there is limited data comparing baseline comorbidities among patients treated during the pandemic relative to those treated in non-pandemic conditions. Materials and Methods A multicenter retrospective cohort study was performed at two Level 1 Trauma centers and one orthopedic specialty hospital to assess demographics, comorbidities, and outcomes among 67 hip fracture patients treated (OTA/AO 31, 32.1) during the peak of the COVID-19 pandemic in New York City (March 20, 2020 to April 24, 2020), including 9 who were diagnosed with COVID-19. These patients were compared to a cohort of 76 hip fracture patients treated 1 year prior (March 20, 2019 to April 24, 2019). Baseline demographics, comorbidities, treatment characteristics, and respiratory symptomatology were evaluated. The primary outcome was inpatient mortality. Results Relative to patients treated in 2019, patients with hip fractures during the pandemic had worse Charlson Comorbidity Indices (median 5.0 vs 6.0, P = .03) and American Society of Anesthesiologists (ASA) scores (mean 2.4 vs 2.7, P = .04). Patients during the COVID-19 pandemic were more likely to have decreased ambulatory status (P<.01) and a smoking history (P = .04). Patients in 2020 had longer inpatient stays (median 5 vs 7 days, P = .01), and were more likely to be discharged home (61% vs 9%, P<.01). Inpatient mortality was significantly increased during the COVID-19 pandemic (12% vs 0%, P = .002). Conclusions Patients with hip fractures during the COVID-19 pandemic had worse comorbidity profiles and decreased functional status compared to patients treated the year prior. This information may be relevant in negotiations regarding reimbursement for cost of care of hip fracture patients with COVID-19, as these patients may require more expensive care.
Collapse
Affiliation(s)
- Drake G LeBrun
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Gregory C Ghahramani
- HSS Research Institute, Hospital for Special Surgery, New York, NY, USA.,Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY, USA
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Chris J DeFrancesco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jordan A Gruskay
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Aleksey Dvorzhinskiy
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Elan M Goldwyn
- Department of Orthopaedic Surgery, Orthopaedic Trauma Service, NewYork Presbyterian Queens, Flushing, NY, USA
| | - Christopher L Mendias
- HSS Research Institute, Hospital for Special Surgery, New York, NY, USA.,Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY, USA
| | - William M Ricci
- Department of Orthopaedic Surgery, Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
|
47
|
Singhavi H, Pai A, Mair M, Singhavi J, Gandhi P, Baker A, Das S, Kumar S, Conboy P. SARS-Cov2: a meta-analysis of symptom distribution by continent in 7310 adult COVID-19 infected patients. Virusdisease 2021. [PMID: 34124318 DOI: 10.1007/s13337-021-00699-y/figures/5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
UNLABELLED There is recent evidence that suggests that there are multiple strains of coronavirus in different parts of the world. Moreover, scientist have noted multiple mutations and postulated that these changes might increase the infective rate of the virus. However literature on varying severity of disease based on these strains is absent. In this meta-analysis, we have made an attempt to correlate the symptoms in different continents with respect to various studied strains of virus. We searched three databases, PubMed, EMBASE and EMCARE to identify studies reporting symptoms of COVID-19. All articles published between December 2019 and May 2020 was included in this meta-analysis. A total of 56 studies consisted of 7310 patients were included in the meta-analysis. Mean age of patients varied from 22 to 69.8 years. The pooled proportion of male patients was 52%. Highest incidence of fever (76%) and cough (56%) was noted in Chinese population. Sore throat (29%) was most common in Asian population. Upper respiratory tract symptom like Rhinorrhoea, Anosmia and dysgeusia (32%, 47% and 39%) were well documented in European population as compared to the other continents. Nausea and diarrhoea were more common in European (17%, 19%) and Australian (12%, 16%) population. Dyspnoea and fatigue were consistently similar in all the continents. We postulate that different mutations in COVID-19 virus may vary its pathogenicity and screening symptoms across all the continents should be not be generalised but continent-specific. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13337-021-00699-y.
Collapse
Affiliation(s)
| | - Ameya Pai
- Tata Memorial Hospital, Mumbai, India
| | - Manish Mair
- Department of Otorhinolaryngology, Infirmary Square, University Hospital of Leicester, Leicester, UK
| | | | - Prachi Gandhi
- Department of Neonatology, University Hospital of Leicester, Leicester, UK
| | - Andrew Baker
- Department of Otorhinolaryngology, Infirmary Square, University Hospital of Leicester, Leicester, UK
| | - Sudip Das
- Department of Otorhinolaryngology, Infirmary Square, University Hospital of Leicester, Leicester, UK
| | - Sanjeev Kumar
- Department of Otorhinolaryngology, Infirmary Square, University Hospital of Leicester, Leicester, UK
| | - Peter Conboy
- Department of Otorhinolaryngology, Infirmary Square, University Hospital of Leicester, Leicester, UK
| |
Collapse
|
|
48
|
Singhavi H, Pai A, Mair M, Singhavi J, Gandhi P, Baker A, Das S, Kumar S, Conboy P. SARS-Cov2: a meta-analysis of symptom distribution by continent in 7310 adult COVID-19 infected patients. Virusdisease 2021; 32:400-409. [PMID: 34124318 PMCID: PMC8187893 DOI: 10.1007/s13337-021-00699-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 05/20/2021] [Indexed: 01/19/2023] Open
Abstract
There is recent evidence that suggests that there are multiple strains of coronavirus in different parts of the world. Moreover, scientist have noted multiple mutations and postulated that these changes might increase the infective rate of the virus. However literature on varying severity of disease based on these strains is absent. In this meta-analysis, we have made an attempt to correlate the symptoms in different continents with respect to various studied strains of virus. We searched three databases, PubMed, EMBASE and EMCARE to identify studies reporting symptoms of COVID-19. All articles published between December 2019 and May 2020 was included in this meta-analysis. A total of 56 studies consisted of 7310 patients were included in the meta-analysis. Mean age of patients varied from 22 to 69.8 years. The pooled proportion of male patients was 52%. Highest incidence of fever (76%) and cough (56%) was noted in Chinese population. Sore throat (29%) was most common in Asian population. Upper respiratory tract symptom like Rhinorrhoea, Anosmia and dysgeusia (32%, 47% and 39%) were well documented in European population as compared to the other continents. Nausea and diarrhoea were more common in European (17%, 19%) and Australian (12%, 16%) population. Dyspnoea and fatigue were consistently similar in all the continents. We postulate that different mutations in COVID-19 virus may vary its pathogenicity and screening symptoms across all the continents should be not be generalised but continent-specific. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13337-021-00699-y.
Collapse
Affiliation(s)
| | - Ameya Pai
- Tata Memorial Hospital, Mumbai, India
| | - Manish Mair
- Department of Otorhinolaryngology, Infirmary Square, University Hospital of Leicester, Leicester, UK
| | | | - Prachi Gandhi
- Department of Neonatology, University Hospital of Leicester, Leicester, UK
| | - Andrew Baker
- Department of Otorhinolaryngology, Infirmary Square, University Hospital of Leicester, Leicester, UK
| | - Sudip Das
- Department of Otorhinolaryngology, Infirmary Square, University Hospital of Leicester, Leicester, UK
| | - Sanjeev Kumar
- Department of Otorhinolaryngology, Infirmary Square, University Hospital of Leicester, Leicester, UK
| | - Peter Conboy
- Department of Otorhinolaryngology, Infirmary Square, University Hospital of Leicester, Leicester, UK
| |
Collapse
|
|
49
|
He Y, Guo ZH, Wu YG, Li R, Xie X, Fu DH. Customized treatment protocols for patients with closed fracture in hospitals at varying coronavirus disease 2019 (COVID-19) risk. BMC Musculoskelet Disord 2021; 22:743. [PMID: 34461864 PMCID: PMC8405043 DOI: 10.1186/s12891-021-04614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 08/05/2021] [Indexed: 01/19/2023] Open
Abstract
Background To determine an optimized treatment protocol during the COVID-19 epidemic for patients with closed fracture and delayed surgery. Methods The epidemic data of three hospitals, randomly selected from different administrative regions of Wuhan, were analyzed retrospectively from 23 January to 31 March 2020. Changes in the number of confirmed cases per day (cumulative and new) of each region were tracked as a reflection of changing epidemic risk levels. The risk level map was drawn. The epidemic status, treatment protocols, and treatment efficiencies for patients with closed fracture in the three hospitals were compared. Results Overall, 138 patients with closed fracture were admitted. Each hospital had established its own protocol, according to the initial perceived risk. Based on the risk level map, over the study period, the risk levels of the three regions changed independently and were not in sync. All patients recovered and were timely discharged. No staff member was detected with COVID-19. Conclusions The COVID-19 risk level of each area is dynamic. To optimize medical resources, avoid cross-infection, and improve efficiency, changes in epidemic risk should be monitored. For patients with closed fracture, treatment protocols should be adjusted according to changes in epidemic risk.
Collapse
Affiliation(s)
- Yu He
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 Jiefang Avenue, 430022, Wuhan, P.R. China
| | - Zhong-Hua Guo
- Department of Orthopedics, People's Hospital of Dongxihu District, Wuhan, P.R. China
| | - Yong-Guang Wu
- Department of Orthopedics, People's Hospital of Caidian District, Wuhan, P.R. China
| | - Rui Li
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 Jiefang Avenue, 430022, Wuhan, P.R. China
| | - Xie Xie
- Department of Traditional Chinese Medicine, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 430060, Wuhan, P.R. China.
| | - De-Hao Fu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 Jiefang Avenue, 430022, Wuhan, P.R. China.
| |
Collapse
|
|
50
|
Iyengar KP, Khatir M, Mohamed MKA, Kariya AD, Jain VK, Sangani C, Adam RF, Suraliwala K. Characteristics and clinical outcomes of hip fracture patients during the first lockdown of COVID-19, lessons learnt: A retrospective cohort analysis. J Perioper Pract 2021; 31:446-453. [PMID: 34388942 DOI: 10.1177/17504589211026067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The management of hip fracture patients has been challenging across the UK in the wake of emergency coronavirus disease 2019 guidelines. AIMS This retrospective, observational cohort study analyses the impact of the first lockdown during the early part of the coronavirus disease 2019 pandemic on the management of hip fracture patients at a district general hospital in the UK. METHODS Comparative analysis to assess hip fracture patients treated at this Trust between 1 April to 31 May 2019 and 1 April to 31 May 2020 was undertaken. The primary outcome measures appraised were 30 and 60-day mortality and the secondary outcome measure included time to surgery. RESULTS There was a higher 30 and 60-day mortality rate in the first lockdown period at 8.1% and 13.5%, respectively, compared to 1.96% and 5.88% in 2019. A significantly lower proportion of hip fracture patients at 59.46% were operated within the 36h target time frame during the first lockdown. CONCLUSION In our Trust, hip fractures were treated as obligatory injuries. However, the mortality was higher in the 2020 cohort with a significant reduction in patients achieving the recommended '36 hours' time to surgery target and accruement of Best Practice Tariff. Enhanced infection control strategies have prepared us for the future.
Collapse
Affiliation(s)
| | | | | | | | - Vijay Kumar Jain
- Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Riad F Adam
- Southport and Ormskirk NHS Trust, Southport, UK
| | | |
Collapse
|