No abstract

The SARS-CoV-2 (COVID-19) pandemic has had a global influence on health care. The authors examined the early effect of hospital- and state-mandated restrictions on an orthopedic surgery department and hypothesized that the volume of ambulatory clinic encounters, office and surgical procedures, and cases would dramatically decrease. A retrospective review was performed of all encounters in an orthopedic surgery department at a level I academic trauma center during a 4-week period, from March 16, 2020, to April 12, 2020. The results were compared with two control 4-week periods, February 17, 2020, to March 15, 2020, and March 16, 2019, to April 12, 2019. Weekly volume and work relative value units (RVUs) of clinic encounters, office and surgical procedures, and cases were assessed. The type of ambulatory visit also was recorded. Comparisons of mean weekly volume and RVUs between the study and control periods were performed with Student's t test. Surgical cases were categorized into fracture or dislocation, acute soft tissue or nerve injury, infection, oncology, and elective or nonurgent. After implementation of hospital- and state-mandated restrictions on elective health care, the volume of ambulatory orthopedic surgery clinic encounters decreased by 74% to 77%, the volume of clinic procedures decreased by 95%, and the volume of surgical cases decreased by 88%. The percentage of clinic visits performed via telemedicine increased from 0.3% to 81.2%. Elective surgical cases ceased, and the volume of nonelective surgical cases decreased by 51%. During the first 4 weeks after COVID-19–related restrictions were imposed, an immediate and dramatic effect was observed. Compared with the control periods, significant reductions were seen in the volume of ambulatory encounters, office-based procedures, and surgical cases. In addition, the volume of nonelective surgical cases decreased by 51%. [ Orthopedics . 2020;43(4):228–232.]

Background: The objective of this study was to determine the rates of patient satisfaction, perceived recurrence of flexion deformity, and additional treatment after collagenase clostridium histolyticum treatment for Dupuytren’s contracture at a minimum of 5-year follow-up. Methods: A retrospective study was performed of 199 digits in 142 patients who underwent collagenase clostridium histolyticum treatments from April of 2010 to December of 2013 with a minimum of 5-year follow-up. Patients were contacted by telephone regarding perceived recurrence, additional treatment, satisfaction, and willingness to undergo this treatment again. Results: At an average 7.2-year follow-up, 160 of 199 digits (80 percent) had perceived recurrence, and 105 of 199 digits (53 percent) underwent additional treatment. Average satisfaction was 6.5 on a Likert scale ranging from 1 to 10, and 67 percent would undergo collagenase clostridium histolyticum treatment again. Multivariable logistic regression analysis showed that higher Charlson Comorbidity Index (OR, 0.77; 95 percent CI, 0.63 to 0.93) and isolated metacarpophalangeal joint involvement (OR, 0.53; 95 percent CI, 0.29 to 0.97) were associated with decreased odds of additional treatment, and higher American Society of Anesthesiologists physical status classification (OR, 2.49; 95 percent CI, 1.35 to 4.48) and nonsmoker status (OR, 0.23; 95 percent CI, 0.09 to 0.59) were associated with willingness to undergo the treatment again. Conclusions: Patients may be counseled that the long-term perceived recurrence rate of Dupuytren’s contractures after collagenase clostridium histolyticum treatment is high, and more than half of patients seek additional treatment. Satisfaction and willingness to undergo collagenase clostridium histolyticum treatment decrease with perceived recurrence. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.