A comparative study looking at trauma and orthopaedic operating efficiency in the COVID-19 era

Abstract

Backgroud COVID-19 has led to a reduction in operating efficiency. We aim to identify these inefficiencies and possible solutions as we begin to pursue a move to planned surgical care. Methods All trauma and orthopaedic emergency surgery were analysed for May 2019 and May 2020. Timing data was collated to look at the following: anaesthetic preparation time, anaesthetic time, surgical preparation time, surgical time, transfer to recovery time and turnaround time. Data for 2019 was collected retrospectively and data for 2020 was collected prospectively. Results A total of 222 patients underwent emergency orthopaedic surgery in May 2019 and 161 in May 2020. A statistically significant increase in all timings was demonstrated in 2020 apart from anaesthetic time which demonstrated a significant decrease. A subgroup analysis for hip fractures demonstrated a similar result. No increase in surgical time was observed in hand and wrist surgery or for debridement and washouts. Although the decrease in anaesthetic time is difficult to explain, this could be attributed to a reduction in combined anaesthetic techniques and possibly the effect of fear. The other increases in time demonstrated can largely be attributed to the PPE required for aerosol generating procedures and other measures taken to reduce spread of the virus. These procedures currently form a large amount of the orthopaedic case load. Conclusion COVID-19 has led to significant reductions in operating room efficiency. This will have significant impact on waiting times. Increasing frequency of regional anaesthesia concurrently with non-aerosol generating surgeries may improve efficiency.

Influence of COVID-19 Protocols on the Efficiency of Trauma Theater: Retrospective Observational Study

“…Our study found that there was no significant difference between the COVID-19 and pre–COVID-19 periods with regard to theater efficiency, unlike several other studies [ 5 - 7 ]. We observed a similar number of operations being performed per theater session across both groups, with the only significant difference between groups occurring in the “procedure start” time and the length of time for check-out after a procedure.…”

“…Several studies reported an increase in patient turnaround times with a decrease in theater utilization times, resulting in an overall decrease in theater efficiency during the COVID-19 pandemic due to the additional infection control protocols [ 5 - 7 ].…”

Characteristics and clinical outcomes of hip fracture patients during the first lockdown of COVID-19, lessons learnt: A retrospective cohort analysis

“…TTS target was missed for another six patients who were either awaiting further investigations or required preoperative optimisation of reversible conditions such as coagulopathy and chest infection. The challenges of reduced theatre availability due to stretched resources, redeployment of theatre staff, staff shortage due to staff self-isolation or illness and the need for preoperative optimisation of sick patients admitted during the first lockdown period have been observed by many authors not only in the UK but all over the world (Andreata et al 2020, Arafa et al 2020, Donovan et al 2020, Malik-Tabassum et al 2020, Mercer et al 2020).…”

Anestesia regional como alternativa para procedimentos médicos na pandemia da COVID-19

“…Quanto as práticas anestésicas, em 2019 a AG combinada com AR foi utilizada em 178 (80,18%) pacientes, AL em 10 (4,5%) e AR em 34 (15,3%) pacientes, respectivamente, enquanto em 2020, a AG combinada com AR foi utilizada em 131 (81,4%) pacientes, AL em 15 (9,3%) e AR em 15 (9,3%) pacientes, respectivamente. Observa-se que em 2020 a quantidade de procedimentos cirúrgicos ortopédicos foi menor quando comparada com 2019 por conta da priorização dos serviços em decorrência da COVID-19, mas mesmo assim, a frequência do emprego da AR aumentou no período, sugerindo sua eficiência para as cirurgias ortopédicas (Mercer et al, 2020).…”