Aerosol generating procedures in orthopaedics and recommended protective gear

Geevarughese, Nikku Mathew; Haq, Rehan Ul

doi:10.1016/j.jcot.2020.08.019

Cited by 11 publications

(33 citation statements)

References 11 publications

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“…• Theatres should have negative pressure room ventilation, and aerosol generating tools e.g. oscillating saws should be used only in necessity [37,38] • One dedicated emergency theatre during peak pandemic time to be expanded to a COVID and Clean theatre where possible…”

Section: Resultsmentioning

confidence: 99%

Increased perioperative mortality for femoral neck fractures in patients with coronavirus disease 2019 (COVID-19): experience from the United Kingdom during the first wave of the pandemic

et al. 2021

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Background The coronavirus disease 19 (COVID-19) pandemic has presented modern healthcare with an unprecedented challenge. At the peak of the pandemic, trauma and orthopaedic services at our institutions undertook internal restructuring, diverting resources to frontline medical care. Consequently, we sought to assess the impact on the elderly and comorbid patients presenting with femoral neck fractures, with a particular focus on 30-day mortality, length of stay, multidisciplinary team involvement and departmental structuring. Method A retrospective analysis of patients presenting with femoral neck fractures at three separate West London NHS Trusts was undertaken between March 11, 2020, to April 30, 2020. Length of stay, 30-day mortality and adherence to parameters constituting the best care evidence-based practice tariffs were compared between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and negative patients. A similar comparison was also conducted between our cohort and the equivalent period in 2018 using data from the National Hip Fracture Database. Results A total of 68 patients presenting with femoral neck fractures were identified, mean age 81 (range 38–98), 73% female. There were 10 confirmed/suspected cases of COVID-19 on admission and a further seven confirmed as inpatients. The 30-day mortality within our cohort was 11.76% compared to 6% nationally in 2018 (p = 0.045). Orthogeriatric reviews occurred within 72 h in 71% of cases compared to 88% in the equivalent 2018 period. Within the cohort, mean length of stay was 17.13 days (SD 5.6, range 8-27 days) for SARS-CoV-2 positive patients compared to 10 days (SD 8.7, range 1–53 days) for negative patients (p < 0.05). Thirty-two patients (47%) required increased packages of care on discharge or rehabilitation. Conclusions The increase in 30-day mortality for SARS-CoV-2 positive patients presenting with femoral neck fractures is multifactorial, resulting from a combination of the direct effects of COVID-19 pneumonia as well as changes to the delivery of orthopaedic services. The provision of multidisciplinary care was directly affected by staff redeployment, particularly reorganisation of orthogeriatric services and lack of continuity of ward based clinical care. Our experiences have re-directed efforts towards the management of theatre teams, patient services and staffing, should we be faced with either a resurgence of COVID-19 or a future pandemic.

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Section: Resultsmentioning

confidence: 99%

Increased perioperative mortality for femoral neck fractures in patients with coronavirus disease 2019 (COVID-19): experience from the United Kingdom during the first wave of the pandemic

et al. 2021

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“…Twelve out of 16 articles recommend that minimum number of staff members should be kept inside the OR for any surgical procedure 5 , 6 , 7 , 10 , 11 , 13 , 14 , 15 , 16 , 18 , 19 , 20 , 25 . Less number of staff will facilitate the implementation of social distancing and also reduce the PPE demand 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Electro-cautery should be used minimally and in minimum setting possible along with a smoke evacuator 5 , 6 , 13 , 15 , 17 , 18 , 19 , 26 . Power devices like drills, saws, reamers and burr should also be used minimally and the power settings should be as low as possible 5 , 6 , 7 , 9 , 11 , 12 , 15 , 16 , 17 , 18 , 19 . Considering using a Gigli saw, sharp osteotomes, and manual reaming whenever possible 15 , 18 .…”

Section: Discussionmentioning

confidence: 99%

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2021_8_2

Verma

Anurag

Yugal³

et al. 2021

Journal of Arthroscopy and Joint Surgery

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Purpose Worldwide COVID 19 has affected the medical practices and Orthopaedics is not any different. Despite risk, the surgeons cannot deny the surgical procedure on patients with suspected or confirmed COVID 19 infection. The purpose of this manuscript is to review various operating room measures which are recommended and being followed to carry out orthopaedic surgeries in the current scenario of COVID 19 pandemic. The information would be useful for orthopaedic surgeons to carry out safe surgical practice for reducing the transmission of COVID 19 infection. Method ology: A systematic literature search was performed using search engines- PubMed, Google Scholar and Scopus from January to August 2020 for relevant research articles. The keywords utilized for systematic literature search were “COVID 19”, “Corona virus” and “Operating room”, “Orthopaedic procedure” in 4 combinations. Duplicates were excluded. Further sorting was done according to the pre-set inclusion and exclusion criteria. Original articles pertaining to orthopaedic surgery and operating room in COVID 19 and available in English language were included. Editorials, case reports, other speciality articles were excluded. Results 16 articles were finally included in review after screening for titles, abstracts and full texts. The information obtained is presented as a narrative review. Conclusion Various important recommendations include use of negative pressure OR, HEPA filters, dedicated separate OR for COVID positive and suspected patients with well defined separate corridors for transport, avoid AGP wherever possible, minimize the number of assistants and staff and follow strict sanitation protocols after each surgery. A well planned systematic approach is warranted to mitigate the risk of transmission of COVID 19 while carrying out orthopaedic surgeries.

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“…During high-risk AGPs (viz. use of power drills, reamers, saws, burrs, pulsed lavage) or long duration moderate-risk AGPs (viz suctioning, use of ultrasonically activated devices, osteotomes, nibblers, Gigli saw and arthroscopic/endoscopic procedures) respiratory protection above 95% is highly recommended [12]. N99/FFP3 respirators provide higher minimum filtration efficiency (99%) to aerosolized particles compared to the 94-95% by N95/FFP2 respirators [6].…”

Section: Policy and Personnel Managementmentioning

confidence: 99%

Impact of COVID-19 on Orthopaedic Care and Practice: A Rapid Review

Chatterji

Patel

Jain

et al. 2021

IJOO

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Introduction The COVID-19 pandemic has led to a large body of literature regarding the impact of COVID-19 on orthopaedic care and practice. This rapid review aims to synthesize this published literature to give the orthopaedic fraternity an overview about the best practices that need to be followed during this period. Methodology A rapid review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement for rapid reviews on the impact of COVID-19 on orthopaedic care and practice. A Pubmed search was done to identify all literature related to the impact of COVID-19 on orthopaedic care and practice, published between December 2019 and October 2020 using a predefined search strategy. The final review included 375 peer-reviewed articles addressing the objectives. Results The majority of articles were expert opinions (37.1%) and narrative reviews (13.1%). There were 17.3% retrospective studies and 2.1% prospective studies with only one randomized control trial and ten systematic reviews. 83.8% of articles had levels of evidence IV and V, 79.5% of the articles were published in core-orthopaedic journals. Maximum publications were from the United States of America (31.7%), followed by India (11.5%). European countries together contributed to 32.0% of all publications. Conclusion COVID-19 has had a significant impact on all aspects of orthopaedic care and practice. The pandemic has affected outpatient clinics, emergency and elective surgery, rehabilitation, resident training, personnel management, use of personal protective equipment, telemedicine and all sub-specialities of orthopaedics. Orthopaedic practice will require the incorporation of new technologies, restructuring of health systems and reorganizing of training programs for optimal patient care. There would also be a need for frequent review of emerging literature to provide evidence-based guidelines to the orthopaedic fraternity which will not only help in mitigation of transmission of disease but also ensure continuity of optimum patient care.

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Aerosol generating procedures in orthopaedics and recommended protective gear

Cited by 11 publications

References 11 publications

Increased perioperative mortality for femoral neck fractures in patients with coronavirus disease 2019 (COVID-19): experience from the United Kingdom during the first wave of the pandemic

Increased perioperative mortality for femoral neck fractures in patients with coronavirus disease 2019 (COVID-19): experience from the United Kingdom during the first wave of the pandemic

2021_8_2

Impact of COVID-19 on Orthopaedic Care and Practice: A Rapid Review

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