Changes of clinical activities in an orthopaedic institute in North Italy during the spread of COVID-19 pandemic: a seven-week observational analysis

Abstract

Purpose The COVID-19 pandemic is importantly affecting the orthopaedic practice all over the world with Northern Italy being the first European area that faced the worst scenario. In this study, the changes in clinical practice occurred in an orthopaedic center in Milan are described. Methods Number and type of admissions, outpatients cancelled and preserved, emergency room, and intensive care unit activities have been analyzed in the timeframe of seven weeks since the beginning of the pandemic (from February 24th to April 10th) and compared with the same period in 2019. Results The planned surgical admissions declined from 2172 in 2019 to 664 in 2020 (69.42%, p < 0.0001), while emergencies increased from 158 to 268 (69.62%). The rehabilitation admissions declined from 414 to 69 (83.33%). The overall admission decreased by 63.52%, the trend showed a drop in the last weeks. Surgery performed in the COVID-19 operating room increased by 16.7% in the last week. Seven deaths occurred (0.7% of all orthopaedics and trauma admissions) compared with four (0.1%) which happened in the same period in 2019 (p = 0.004). Six of these patients were suffering from COVID-19. A total of 23,580 outpatients (93.8%) were cancelled. Emergency room consultations declined by 68.14% and 63.47% among white and green priority, respectively, while increased by 25% and 100% among yellow and red, respectively. Conclusion These numbers show the radical changed scenario in an orthopaedic center in Milan during COVID-19 pandemic. Elective surgery declined rapidly going close to zero, outpatient admissions were restricted to cases that cannot be postponed, while emergencies increased due to the role played by the hospital as referral orthopaedic centre during the pandemic. The still ongoing emergency will have important impacts on the overall orthopaedic healthcare management for the next months.

Changing Pattern of Orthopaedic Trauma Admissions During COVID-19 Pandemic: Experience at a Tertiary Trauma Centre in India

“…Lockdowns of varying degree were imposed in various countries worldwide, and our understanding is that these were not as strict as they were in India. We compared our preliminary observational data to studies evaluating orthopaedic patients in Spain [6] and New Zealand [7]. Although the studies were different from ours, data from Spain [6] noted a similar reduction in traffic and workplace accidents, with reductions in hospital admissions, but the number of geriatric hip fractures remained almost the same; this was somewhat different from our experience.…”

“…The New Zealand study [7] looked at variations of volume and pattern in a level 1 trauma centre over two 14-day periods; they noted a 43% reduction in injury related admissions, and 48% reduction in paediatric admissions, and documented a predominance of injury at home, specifically falls in all age groups. We also found overall reduction in number of paediatric and elderly patients but there was no significant difference in terms of percentage.…”

A look at the global impact of SARS CoV-2 on orthopedic services

“…Nine centers reported the number of elective orthopedic procedures performed both before and during the COVID-19 pandemic. 9 , 10 , 16 , 17 , 20 , 29 , 36 , 38 , 39 Cumulatively, the number of elective surgeries decreased by 80% (2013/17400, 0.20, CI: 0.12 to 0.29) ( Fig. 2 ).…”

“…A comparison of trauma surgery numbers was reported in nine centers, 16 , 17 , 20 , 24 , 28 , 29 , 36 , 38 , 39 of which six were reported as major trauma centers. Seven centers observed a lower volume of trauma procedures during the pandemic, as compared to pre-pandemic times, amounting to an overall decrease of 47% (3887/17561, 0.53, CI: 0.37 to 0.69) ( Fig.…”

“…reported an increase of 69.6% and 35.7% respectively in trauma surgeries. 36 , 39 Interestingly, all the centers included low-energy injuries and orthogeriatric fractures within the number of trauma procedures. This could be a possible explanation behind the phenomenon of the disproportionate decreases between elective and trauma surgeries, as centers listed what were usually non-urgent procedures, as trauma procedures, in order to continue the ability to treat such cases.…”