Covid-19

Simpson, A. H. R. W.; Dall, G; Haas, Jürgen

doi:10.1302/2046-3758.94.bjr-2020-0130

Cited by 23 publications

(10 citation statements)

References 23 publications

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“…Continuing changes to national guidance suggests that only the use of high-speed devices on the respiratory tract are considered AGP 1 . This is contradictory to other evidence that exists in the literature regarding aerosol production and the use of high-speed devices 11 , 12 , 13 . Currently, we have chosen to continue using full PPE for orthopaedic procedures involving use of high-speed devices, accepting the reduced efficiency in order to maintain patient and staff safety.…”

Section: Discussioncontrasting

confidence: 92%

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

Mercer

Agarwal

Dayananda

et al. 2020

Perioperative Care and Operating Room Management

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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.

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Section: Discussioncontrasting

confidence: 92%

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

Mercer

Agarwal

Dayananda

et al. 2020

Perioperative Care and Operating Room Management

View full text Add to dashboard Cite

show abstract

“… 19 – 21 These risks are a common occurrence in the urgent and revision patient populations. 17 As demonstrated in our study only patients with an ASA of 3 or greater died following infection with COVID-19. We have had no 30-day mortality in patients ASA grades 1 or 2.…”

Section: Discussionsupporting

confidence: 53%

“…This is likely a result of concerns regarding intubation, an aerosol generating procedure, increasing viral load to healthcare workers. 17 Spinal anaesthesia has been reported to reduce in-hospital mortality and length of hospitalization but to have no effect on 30-day mortality. 18 …”

Section: Discussionmentioning

confidence: 99%

30-day mortality following trauma and orthopaedic surgery during the peak of the COVID-19 pandemic

et al. 2020

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Aims Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing orthopaedic surgery during the peak of the pandemic within our region. Methods This multicentre study reviewed data on all patients undergoing trauma and orthopaedic surgery in a region from 18 March 2020 to 27 April 2020. Information was collated from regional databases. Patients were COVID-19-positive if they had positive laboratory testing and/or imaging consistent with the infection. 30-day mortality was assessed for all patients. Secondly, 30-day mortality in fracture neck of femur patients was compared to the same time period in 2019. Results Overall, 496 operations were carried out in 484 patients. The overall 30-day mortality was 1.9%. Seven out of nine deceased patients underwent surgery for a fractured neck of femur. In all, 27 patients contracted COVID-19 in the peri-operative period; of these, four patients died within 30 days (14.8%). In addition, 21 of the 27 patients in this group had a fractured neck of femur, 22 were over the age of 70 years (81.5%). Patients with American Society of Anesthesiologists (ASA) grade > 3 and/or age > 75 years were at significantly higher risk of death if they contracted COVID-19 within the study period. Conclusion Overall 30-day postoperative mortality in trauma and orthopaedic surgery patients remains low at 1.9%. There was no 30-day mortality in patients ASA 1 or 2. Patients with significant comorbidities, increasing age, and ASA 3 or above remain at the highest risk. For patients with COVID-19 infection, postoperative 30-day mortality was 14.8%. The reintroduction of elective services should consider individual patient risk profile (including for ASA grade). Effective postoperative strategies should also be employed to try and reduce postoperative exposure to the virus. Cite this article: Bone Joint Open 2020;1-7:392–397.

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“…This includes asymptomatic carriers as well. 6 , 7 , 8 In human body, the SARS-CoV-2 spike protein attaches to the angiotensin-converting enzyme 2 receptor and instigates a potentially harmful inflammatory cascade. Apart from the kidney, gastrointestinal tract, cardiovascular system, and alveolar epithelium, these receptors are also found in bone marrow–derived stem cells.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Spread of Infection During Craniotomy/Craniostomy on Patients with Active Coronavirus Disease 2019 (COVID-19) Infection: Myth or Fact?

et al. 2021

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Covid-19

Cited by 23 publications

References 23 publications

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

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

30-day mortality following trauma and orthopaedic surgery during the peak of the COVID-19 pandemic

The Risk of Spread of Infection During Craniotomy/Craniostomy on Patients with Active Coronavirus Disease 2019 (COVID-19) Infection: Myth or Fact?

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