COVID-19 among patients with orthopedic surgery: our experience from the Middle East

Abstract

Background We report our experiences with COVID-19 in one of the largest referral orthopedic centers in the Middle East and aimed to describe the epidemiology and clinical characteristics of these patients. Methods During February 20 and April 20, 2020, patients who underwent orthopedic surgery and healthcare staff who were in contact with these patients were screened for COVID-19. To identify patients who were in the incubation period of COVID-19 during their hospital stay, all patients were tested again for COVID-19 4 weeks after discharge. Results Overall, 1244 patients underwent orthopedic surgery (1123 emergency and 121 elective) during the study period. Overall, 17 patients were diagnosed with COVID-19 during hospital admission and seven after discharge. Among the total 24 patients with COVID-19, 15 were (62.5%) males with a mean (SD) age of 47.0±1.6 years old. Emergency surgeries were performed in 20 (83.3%) patients, and elective surgery was done in the remaining 4 patients which included one case of posterior spinal fusion, spondylolisthesis, acromioclavicular joint dislocation, and one case of leg necrosis. A considerable number of infections occurred in patients with intertrochanteric fractures (n=7, 29.2%), followed by pelvic fractures (n=2, 8.3%), humerus fractures (n=2, 8.3%), and tibial plateau fractures (n=2, 8.3%). Fever (n=11, 45.8%) and cough (n=10, 37.5%) were the most common symptoms among patients. Laboratory examinations showed leukopenia in 2 patients (8.3%) and lymphopenia in 4 (16.7%) patients. One patient with a history of cancer died 2 weeks after discharge due to myocardial infarction. Among hospital staff, 26 individuals contracted COVID-19 during the study period, which included 13 (50%) males. Physicians were the most commonly infected group (n = 11), followed by operation room technicians (n = 5), nurses (n = 4), and paramedics (n = 4). Conclusions Patients who undergo surgical treatment for orthopedic problems, particularly lower limb fractures with limited ambulation, are at a higher risk of acquiring COVID-19 infections, although they may not be at higher risks for death compared to the general population. Orthopedic surgeons in particular and other hospital staff who are in close contact with these patients must be adequately trained and given appropriate personal protective equipment during the COVID-19 outbreak.

Orthopedic Surgery in Ambulatory Surgery Centers During the COVID-19 Pandemic: Low Incidence of Infection Among Patients, Surgeons, and Staff

“…Patients were screened for COVID-19 before surgery and tested, along with the hospital staff, four weeks after discharge. The incidence of COVID-19 was 1.9% in patients and 5.5% in hospital staff [28]. To our knowledge, this report is the first investigation of COVID-19 incidence among the patients, staff, and surgeons in outpatient orthopedic ASCs.…”

“…There were no positive tests among surgeons or healthcare workers [27]. Another 2021 study analyzed the incidence of COVID-19 cases among patients and hospital staff who were in contact with them in one of the largest referral orthopedic hospitals in Iran [28]. Patients were screened for COVID-19 before surgery and tested, along with the hospital staff, four weeks after discharge.…”

COVID-19 infection rate after urgent versus elective total hip replacement among unvaccinated individuals: A multicenter prospective cohort amid the COVID-19 pandemic

“…Most previous studies deemed safe resumption of surgeries under safety protocols [ [25] , [26] , [27] , [28] , [29] , [30] , [31] ]. In a study in the UK, Infection with COVID-19 after hip and knee arthroplasty was comparable to the general population (0.5%), and LOS is the only risk factor [ 25 ].…”

The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19

“…The COVID-19 pandemic imposed healthcare systems worldwide with new challenges and considerable organisational efforts [ 5 – 10 ]. Often far-reaching process changes, such as the management of patient flows, had to be implemented in everyday clinical practice within a very short period [ 11 – 15 ]. The management of COVID-19 is complex and, to date, no shared guidelines exist [ 16 – 18 ].…”