Effect of COVID-19 on surgical management of open fractures and infection rates: A tertiary care experience in Indian set-up

Abstract

Background: Open fractures form one of the most common musculoskeletal injuries and are often complicated by infection. In this unprecedented situation, the additional infection rates, further add to the burden of the already compromised healthcare setup. The present study is done to see the effect of COVID-19 on management of open fractures. Methods: A retrospective evaluation of patients with open fractures from March 25th , 2020 to July 21st , 2020 (group 1) and March 25th , 2019 to July 21st , 2019 (group 2) was performed. These patients were assessed for demographic details, diagnosis, type of surgery, delay from injury to admission, delay from admission to surgery, postoperative hospital stay, acute infection rates, readmission rates and associated injuries. Results: A total of 52 patients with 59 open fractures in 2020 and 89 patients with 101 open fractures in 2019 met the inclusion criteria. The mean age was 34.76 years and 32.74 years in 2020 and 2019 respectively. Road side accidents were predominant in both the groups, comprising of 38 (73.07%) and 67 (75.28%) respectively(n.s.); adult patients were 42 (80.76%) and 79 (88.76%) respectively(n.s.); paediatric patients were 10 (19.23%) and 10 (11.23%) respectively(n.s.); tibia was the most common bone involved, comprising of 14 (23.72%) and 27 (26.73%) open fractures respectively(n.s.); external fixator was the most commonly used implant during COVID-19 time with 42 (71.18%) and 51 (50.49%) respectively(p ¼ 0.005); the infection rate was 25.42% and 20.79% respectively(n.s.); the time for administration of first intravenous antibiotic dose was on 6.75 h and 4.04 h respectively(p < 0.0001); average time between the admission and surgical debridement was 24.04 h and 19.32 h respectively(n.s.); referral cases were 33 (63.46%) and 44 (49.43%) respectively(n.s.); re-admission rates were 7/52 (13.46%) and 10/89(11.23%) respectively(n.s.). Conclusion: Despite the decrease in total trauma cases, a delay in presentation to the emergency room/ administration of first dose of antibiotic and increase in temporary fixation in form of external fixator was observed. Further, an increase in infection rates, referral cases and readmission rates were observed, though not statistically significant.

The Impact of COVID-19 Pandemic on Orthopedic Trauma Practice: An Experience at a Tertiary Care Center in Northern India

“…Moreover, orthopedic procedures require the use of drills and saws that are aerosol-generating, so only lifethreatening or limb-saving surgeries were performed during this period. Similar observations were recorded in other parts of the world [9][10][11].…”

Impact of COVID-19 Pandemic on Open Fractures: a Retrospective Multi-centre Cohort Study in the Different Risk Periods of China

“…The reason may have been isolation measures. However, the time from hospital admission to surgery did not change signi cantly [4]. In contrast, although without statistical signi cance, we found that the time from injury to emergency department shortened, whereas the time from admission to surgery dramatically extended in the high-risk period.…”

“…Patients with severe or multiple injuries need immediate attention and transfer from the emergency department to the operating room, with no time to wait for most blood test results. However, to identify potential patients with COVID-19, various departments of medical institutions usually need to add a series of prevention and control measures, which increase the preoperative preparing time and delay the treatment, including the surgery and the application of antibiotics [4]. Meanwhile, clinical guides by the National Health Service suggest that all patients who are 'obligatory inpatients' must have their 'treatment expedited' to avoid pre-op delay and expedite rehab to minimize the length of stay [5].…”

Epidemiologic characteristics and pre-hospital care of traumatic injuries during the COVID-19 pandemic in an emerging and developing country: A single tertiary centre experience

“…In a previous study by Gupta et al similar observations were reported during lockdown period compared to the pre lockdown period, simulating the results of the present study. 18 …”

“…Because the peak of COVID-19 cases presented at different times in various countries around the world, much has been stated about the global community response to the virus in a short period of 6–8 weeks with a small number of cases and only few studies present long term observational research, in identifying epidemiologic factors and challenges amid response to the COVID-19 pandemic. 18 The present study will not only summarize the deficiencies and better understanding of COVID-19, but will also cater to the future outbreaks and timely actions need to be taken, to tackle these extraordinary situations in a more optimal way.…”