Evaluating the Strategies for Orthopedic and Spine Surgeries during COVID-19 Pandemic in India- a Retrospective Analysis of 24 Patients in a Multispecialty Hospital- Are We Heading to a New Normal?

Abstract

Study Design: Retrospective study.Purpose: To present precautionary measures for the orthopedic and spine surgery patients, operating them as per the protocol and analyze findings that can be implemented in non-urgent surgeries during Covid-19 pandemic. Other aim was to analyze the role of multidisciplinary approach, average hospital stay, additional cost behind investigations and hospital bill to guide the patients.Overview of Literature: The literature mentioned to postpone or delay all non-urgent surgeries related to orthopedic and spine conditions till Covid-19 pandemic continues. However, it is not predicted when will this end. No study focusing to conduct essential but non-urgent orthopedic and spine surgeries during this pandemic. Methods: Between March 11, 2020 and May 8, 2020, information on 24 operated orthopedic and spine surgeries were prospectively collected at our institution. Patients were examined in either designated Flu Clinic or out patient department (OPD) after completing screening protocol for Covid-19. Flu clinic team examined all patients and blood investigations, x-ray chest and additional high resolution CT scan were ordered before admission. Patients with symptoms were investigated with RT-PCR for Covid-19. Standardized protocols using multidisciplinary approach were followed for outpatient clinic, admission, surgery and hospital stay regarding Covid-19. Analysis of patients’ hospital stay, hospital bill, admission time and their results of surgeries were performed.Results: 24 patients were operated for orthopedic and spine surgeries with triage as urgent surgeries. 8 and 16 patients were admitted through flu clinic and OPD, respectively; which caused average admission time 179.4+/-138.5 minutes from presentation to admission. All patients managed orthopedic and spine surgeries with improved VAS from average 8.5+/-0.6 preoperatively to 2.7+/-1.0 postoperatively. There was average increase of 5.4+/-2.4% in the overall cost compared to final bill pertaining to Covid-19 precautionary measures. There was no patient or healthcare worker who developed symptoms related to Covid-19.Conclusions: Surgeries should be conducted during Covid-19 pandemics according to their need either to save lives or to provide improved quality of life. Multidisciplinary approach following strict precautionary measures can make it a new-normal norm for the healthcare providers.