Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative

Abstract

ObjectiveThis is the first British multicentre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak.DesignA longitudinal, multicentre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from 17 March 2020 compared with the same period in 2019.SettingHospitals from six major urban cities were recruited around the UK, including London.ParticipantsA total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion.Primary and secondary outcome measuresPrimary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia used.ResultsDuring the COVID-19 period, there was a 34% reduction in acute orthopaedic trauma referrals compared with 2019 (1792 down to 1183 referrals), and a 29.5% reduction in surgical interventions (993 down to 700 operations). The mortality rate was more than doubled for both risk and odds ratios during the COVID-19 period for all referrals (1.3% vs 3.8%, p=0.0005) and for those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-19-related complications (vs non-COVID-19 causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID-19, there was an increase in odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters, as well as doubled odds of a consultant acting as the primary surgeon.ConclusionAlthough there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared with the same time interval 1 year ago.

Clinical outcomes of non-COVID-19 orthopaedic patients admitted during the COVID-19 pandemic: a multi-centre interrupted time series analysis across hospitals in six different countries

“…As most hospitals had to ensure sufficient capacity for the surge of COVID-19 patients, patients admitted during the COVID-19 pandemic period are likely a selection of more urgent and complex patients for which care could not be postponed. This is supported by findings of two previous studies reporting higher mortality for orthopaedic patients admitted during the COVID-19 pandemic when compared with the pre-pandemic period 14 21. Yet, other studies found similar mortality risks when examining the impact of the COVID-19 pandemic for hip fracture patients22 23 and patients who underwent hip or knee arthroplasty surgery24 compared with expected mortality risks based on pre-pandemic years.…”

“…COVID-19 caused by the SARS-CoV-2 virus had a tremendous effect on healthcare systems worldwide. Hospitals had to restructure to accommodate the influx of COVID-19 patients and prioritise acute care for non-COVID-19 patients, which disrupted orthopaedic care worldwide including reductions in elective and emergency surgical interventions,1–13 reduced clinic capacity3 4 6 10 12 and a decrease in orthopaedic trauma referrals and emergency admissions 6 7 12 14 15. Even more, the COVID-19 pandemic have led to an estimated total health loss for elective orthopaedic arthroplasty patients of approximately 30 000 QALYs, with decades of back-log of surgical capacity for these patients if capacity is not increased 13.…”

Trends of Referrals Throughout the Kingdom, A Retrospective Analysis of the Saudi Medical Appointments and Referrals Centre Registry, Saudi Arabia

“…This notable drop could be the result of nationwide lockdowns which have occurred in the Kingdom of Saudi Arabia and across nations worldwide, along with the fear of attending the healthcare setting due to the risk of catching the infection. Similar drops have been witnessed across countries during the same period including the United Kingdom (UK) and Italy, increasing the likelihood of it being outbreak related [12][13][14] .…”

A retrospective evaluation of characterization, clinical course and anaesthesia management of emergency trauma surgical patients during first wave of COVID-19 pandemic at a tertiary care center in India

“…18 Sugand K et al in a longitudinal, multicenter, retrospective, observational, cohort study conducted in United Kingdom during the peak 6 weeks of the first wave from 17 March 2020 compared with the same period in 2019 observed, that for the patients undergoing surgery for acute orthopaedic trauma during COVID-19, there was an increase in odds of aerosolising-generating anaesthesia by three-quarters. 19 In summary, it is obvious that the emergency trauma surgeries will continue even during pandemics in periods of general lockdown as well as unlock. Anaesthesia teams working in centres with trauma care must consider this while developing strategies and reallocating resources during such health emergencies, epidemics or pandemics.…”