Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center

Abstract

Purpose In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. Methods All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. Results During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. Conclusion This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.

Effect of coronavirus (COVID-19) pandemic on orthopedic trauma patients presenting in the emergency department of a maximum care hospital and level 1 trauma center

“…In addition, the lack of school accidents due to the nationwide closure of schools further contributes to the reduction of the number of these patients. In the present study, a decreasing number of traffic-, sports- and work-related accidents in the period of the pandemic were observed which is also in accordance with previous studies [ 5 , 7 ].…”

“…However in this study the proportion of patients suffering from fractures or diagnoses requiring surgery was increased. This is in line with the results of a study by Kreis et al which reported an increased incidence proportion of emergency operations during the shutdown [ 5 ].…”

“…Overall there was a one third decrease of patients treated at our ED due to musculoskeletal problems, which was mainly due to a decreasing number of patients not requiring acute inpatient treatment. This decrease of emergency patients is in line with other studies from other level one trauma centers in Germany which reported a similar reduction in emergency patients [ 5 – 7 ]. A similar extent of the reduction in presentations was also found in a study from Spain.…”

Impact of the COVID-19 pandemic on the management of open fractures in a major trauma centre

“…Despite this and despite a strict lockdown in London, our trauma workload persisted and, as we have demonstrated in this study, our open fracture workload remained similar to pre-COVID times. 12 , 13 The prediction was therefore, that the quality of care for open fractures was compromised due to the number of pressures placed on our service provision.…”

Emergency surgery and trauma during COVID-19 pandemic: safe, smart and kind!

“…Although the overall volume of injuries and cases with acute abdominal conditions admitted to the emergency department decreased due to lockdown and containment strategy, new challenges had to be managed [5][6][7][8]; skeletal trauma surgeons reported higher mortality rates in COVID-19 positive patients with hip fractures [9] and an increasing incidence proportion of emergency operations and severe open fractures [10], while emergency general surgeons, to spare resources and protect the population, had to modify their decision making process shifting towards a tailored conservative approach and struggled with more severe cases due to late presentation of patients with acute abdominal conditions [11][12][13].…”