Outcome of trauma and orthopaedic surgery at a UK District General Hospital during the Covid-19 pandemic

Abstract

Introduction: There are suggestions that elective surgery performed during the incubation period of COVID-19 infection may cause an immediate impairment of cell-mediated immunity, leading to high morbidity and mortality. However is contrasting data about the associated mortality. Since the outbreak, our unit has maintained a prospective database recording Trauma and Orthopaedic surgical activity. Our aim was to share our experience of the first 3 months with prospective data on outcome of essential surgery during the covid-19 peak. Our focus in this report was on the mortality rate as services begin to open. Methods: We prospectively collected data during the peak of the pandemic in the UK, for fracture neck of femur patients (NOF) the most commonly performed surgical procedure and the most vulnerable during this period. We compared this Covid-19 cohort of NOFs against a cohort of NOF's during the same time in 2019 and another cohort of NOF's in 2020 outside the lockdown period to compare mortality rates and give a broader perspective. Results: During the period March 1, 2020 to May 31, 2020, total of 206 patients were operated. Ninetyfour fracture NOF and another one hundred twelve essential surgical procedures were performed. In the NOF cohort, there were nine patients that died. Three of them were covid-19 positive, one was not tested and the rest five were covid-19 negative. There was no mortality reported in the non NOF group. Conclusion: In our unit, during the lock down period, mortality rate in patients undergoing fracture NOF was not significantly different from a similar cohort earlier in the year and similar period last year. We have not observed any mortality, to date in the Non NOF procedures carried out.

The global burden of trauma during the COVID-19 pandemic: A scoping review

“…29,591patients were studied during the COVID-19 pandemic, with reported ages ranging from under one to 103 years. The mean age was reported for 3,236 patients and was 43.7 years 13,18,19,22,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] . An average of 54.8% were male.…”

“…33 patients were COVID-19 positive on their first presentation, and 10 acquired COVID-19 after admission to hospital. The reported prevalence of COVID-19 in trauma patients ranged from zero in a District General Hospital in the UK 18 to 5.68% over multiple hospitals in Belgium 16 . 3 studies reported on mortality in nonproximal femur trauma patients; Sobti et al 18 reported that none of their patients died,…”

Postoperative mortality among surgical patients with COVID-19: a systematic review and meta-analysis

“…Evidence revealed that mortality of patients hospitalized with COVID-19 was very high which is strongly associated with the presence of comorbidities, smoking, and substance use [23,25,34,39,45,51,52].…”

Postoperative mortality among surgical patients with COVID-19: A systematic review and meta-analysis

“…Evidence revealed that mortality of patients hospitalized with COVID-19 was very high which is strongly associated with the presence of comorbidities, smoking, and substance use [23,25,34,39,46,[52][53][54].…”