Outcomes of orthopaedic trauma patients undergoing surgery during the peak period of COVID-19 infection at a UK major trauma centre

Abstract

Background To review the clinical outcomes of all patients undergoing emergency orthopaedic trauma surgery at a UK major trauma centre during the first 6 weeks of the COVID-19 related lockdown. Methods A retrospective review was performed of all patients who underwent emergency orthopaedic trauma surgery at a single urban major trauma centre over the first six-week period of national lockdown. Demographics, co-morbidities, injuries, injury severity scores, surgery, COVID-19 status, complications and mortalities were analysed. Results A total of 76 patients were included for review who underwent multiple procedures. Significant co-morbidity was present in 72%. The overall COVID-19 infection rate of the study population at any time was 22%. Sub-group analysis indicated 13% had active COVID-19 at the time of surgery. Only 4% of patients developed COVID-19 post surgery with no mortalities in this sub-group. The overall mortality rate was 4%. The overall complication rate was 14%. However mortality and complications rates were higher if the patients had active COVID-19 at surgery, if they were over 70 years and had sustained life-threatening injuries. Conclusion The overall survival rate for patients undergoing emergency orthopaedic trauma surgery during the COVID-19 peak was 96%. The rate of any complication was more significant in those presenting with active COVID-19 infections who had sustained potentially life threatening injuries and were over 70 years of age. Conversely those without active COVID-19 infection and who lacked significant co-morbidities experienced a lower complication and mortality rate.

Low 30-day mortality in South African orthopaedic patients undergoing surgery at an academic hospital during the first wave of the COVID-19 pandemic: It was safe to perform orthopaedic procedures at our hospital during the first COVID-19 peak

“…The low 30-day mortality rate of our patient cohort during the first COVID-19 peak is similar to figures published by Sobti et al, [10] Karayiannis et al, [11] Price et al, [12] Hope et al [13] and Giorgi et al [14] (2.3% v. 4.3%, 1.9%, 3%, 4% and 4.6%, respectively), and is considerably lower than mortality rates reported in other regions in the UK and other developing countries (11.76% -53%). [5,[7][8][9]13] The specific reasons for this lower mortality rate are not clear from our study, but may be attributed to an overall younger population undergoing surgery in our academic hospital and many lower-risk procedures being performed during this timeframe. We show that surgery was, for the most part, safely conducted despite the risk of SARS-CoV-2 infection and postoperative complications.…”

“…The research for this study was done in partial fulfulment of the requirements for RW's PhD degree at the University of Cape Town. Price et al [12] Retrospective, single-centre observational cohort study Hope et al [13] Retrospective review 23 March -4 April 2020 76 10 ( 13) 3 ( 4)…”

“…Another UK-based study reported an overall survival rate of 96% for patients undergoing emergency orthopaedic trauma surgery during the COVID-19 peak. [13] An Italian experience recorded an overall mortality of 4.6% (n=3) among fracture trauma patients. [14] Of those who died, 5.8% (n=1) were SARS-CoV-2positive and 4.1% (n=2) were SARS-CoV-2-negative (p>0.05); 17 patients were SARS-CoV-2-positive on admission or became positive within 14 days of admission.…”

Potential Immune Indicators for Predicting the Prognosis of COVID-19 and Trauma: Similarities and Disparities

“…Other studies also found higher intensive care unit (ICU) admission and mortality rates after elective surgery on asymptomatic COVID-19 patients (18,19). A retrospective study indicated higher mortality and complications rates in patients with active COVID-19 who were over 70 years of age with orthopaedic trauma surgery (20). Furthermore, study of patients admitted to Pennsylvania trauma centers showed that traumatic injury concomitant with COVID-19 infection may increase risks of morbidity and mortality (21).…”

SARS-CoV-2 in the knee joint: a cadaver study

“…Patients with comorbid conditions including hypertension, diabetes and pulmonary disease are highly represented among hospitalised patients with COVID-19 disease, suggesting the presence of risk factors that may predispose heightened susceptibility to SARS-CoV-2 infection (25). In the literature there are several studies highlighting that mortality and the risk of developing post-surgical complications increase if there are concomitant comorbidities or an older age (>70 years) in COVID-19 patients (26,27) undergoing surgical procedures. Nonetheless, this topic is still a matter of debate, as some authors like Vranis and colleagues showed a mortality rate of 10% and a rate of Intensive Care Unit admissions of 18% after surgery, suggesting that patients COVID-19 undergoing surgery do not appear to have a significantly increased risk of mortality with respect to non-surgical COV-ID-19 patients.…”