The Early Effect of COVID-19 Restrictions on an Academic Orthopedic Surgery Department

Abstract

The SARS-CoV-2 (COVID-19) pandemic has had a global influence on health care. The authors examined the early effect of hospital- and state-mandated restrictions on an orthopedic surgery department and hypothesized that the volume of ambulatory clinic encounters, office and surgical procedures, and cases would dramatically decrease. A retrospective review was performed of all encounters in an orthopedic surgery department at a level I academic trauma center during a 4-week period, from March 16, 2020, to April 12, 2020. The results were compared with two control 4-week periods, February 17, 2020, to March 15, 2020, and March 16, 2019, to April 12, 2019. Weekly volume and work relative value units (RVUs) of clinic encounters, office and surgical procedures, and cases were assessed. The type of ambulatory visit also was recorded. Comparisons of mean weekly volume and RVUs between the study and control periods were performed with Student's t test. Surgical cases were categorized into fracture or dislocation, acute soft tissue or nerve injury, infection, oncology, and elective or nonurgent. After implementation of hospital- and state-mandated restrictions on elective health care, the volume of ambulatory orthopedic surgery clinic encounters decreased by 74% to 77%, the volume of clinic procedures decreased by 95%, and the volume of surgical cases decreased by 88%. The percentage of clinic visits performed via telemedicine increased from 0.3% to 81.2%. Elective surgical cases ceased, and the volume of nonelective surgical cases decreased by 51%. During the first 4 weeks after COVID-19–related restrictions were imposed, an immediate and dramatic effect was observed. Compared with the control periods, significant reductions were seen in the volume of ambulatory encounters, office-based procedures, and surgical cases. In addition, the volume of nonelective surgical cases decreased by 51%. [ Orthopedics . 2020;43(4):228–232.]

Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic

“…5 In orthopedic surgery, non-urgent diagnostic imaging was postponed, outpatient physical therapy and occupational therapy were decreased, and non-urgent elective procedures were postponed. 6,7 As a society, social distancing and travel restrictions have reduced the volume of patients experiencing trauma, while the amount of osteoporotic and fragility hip fractures have remained constant during the pandemic. 5,[8][9][10][11][12][13] There is compelling evidence that early surgery, prompt orthogeriatric care, a multidisciplinary approach, and early postoperative ambulation improves outcomes for patients with hip fractures.…”

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

“…Fifty-nine articles met the inclusion criteria and were considered for the analysis. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 The excluded thirty-four papers were editorials, letters, duplicate entries, and articles with no discussion on telemedicine even in the full text ( Figure 1 ). The monthly contributions trend of the orthopaedic telemedicine-related articles is shown in Figure 2 .…”

“…Most surveys reported widespread adoption of telemedicine as the main patient care modality. 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 Telemedicine can address the general and specialised needs of osteoporotic patients, paediatric deformities, fracture patients, and sports injuries. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 High patient and doctor satisfaction has been recorded with telemedicine.…”

Impact of the first COVID-19 shutdown on traumatological patient volumes in Switzerland

“…In many countries, a decrease in elective and non-elective trauma cases was noticed [6] . Earp et al [6] found that surgical cases had decreased by 88%.…”

“…In many countries, a decrease in elective and non-elective trauma cases was noticed [6] . Earp et al [6] found that surgical cases had decreased by 88%. Possible reasons for this decline could be due to governmental restrictions or patients choosing to delay (elective) surgeries because of fear of a COVID-19-transmission.…”