The impact of COVID-19 on foot and ankle surgery in a major trauma centre

Stringer, Howard; Molloy, Andrew; Craven, Joanne; Moorehead, J.D.; Santini, Alasdair; Mason, Lyndon

doi:10.1016/j.foot.2020.101772

Cited by 6 publications

(10 citation statements)

References 16 publications

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“… 3 , 8 , 29 Over time, there has been an increase in elective case restrictions, delays in surgery, and changes in practices, which has warranted several investigations to assess management changes and outcomes associated with COVID-19 in patients undergoing ankle fracture surgery. 13 , 23 , 27 , 30 , 32 Large-scale studies evaluating the trends of ankle fracture surgery during the pandemic are lacking.…”

Section: Introductionmentioning

confidence: 99%

Ankle Fracture and Length of Stay in US Adult Population Using Data From the National COVID Cohort Collaborative

Pitts

Levitt

Patch

et al. 2022

Foot & Ankle Orthopaedics

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Background: The National COVID Cohort Collaborative (N3C) is an innovative approach to integrate real-world clinical observations into a harmonized database during the time of the COVID-19 pandemic when clinical research on ankle fracture surgery is otherwise mostly limited to expert opinion and research letters. The purpose of this manuscript is to introduce the largest cohort of US ankle fracture surgery patients to date with a comparison between lab-confirmed COVID-19–positive and COVID-19–negative. Methods: A retrospective cohort of adults with ankle fracture surgery using data from the N3C database with patients undergoing surgery between March 2020 and June 2021. The database is an NIH-funded platform through which the harmonized clinical data from 46 sites is stored. Patient characteristics included body mass index, Charlson Comorbidity Index, and smoking status. Outcomes included 30-day mortality, overall mortality, surgical site infection (SSI), deep SSI, acute kidney injury, pulmonary embolism, deep vein thrombosis, sepsis, time to surgery, and length of stay. COVID-19–positive patients were compared to COVID-19–negative controls to investigate perioperative outcomes during the pandemic. Results: A total population of 8.4 million patient records was queried, identifying 4735 adults with ankle fracture surgery. The COVID-19–positive group (n=158, 3.3%) had significantly longer times to surgery (6.5 ± 6.6 vs 5.1 ± 5.5 days, P = .001) and longer lengths of stay (8.3 ± 23.5 vs 4.3 ± 7.4 days, P < .001), compared to the COVID-19–negative group. The COVID-19–positive group also had a higher rate of 30-day mortality. Conclusion: Patients with ankle fracture surgery had longer time to surgery and prolonged hospitalizations in COVID-19–positive patients compared to those who tested negative (average delay was about 1 day and increased length of hospitalization was about 4 days). Few perioperative events were observed in either group. Overall, the risks associated with COVID-19 were measurable but not substantial. Level of Evidence: Level III, retrospective cohort study.

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Section: Introductionmentioning

confidence: 99%

Ankle Fracture and Length of Stay in US Adult Population Using Data From the National COVID Cohort Collaborative

Pitts

Levitt

Patch

et al. 2022

Foot & Ankle Orthopaedics

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“…We have not analysed as part of this study the effect on the change of management on the clinical outcome of the affected patients. However, in a recent paper from our unit on foot and ankle surgery during the COVID-19 pandemic, it was shown that in 12 cases management was changed due to the COVID-19 pandemic resulting in three undergoing surgery at a later date [12]. There has been concern regarding the long term effect such rationing of care will have on patients who have had trauma, however it is clear in our study that the numbers of trauma referrals reduced proportionally to the number of undertaken surgical cases.…”

Section: Discussionmentioning

confidence: 99%

“…Initially, SARS-CoV-2 testing was not undertaken unless patients were symptomatic with routine testing introduced on 1 st June. Three time intervals were defined, totalling 33-weeks; 'Pre-lockdown' covering 16 weeks before 23 rd March; 'Lockdown' covering nine weeks from 23 rd March to 24 th May; and 'Post-lockdown' covering eight weeks from 24 th May to 16 th July as in previous studies [12]. Time periods were dictated by the UK Government announcements of national lockdown and easing of lockdown measurements [13].…”

Section: Methodsmentioning

confidence: 99%

Variation in Trauma Admission During the COVID-19 Pandemic in a Major Trauma Unit - An Observational Study

Santini¹

2021

BJSTR

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Following the World Health Organization declaration of a COVID-19 pandemic, there was a severe impact on UK trauma provision. Our aim in this paper was to examine the effect of alteration in working patterns and 'lockdown' on trauma and orthopaedic referral and management in a major trauma centre.Methods: All trauma referrals to the Liverpool Orthopaedic and Trauma Service were analysed over a 33-week period, divided into 'Pre-lockdown', 'Lockdown', and 'Postlockdown'.Results: 1661 orthopaedic trauma operations were undertaken -967 in 'prelockdown', 193 in 'lockdown' and 501 in 'post-lockdown'. An average weekly reduction in numbers of referrals to virtual fracture clinic and trauma cases undergoing surgery was observed, with numbers in virtual fracture clinic and in trauma cases undergoing surgery falling by similar amounts from prelockdown to lockdown (51.71% drop in virtual fracture clinic referrals and 54.38% reduction in trauma cases undergoing surgery). Hip fractures occupied significantly more theatre time compared to other trauma in the lockdown period. Post-lockdown, there was a rebound effect in the trauma numbers of lower limb surgery (excluding hip) and central surgery. Conclusion:The COVID-19 pandemic lockdown resulted in a significant change in practice and a reduction in both the presenting trauma numbers and those undergoing surgery in our trauma and orthopaedic department. The effect of the lockdown on trauma numbers has had a major mitigating effect on the consequences of rationing of resources.

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“…The existing body of literature predominantly addresses the repercussions of the COVID-19 pandemic, emphasising incident rates, patient demographics, and diverse facets of patient care. This study delves into the impact on surgically treated trauma cases admitted to the Liverpool Orthopaedic and Trauma Service during a 33-week period [ 9 ]. The analysis revealed a noteworthy decline in foot and ankle fractures, constituting 15.20% of all trauma cases pre-lockdown and diminishing to 8.81% during lockdown [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic and Lockdown on Adult Foot and Ankle Fractures Presenting to the Largest Trust in the United Kingdom

Nath,

Akbari,

Alam

et al. 2023

Cureus

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Background The COVID-19 pandemic induced unprecedented changes in medical practices, prompting a reassessment of their impact on adult foot and ankle fractures within the National Health Service (NHS). This study employs a retrospective observational approach, leveraging the Pathpoint™ eTrauma platform for a comprehensive analysis of prospectively collected data. Methods Data encompassing weekly fracture incidence, weekly surgical procedures, patient demographics, and mean wait time from injury presentation to surgery were systematically evaluated. The study population included all adults (18+) admitted during five distinct periods: pre-pandemic, national lockdown 1, post-lockdown, national lockdown 2, and national lockdown 3. Results An analysis of 434 foot and ankle fractures revealed that national lockdown 1 exhibited the lowest fracture incidence (4.97 per week) and surgeries performed (4.77 per week), reflecting a notable reduction in trauma cases and elective procedures. Conversely, post-lockdown displayed the highest fracture incidence (7.46 per week) and surgeries performed (6.31 per week), suggesting a resurgence in both trauma and elective surgical activities. The pre-pandemic cohort, characterized by the highest mean age (51.98 years) and mean wait time (8.74 days), served as a temporal baseline. Conclusion While the incidence of fractures decreased during all three national lockdowns compared to pre-pandemic or post-lockdown periods, a gradual increase was observed in subsequent lockdowns. Notably, mean wait times showed a significant reduction, reaching the lowest point (5.79 days) during national lockdown 3. These findings underscore the complex interplay between pandemic-related disruptions, evolving guidelines, and adaptive measures within the healthcare system, influencing the dynamics of foot and ankle fracture management.

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The impact of COVID-19 on foot and ankle surgery in a major trauma centre

Cited by 6 publications

References 16 publications

Ankle Fracture and Length of Stay in US Adult Population Using Data From the National COVID Cohort Collaborative

Ankle Fracture and Length of Stay in US Adult Population Using Data From the National COVID Cohort Collaborative

Variation in Trauma Admission During the COVID-19 Pandemic in a Major Trauma Unit - An Observational Study

The Impact of the COVID-19 Pandemic and Lockdown on Adult Foot and Ankle Fractures Presenting to the Largest Trust in the United Kingdom

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