Time-sensitive ambulatory orthopaedic soft-tissue surgery paradigms during the COVID-19 pandemic

Abstract

Purpose Timing of surgery for orthopaedic injuries continues to evolve, as an improved understanding of biology, healing, and technological advances continues to challenge historical norms. With the growing COVID-19 pandemic stretching limited healthcare resources, postponing surgery becomes an inevitable and unenviable task for most orthopaedic surgeons, and a shift in outpatient paradigms is required to mitigate poor outcomes in patients. Methods A scoping review of five databases on surgical timing and orthopaedic soft-tissue injuries was performed. All randomized controlled trials, longitudinal cohort studies, retrospective case series, systematic reviews, meta-analyses, and expert opinions were included for review, with 65 studies meeting the inclusion criteria. Results Better outcomes appear to be associated with early surgery for subluxations (< 1 week), recurrent dislocations (> 2 episodes), ligamentous and tendinous injuries (< 2 weeks), and bony avulsion injuries (< 3 weeks). Spinal conditions with neurological compromise should be operated on within 24 hours and spinal instability within 72 hours to reduce the risk of complications and poor outcomes. Conclusion Most soft-tissue orthopaedic injuries can be managed with outpatient ambulatory surgery in a semi-elective setting. As the paradigm for outpatient surgery shifts due to technological advances and the COVID-19 pandemic, it is critical for surgeons to time their surgery appropriately to maintain the high standards of orthopaedic practice.

Management of Outpatient Elective Surgery for Arthroplasty and Sports Medicine During the COVID-19 Pandemic: A Scoping Review

“…The distribution in level of evidence was as follows: 14% (n = 4) of articles were level 3, 8 , 10 , 12 , 30 14% (n = 4) were level 4, 13 , 16 , 18 , 31 and 72% (n = 21) of articles were level 5. 1 - 7 , 14 , 15 , 17 , 19 - 29 The majority of studies were categorized as expert opinion/societal guidelines (55%). The most common theme among articles was general management recommendations on the resumption of elective arthroplasty and sports medicine surgery (n = 11 articles).…”

“… 23 Tables 2 and 3 summarize the time sensitivities of arthroplasty and musculoskeletal soft tissue disorders requiring surgery, respectively, based on the recommendations in the articles included in this scoping review. 2 , 6 , 7 , 12 , 13 , 19 , 22 , 23 , 25 …”

“…During the onset of the COVID-19 pandemic, elective orthopaedic surgery was quickly deemed nonessential and postponed, with the intent to mitigate risk to the patient and surgical team, conserve personal protective equipment (PPE), and remain cautious given the uncertain trajectory of COVID-19 transmission. 2 , 31 Several reports showed a decrease of 74% in arthroplasty and 84% in sports medicine cases in the United States, with a similar reduction in arthroplasty and arthroscopy procedures globally, creating a backlog of patients awaiting surgery. 3 , 7 , 9 , 16 One study predicted between 77,000 (best-case scenario) and 372,000 (worst-case scenario) primary total hip arthroplasty and total knee arthroplasty cases in the United States would require rescheduling, with projections of catch-up time ranging from 9.09 months (best-case scenario) to 34.75 months (worst-case scenario).…”

Orthopaedics and COVID-19: The surgery, the surgeon and the susceptible - a scoping review

“…6 Ding et al performed a review specifically on timing to surgery for traumatic soft tissue injuries in order to prevent negative outcomes. 8 Testing patients for SARS-CoV-2 is considered to be necessary for a myriad of reasons. First, there is a high proportion of asymptomatic patients shedding viral matter (estimates vary across a wide range, from 5 to 80%).…”

“…• All HCWs and patients are to practise hand hygiene and wear surgical masks. 6,8,9,18,20 • All staff should practise social distancing. 6,8 • Regular decontamination of personal items such as stethoscopes and cellphones is to be done.…”