Effects of the COVID-19 Pandemic on the Management of Spinal Disorders - Results of a National Survey. / Auswirkungen der COVID-19-Pandemie auf die Behandlung von Wirbelsäulenerkrankungen ­ Ergebnisse einer nationalen Umfrage.

INTRODUCTION: Far-reaching political steps to contain the COVID-19 pandemic have been undertaken in recent weeks. These also impact on surgical specialties not directly involved in the management of patients infected with the coronavirus. The Spine Section, the interdisciplinary professional political arm of the German Spine Society (DWG), the Professional Association for Orthopedic and Trauma Surgery (BVOU), and the Federal Association of German Neurosurgeons (BDNC) conducted a survey on the collateral effects of the pandemic on spine surgery in Germany. METHOD: This cross-sectional study included outpatient, day-patient and inpatient facilities caring for patients with spinal disorders during the COVID-19 pandemic. The survey was designed to analyse the impact of the COVID-19 pandemic on the management of inpatients and outpatients with spinal disorders and to assess the economic ramifications in the various settings. RESULTS: All members of the Spine Section (n = 134) were invited to participate in the questionnaire consented by BVOU and BDNC. The questions were answered anonymously, and the personal data entered did not permit any de-anonymisation. All in all, 68% (n = 91) of the respondents completed the survey in full. Based on the type of employment (practice 30%, practice/staff: 45% and staff: 25%) and range of activities (conservative: 5%, conservative/operative: 75%, operative: 20%) the survey by the Spine Section can be regarded as representative. 95% of the practices/outpatient clinics reported a decline in their number of patients. In addition, the number of operations performed fell by 36% (SD 17%). The percentage of elective procedures declined from approximately 78% to 6%. As a result, more than half of the physicians anticipated moderate (20 - 40%) economic challenges and 25% major (> 50%) financial problems. CONCLUSION: In order to cushion collateral damage in the wake of future pandemic management, any implications in the interdisciplinary management of patients with spinal disorders should be based on these results.

Collateral effect of COVID-19 on orthopedic and trauma surgery.

OBJECTIVES: The purpose of this study was to assess the impact of the COVID-19 pandemic on orthopedic and trauma surgery in private practices and hospitals in Germany. DESIGN: In this cross-sectional study, an online-based anonymous survey was conducted from April 2th to April 16th 2020. SETTING: The survey was conducted among 15.0000 of 18.000 orthopedic and trauma surgeons in Germany, both in private practices and hospitals. PARTICIPANTS: All members of the German Society of Orthopedic and Trauma Surgery (DGOU) and the Professional Association for Orthopedic and Trauma Surgery (BVOU). were invited by e-mail to participate in the survey. MAIN OUTCOME MEASURES: Out of 50 questions 42 were designed to enquire a certain dimension of the pandemic impact and contribute to one of six indices, namely "Preparedness", "Resources", "Reduction", "Informedness", "Concern", and "Depletion". Data was analyzed in multiple stepwise regression, aiming to identify those factors that independently influenced the indices. RESULTS: 858 orthopedic and trauma surgeons participated in the survey throughout Germany. In the multiple regression analysis, being employed at a hospital was identified as an independent positive predictor in the indices for "Preparedness", "Resources", and "Informedness" and an independent negative predictor regarding "Depletion". Self-employment was found to be an independent positive predictor of the financial index "Depletion". Female surgeons were identified as an independent variable for a higher level of "Concern". CONCLUSIONS: The study confirms a distinct impact of the COVID-19 pandemic on orthopedic and trauma surgery in Germany. The containment measures are largely considered appropriate despite severe financial constraints. A substantial lack of personal protective equipment (PPE) is reported. The multiple regression analysis shows that self-employed surgeons are more affected by this shortage as well as by the financial consequences than surgeons working in hospitals. WHAT ARE THE NEW FINDINGS: The COVID-19 pandemic has a profound impact on orthopedic and trauma surgery as an unrelated specialty. Self-employed surgeons are affected especially by a shortage of PPE and financial consequences. HOW MIGHT IT IMPACT ON CLINICAL PRACTICE IN THE NEAR FUTURE: Political and financial support can now be applied more focused to subgroups in the field of orthopedics and trauma surgery with an increased demand for support. A special emphasis should be set on the support of self-employed surgeons which are a more affected by the shortage of PPE and financial consequences than surgeons working in hospitals.