ABSTRACT
INTRODUCTION: Coronavirus disease 2019 (COVID-19) has resulted in a global pandemic with several hundred million infections worldwide. COVID-19 causes systemic complications that last beyond the initial infection. It is not known whether patients who undergo elective orthopaedic surgeries after COVID-19 are at increased risk of complications. The purpose of this study was to evaluate whether patients who undergo orthopaedic procedures after recent COVID-19 diagnosis are at increased risk of complications compared with those who have not had a recent COVID-19 diagnosis. METHODS: The TriNetX Research Network database was queried for patients undergoing elective orthopaedic surgeries from April 2020 to January 2022 in the following subspecialties: arthroscopic surgery, total joint arthroplasty, lumbar fusion, upper extremity surgery, foot and ankle (FA) surgery. Cohorts were defined by patients undergoing surgery with a diagnosis of COVID-19 from 7 to 90 days before surgery and those with no COVID-19 diagnosis 0 to 90 days before surgery. These cohorts were propensity-score matched based on differences in demographics and comorbidities. The matched cohorts were evaluated using measures of association analysis for complications, emergency department (ER) visits, and readmissions occurring 90 days postoperatively. RESULTS: Patients undergoing arthroscopic surgery were more likely to experience venous thromboembolism (VTE) (P = 0.006), myocardial infarction (P = 0.001), and ER visits (P = 0.001). Patients undergoing total joint arthroplasty were more likely to experience VTE (P < 0.001), myocardial infarction (P < 0.001), pneumonia (P< 0.001), and ER visits (P = 0.037). Patients undergoing lumbar fusion were more likely to experience VTE (P = 0.016), infection (P < 0.001), pneumonia (P < 0.001), and readmission (P = 0.006). Patients undergoing upper extremity surgery were more likely to experience VTE (P = 0.001) and pneumonia (P = 0.015). Patients undergoing foot and ankle surgery were more likely to experience VTE (P < 0.001) and pneumonia (P < 0.001). CONCLUSION: There is an increased risk of complications in patients undergoing orthopaedic surgery after COVID-19 infection; all cohorts were at increased risk of VTE and most at increased risk of pneumonia. Additional investigation is needed to stratify the risk for individual patients.
ABSTRACT
The use of telemedicine has expanded amid the COVID-19 pandemic and office closures and cancellation of elective surgeries early in the pandemic helped propagated its use. Previous studies have described the feasibility of telemedicine, however, little has been reported on patient perception and preferences within orthopaedics. The objective of this study was to evaluate satisfaction and preferences of telemedicine from the perspective of patients within an orthopaedic spine clinic. A cross-sectional, anonymous survey was implemented as a prospective quality improvement initiative. The survey was sent to patients who had an in-office or telemedicine visit with a provider in our orthopaedic spine clinic. Statistical analysis was performed on the results of the survey. The survey was sent to 1129 patients and a total of 316 patients responded. Twenty-one percent of respondents had a telemedicine appointment. There was no difference in satisfaction among groups (P = .288) and those with telemedicine appointments were more likely to have had a previous experience with this type of visit (P = .004) and were more inclined to use it in the future (P < .001). Patients preferred telemedicine because of the ability to get earlier appointments (P < .001) and the convenience of the visits (P < .001). Patients preferred in-office visits because they received hands-on physical exams (P = .003) or imaging (P = .041). Telemedicine is a viable alternative to in-office appointments for spine patients, as evidenced by similar levels of patient satisfaction. Sooner appointments and convenience are attractive elements of telemedicine visits, while the desire for physical examination remains a barrier to adoption in this population.