The Impact of the COVID-19 Pandemic on Spine Surgery in Central Europe: A Questionnaire-Based Study.

OBJECTIVE: The severe acute respiratory coronavirus 2 (SARS-CoV2) crisis led to many restrictions in daily life and protective health care actions in all hospitals to ensure basic medical supply. This questionnaire-based study among spinal surgeons in central Europe was generated to investigate the impact of coronavirus disease 2019 (COVID-19) and consecutively the differences in restrictions in spinal surgery units. METHODS: An online survey consisting of 32 questions on the impact of the COVID-19 pandemic and the related restrictions on spinal surgery units was created. Surgical fellows and consultants from neurosurgical, orthopedic, and trauma departments were included in our questionnaire-based study with the help of Austrian, German, and Swiss scientific societies. RESULTS: In a total of 406 completed questionnaires, most participants reported increased preventive measurements at daily clinical work (split-team work schedule [44%], cancellation of elective and/or semielective surgeries [91%]), reduced occurrence of emergencies (91%), decreased outpatient work (45%) with increased telemedical care (73%) and a reduced availability of medical equipment (75%) as well as medical staff (30%). Although most physicians considered the political restrictive decisions to be not suitable, most considered the medical measures to be appropriate. CONCLUSIONS: The COVID-19 pandemic resulted in comparable restrictive measures for spinal surgical departments in central Europe. Elective surgical interventions were reduced, providing additional resources reserved for severe acute respiratory coronavirus 2-positive patients. Although similar restrictions were introduced in most participants' departments, the supply of personal protective equipment and the outpatient care remained insufficient and should be re-evaluated intensively for future global health care crises.

Prioritising of hip and knee arthroplasty procedures during the COVID-19 pandemic: the European Hip Society and the European Knee Associates Survey of Members.

PURPOSE: During the COVID-19 pandemic there has been a massive reduction of arthroplasty services due to reallocation of hospital resources. The unique challenge for clinicians has been to define which arthroplasty patients most urgently require surgery. The present study aimed to investigate priority arthroplasty procedures during the pandemic and in the reinstatement period from the surgeon's perspective. MATERIAL AND METHODS: An online survey was conducted among members of the European Hip Society (EHS), European Knee Associates (EKA) and other invited orthopaedic arthroplasty surgeons (experts) from across the world. The survey consisted of 17 different arthroplasty procedures/indications of which participants were asked to choose and rank the most important 10. RESULTS: Four hundred and thirty-nine arthroplasty surgeons from 44 countries responded. The EHS and EKA had a 43% response rate of members. In weighted average points, the majority of respondents (67.5 points) ranked 'acute fractures requiring arthroplasty (Periprosthetic fractures, THA/hemi-arthroplasty for femoral neck fractures)' as priority indication number one, followed by 'first-stage explantations for acute PJI (periprosthetic joint infection)' in second place and priority indication (45.9 points) three as 'one-stage revision for acute PJI' (39.7 points). CONCLUSIONS: There was agreement that femoral neck fractures, periprosthetic fractures, and acute infections should be prioritised and cannot be postponed in the setting of the COVID-19 pandemic. As arthroplasty procedures are being resumed in most countries now, there has also been a relaxation of lockdown rules in most countries, which might cause a so-called second wave of the pandemic. Therefore, the results of the current study present a proposal by experts as to which operations should be prioritised in the setting of a second wave of the pandemic.

Impact of the COVID-19 pandemic on patients suffering from musculoskeletal tumours.

BACKGROUND: The aim of the current study was to evaluate the impact of the coronavirus disease (COVID-19) pandemic on musculoskeletal tumor service by conducting an online survey of physicians. METHODS: The survey was conducted among the members of the ISOLS (International Society of Limb Salvage) and the EMSOS (European Musculo-Skeletal Oncology Society). The survey consisted of 20 questions (single, multiple-response, ranked): origin and surgical experience of the participant (four questions), potential disruption of healthcare (12 questions), and influence of the COVID-19 pandemic on the particular physician (four questions). A matrix with four different response options was created for the particular surgical procedures). RESULTS: One hundred forty-nine physicians from five continents completed the survey. Of the respondents, 20.1% and 20.7% stated that surgery for life-threatening sarcomas were stopped or delayed, respectively. Even when the malignancy was expected to involve infiltration of a neurovascular bundle or fracture of a bone, still 13.8% and 14.7% of the respondents, respectively, stated that surgery was not performed. In cases of pending fractures of bone tumors, 37.5 to 46.2% of operations were canceled. CONCLUSION: The SARS-CoV-2 pandemic caused a significant reduction in healthcare (surgery, radiotherapy, chemotherapy) for malignancies of the musculoskeletal system. Delaying or stopping these treatments is life-threatening or can cause severe morbidity, pain, and loss of function. Although the coronavirus disease causes severe medical complications, serious collateral damage including death due to delayed or untreated sarcomas should be avoided.

Preparation for the next COVID-19 wave: The European Hip Society and European Knee Associates recommendations.

PURPOSE: To plan for the continuance of elective hip and knee arthroplasty during a resurgence or new wave of COVID-19 infections. METHOD: A systematic review was conducted using the terms "COVID-19" or "SARS-Cov-2" and "second wave". No relevant citations were found to inform on recommendations the plan. Therefore, an expert panel of the European Hip Society and the European Knee Associates was formed to provide the recommendations. RESULTS: Overall, the recommendations consider three phases; review of the first wave, preparation for the next wave, and during the next wave. International and national policies will drive most of the management. The recommendations focus on the preparation phase and, in particular, the actions that the individual surgeon needs to undertake to continue with, and practice, elective arthroplasty during the next wave, as well as planning their personal and their family's lives. The recommendations expect rigorous data collection during the next wave, so that a cycle of continuous improvement is created to take account of any future waves. CONCLUSIONS: The recommendations for planning to continue elective hip and knee arthroplasty during a new phase of the SARS-Cov-2 pandemic provide a framework to reduce the risk of a complete shutdown of elective surgery. This involves engaging with hospital managers and other specialities in the planning process. Individuals have responsibilities to themselves, their colleagues, and their families, beyond the actual delivery of elective arthroplasty.

Impact of the COVID-19 pandemic on orthopaedic and trauma surgery training in Europe.

PURPOSE: This study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery training in Europe by conducting an online survey among orthopaedic trainees. METHODS: The survey was conducted among members of the Federation of Orthopaedic and Trauma Trainees in Europe (FORTE). It consisted of 24 questions (single-answer, multiple-answer, Likert scales). Orthopaedic trainees' demographic data (six questions), clinical role changes (four questions), institutional changes due to the COVID-19 pandemic (nine questions), and personal considerations (five questions) were examined. RESULTS: Three hundred and twenty-seven trainees from 23 European countries completed the survey. Most trainees retained their customary clinical role (59.8%), but a significant number was redeployed to COVID-19 units (20.9%). A drastic workload decrease during the pandemic was reported at most institutions. Only essential activities were performed at 57.1% of institutions and drastic disruptions were reported at 36.0%. Of the respondents, 52.1% stated that faculty-led education was restricted and 46.3% pursued self-guided learning, while 58.6% stated that surgical training was significantly impaired. Concerns about the achievement of annual training goals were expressed by 58.2% of the participants, while 25.0% anticipated the need for an additional year of training. CONCLUSIONS: The SARS-CoV-2 pandemic significantly affected orthopaedic and trauma training in Europe. Most trainees felt the decrease in clinical, surgical, and educational activities would have a detrimental effect on their training. Many of them consulted remote learning options to compensate training impairment, stating that after the COVID-19 pandemic electronic educational approaches may become more relevant in future.

Resuming hip and knee arthroplasty after COVID-19: ethical implications for wellbeing, safety and the economy.

Reinstating elective hip and knee arthroplasty services presents significant challenges. We need to be honest about the scale of the obstacles ahead and realise that the health challenges and economic consequences of the COVID-19 pandemic are potentially devastating.We must also prepare to make difficult ethical decisions about restarting elective hip and knee arthroplasty. These decisions should be based on the existing evidence-base, reliable data, the recommendations of experts, and regional circumstances.