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From "business continuity" to "back to business" for orthopaedic surgeons during the COVID-19 pandemic.
Liow, Ming Han Lincoln; Tay, Kenny Xian Khing; Yeo, Nicholas Eng Meng; Tay, Darren Keng Jin; Goh, Seo Kiat; Koh, Joyce Suang Bee; Howe, Tet Sen; Tan, Andrew Hwee Chye.
  • Liow MHL; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
  • Tay KXK; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
  • Yeo NEM; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
  • Tay DKJ; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
  • Goh SK; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
  • Koh JSB; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
  • Howe TS; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
  • Tan AHC; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
Bone Jt Open ; 1(6): 222-228, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-940050
Semantic information from SemMedBD (by NLM)
1. COVID-19 CAUSES Challenge
Subject
COVID-19
Predicate
CAUSES
Object
Challenge
2. Operating PROCESS_OF Team
Subject
Operating
Predicate
PROCESS_OF
Object
Team
3. Elective procedure TREATS Comorbidity
Subject
Elective procedure
Predicate
TREATS
Object
Comorbidity
4. Comorbidity PROCESS_OF Elderly (population group)
Subject
Comorbidity
Predicate
PROCESS_OF
Object
Elderly (population group)
5. Elective procedure TREATS Elderly (population group)
Subject
Elective procedure
Predicate
TREATS
Object
Elderly (population group)
6. American College of Cardiology/American Heart Association Lesion Complexity Score C PROCESS_OF Persons
Subject
American College of Cardiology/American Heart Association Lesion Complexity Score C
Predicate
PROCESS_OF
Object
Persons
7. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
8. COVID-19 CAUSES Challenge
Subject
COVID-19
Predicate
CAUSES
Object
Challenge
9. Operating PROCESS_OF Team
Subject
Operating
Predicate
PROCESS_OF
Object
Team
10. Elective procedure TREATS Comorbidity
Subject
Elective procedure
Predicate
TREATS
Object
Comorbidity
11. Comorbidity PROCESS_OF Elderly (population group)
Subject
Comorbidity
Predicate
PROCESS_OF
Object
Elderly (population group)
12. Elective procedure TREATS Elderly (population group)
Subject
Elective procedure
Predicate
TREATS
Object
Elderly (population group)
13. American College of Cardiology/American Heart Association Lesion Complexity Score C PROCESS_OF Persons
Subject
American College of Cardiology/American Heart Association Lesion Complexity Score C
Predicate
PROCESS_OF
Object
Persons
14. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges to healthcare systems worldwide. Orthopaedic departments have adopted business continuity models and guidelines for essential and non-essential surgeries to preserve hospital resources as well as protect patients and staff. These guidelines broadly encompass reduction of ambulatory care with a move towards telemedicine, redeployment of orthopaedic surgeons/residents to the frontline battle against COVID-19, continuation of education and research through web-based means, and cancellation of non-essential elective procedures. However, if containment of COVID-19 community spread is achieved, resumption of elective orthopaedic procedures and transition plans to return to normalcy must be considered for orthopaedic departments. The COVID-19 pandemic also presents a moral dilemma to the orthopaedic surgeon considering elective procedures. What is the best treatment for our patients and how does the fear of COVID-19 influence the risk-benefit discussion during a pandemic? Surgeons must deliberate the fine balance between elective surgery for a patient's wellbeing versus risks to the operating team and utilization of precious hospital resources. Attrition of healthcare workers or Orthopaedic surgeons from restarting elective procedures prematurely or in an unsafe manner may render us ill-equipped to handle the second wave of infections. This highlights the need to develop effective screening protocols or preoperative COVID-19 testing before elective procedures in high-risk, elderly individuals with comorbidities. Alternatively, high-risk individuals should be postponed until the risk of nosocomial COVID-19 infection is minimal. In addition, given the higher mortality and perioperative morbidity of patients with COVID-19 undergoing surgery, the decision to operate must be carefully deliberated. As we ramp-up elective services and get "back to business" as orthopaedic surgeons, we have to be constantly mindful to proceed in a cautious and calibrated fashion, delivering the best care, while maintaining utmost vigilance to prevent the resurgence of COVID-19 during this critical transition period. Cite this article Bone Joint Open 2020;1-6222-228.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Clinical Practice Guide / Prognostic study Language: English Journal: Bone Jt Open Year: 2020 Document Type: Article Affiliation country: 2633-1462.16.BJO-2020-0036.R1

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Clinical Practice Guide / Prognostic study Language: English Journal: Bone Jt Open Year: 2020 Document Type: Article Affiliation country: 2633-1462.16.BJO-2020-0036.R1