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IMPACT-Restart: the influence of COVID-19 on postoperative mortality and risk factors associated with SARS-CoV-2 infection after orthopaedic and trauma surgery.
Clement, Nicholas D; Hall, Andrew James; Makaram, Navnit S; Robinson, Patrick G; Patton, Robyn F L; Moran, Matthew; Macpherson, Gavin J; Duckworth, Andrew D; Jenkins, Paul J.
  • Clement ND; Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
  • Hall AJ; Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
  • Makaram NS; Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
  • Robinson PG; Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
  • Patton RFL; Biomedical Sciences, Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
  • Moran M; Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
  • Macpherson GJ; Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
  • Duckworth AD; Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
  • Jenkins PJ; University of Edinburgh, Edinburgh, UK.
Bone Joint J ; 102-B(12): 1774-1781, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-949095
ABSTRACT

AIMS:

The primary aim of this study was to assess the independent association of the coronavirus disease 2019 (COVID-19) on postoperative mortality for patients undergoing orthopaedic and trauma surgery. The secondary aim was to identify factors that were associated with developing COVID-19 during the postoperative period.

METHODS:

A multicentre retrospective study was conducted of all patients presenting to nine centres over a 50-day period during the COVID-19 pandemic (1 March 2020 to 19 April 2020) with a minimum of 50 days follow-up. Patient demographics, American Society of Anesthesiologists (ASA) grade, priority (urgent or elective), procedure type, COVID-19 status, and postoperative mortality were recorded.

RESULTS:

During the study period, 1,659 procedures were performed in 1,569 patients. There were 68 (4.3%) patients who were diagnosed with COVID-19. There were 85 (5.4%) deaths postoperatively. Patients who had COVID-19 had a significantly lower survival rate when compared with those without a proven SARS-CoV-2 infection (67.6% vs 95.8%, p < 0.001). When adjusting for confounding variables (older age (p < 0.001), female sex (p = 0.004), hip fracture (p = 0.003), and increasing ASA grade (p < 0.001)) a diagnosis of COVID-19 was associated with an increased mortality risk (hazard ratio 1.89, 95% confidence interval (CI) 1.14 to 3.12; p = 0.014). A total of 62 patients developed COVID-19 postoperatively, of which two were in the elective and 60 were in the urgent group. Patients aged > 77 years (odds ratio (OR) 3.16; p = 0.001), with increasing ASA grade (OR 2.74; p < 0.001), sustaining a hip (OR 4.56; p = 0.008) or periprosthetic fracture (OR 14.70; p < 0.001) were more likely to develop COVID-19 postoperatively.

CONCLUSION:

Perioperative COVID-19 nearly doubled the background postoperative mortality risk following surgery. Patients at risk of developing COVID-19 postoperatively (patients > 77 years, increasing morbidity, sustaining a hip or periprosthetic fracture) may benefit from perioperative shielding. Cite this article Bone Joint J 2020;102-B(12)1774-1781.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Postoperative Complications / Elective Surgical Procedures / Risk Assessment / Arthroplasty, Replacement, Hip / SARS-CoV-2 / COVID-19 / Hip Fractures Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Bone Joint J Year: 2020 Document Type: Article Affiliation country: 0301-620X.102B12.BJJ-2020-1395.R2

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Postoperative Complications / Elective Surgical Procedures / Risk Assessment / Arthroplasty, Replacement, Hip / SARS-CoV-2 / COVID-19 / Hip Fractures Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Bone Joint J Year: 2020 Document Type: Article Affiliation country: 0301-620X.102B12.BJJ-2020-1395.R2