ABSTRACT
Background: The Coronavirus disease (COVID-19) pandemic has contributed to over 1,000,000 deaths worldwide. Hospitals responded by expanding services to accommodate the forecasted rise in COVID-19-related admissions. We describe the effects these changes had on management of orthopaedic trauma and patient outcomes at a district general hospital in Southern England. Methods: Data were extrapolated retrospectively from two separate 6-week periods in 2019 and 2020 (1st April-13th May) using electronic records of patients referred to the orthopaedic team. Soft tissue injuries were included where a confirmed diagnosis was made with radiological evidence. Patients were excluded if no orthopaedic intervention was required. Data were compared between the two time periods. Results: There were fewer attendances to hospital in 2020 compared with 2019 (178 vs. 328), but time from presentation to surgery significantly increased in 2020 (2.94 days vs. 4.91 days, p = 0.009). There were fewer operative complications in 2020 (36/145 vs. 11/88, p < 0.001). However, ordinal logistic regression analysis found a significantly greater complication severity in 2020 including death (p = 0.039). Complication severity was unrelated to COVID-19 status. Conclusions: Restructuring of orthopaedic services in response to the COVID-19 pandemic has been associated with significant delays to surgery and higher post-operative complication severity. Our results demonstrate the need for fast-track emergency operative orthopaedic services in UK district general hospitals whilst the COVID-19 pandemic continues.
ABSTRACT
PURPOSE: This study aimed to determine patients' experiences following inguinal hernia repair at a tertiary hospital and associated cottage hospital in terms of postherniorraphy pain and follow-up. METHODS: After exclusions, 373 adult patients undergoing inguinal hernia repair at Derriford and Tavistock hospitals during a 1-year period from October 2017 were sent a questionnaire regarding preoperative pain experience, current symptoms, and pain severity at 28 days and other intervals postoperatively. Statistical analysis of responses included unpaired t test to compare means and χ2 test for discrete variables with a p value < 0.05 regarded as statistically significant. RESULTS: The survey response rate was 68% (253/373). The mean pain score on visual analogue scale was 1.5 at 28 days postoperatively in those without preoperative pain compared to 3.2 in those with preoperative pain (p = 0.0001). Although 64 (25%) patients complained of pain at a mean follow-up of 47.9 ± 15.6 weeks, pain severity was insignificant after 28 days. Gender, employment status and mesh type did not affect pain scores. Return to normal activity after laparoscopic repair was longer than after open repair (5.4 ± 3.4 versus 4.2 ± 2.2 weeks, respectively; p = 0.0322). Overall, 34.6% thought follow-up was necessary and patients were more likely to agree with a decision not to follow them up. CONCLUSION: This study puts postherniorrhaphy pain in perspective of preoperative pain. Active discussion with patients prior to discharge or telephone follow-up by an appropriate individual may reduce the need for hospital follow-up.
