Clinical Characteristics and Learning Outcomes of Managing Orthopaedic Trauma Patients during the First Wave of Covid- 19 Pandemic: A Retrospective Cohort Analysis.

BACKGROUND: Management of trauma and emergency orthopaedic conditions during the pandemic was reorganised across the United Kingdom including our hospital following the COVID-19 British Orthopaedic Association and National Health Service England guidelines. AIMS: This retrospective, observational cohort study analyses the impact of the first wave of COVID-19 pandemic on trauma and emergency patient care at a district general hospital. A comparative analysis to assess patient characteristics and clinical outcomes during the initial phase of COVID-19 outbreak with a cohort of patients treated during a similar period in 2019 was undertaken. METHODS: Patients who underwent trauma and emergency surgeries between 01 April to 31 May 2020 at a Northwest Mersey NHS Trust were studied and compared to a similar period in 2019. The outcome measures assessed were 30- and 60-day mortality, Time to Surgery, length of stay after surgery, systemic and orthopaedic complications including the subsequent need for surgery. RESULTS: Overall, there was a decrease in the number of patients who underwent trauma or emergency surgery from 184 in 2019 to 116 in 2020. 30- and 60-day mortality slightly increased by 2.05% and 2.68%, respectively. Time to surgery and hospital length of stay were comparable between both cohorts. CONCLUSION: Continuity of services to patients with obligatory injuries was managed using enhanced personal protective equipment and infection control strategies including segregation of patients based on COVID-19 status. Lessons learnt during this period such as COVID-19 testing regime and care pathways have prepared us for the near future. LEVEL OF STUDY: Retrospective Cohort study; Level III.

CONTEXTE: La gestion des traumatismes et des urgences orthopédiques pendant la pandémie a été réorganisée dans tout le Royaume-Uni, y compris dans notre hôpital, conformément aux directives COVID-19 de la British Orthopaedic Association et du National Health Service England. OBJECTIFS: Cette étude de cohorte rétrospective et observationnelle analyse l'impact de la première vague de la pandémie COVID-19 sur les soins aux patients en traumatologie et en urgence dans un hôpital général de district. Une analyse comparative visant à évaluer les caractéristiques des patients et les résultats cliniques pendant la phase initiale de l'épidémie de COVID-19 avec une cohorte de patients traités pendant une période similaire en 2019 a été entreprise. MÉTHODES: Les patients qui ont subi des traumatismes et des chirurgies d'urgence entre le 01 avril et le 31 mai 2020 dans un Northwest Mersey NHS Trust ont été étudiés et comparés à une période similaire en 2019. Les mesures de résultats évaluées étaient la mortalité à 30 et 60 jours, le délai d'intervention chirurgicale, la durée du séjour après la chirurgie, les complications systémiques et orthopédiques, y compris le besoin ultérieur de chirurgie. RÉSULTATS: Dans l'ensemble, le nombre de patients ayant subi une chirurgie traumatique ou d'urgence a diminué, passant de 184 en 2019 à 116 en 2020. La mortalité à 30 et 60 jours a légèrement augmenté de 2,05 % et 2,68 %, respectivement. Le délai d'intervention chirurgicale et la durée de séjour à l'hôpital étaient comparables entre les deux cohortes. CONCLUSION: La continuité des services aux patients présentant des blessures obligatoires a été gérée en utilisant des équipements de protection individuelle améliorés et des stratégies de contrôle des infections, y compris la ségrégation des patients en fonction de leur statut COVID-19. Les leçons apprises au cours de cette période, telles que le régime de test COVID-19 et les parcours de soins, nous ont préparés pour l'avenir proche. NIVEAU DE L'ÉTUDE: Étude rétrospective de cohorte ; Niveau III. MOTS-CLÉS: COVID-19; Coronavirus; pandémie; traumatisme; orthopédie ; mortalité; test COVID-19; évaluation des résultats; soins de santé.

Characteristics and clinical outcomes of hip fracture patients during the first lockdown of COVID-19, lessons learnt: A retrospective cohort analysis.

BACKGROUND: The management of hip fracture patients has been challenging across the UK in the wake of emergency coronavirus disease 2019 guidelines. AIMS: This retrospective, observational cohort study analyses the impact of the first lockdown during the early part of the coronavirus disease 2019 pandemic on the management of hip fracture patients at a district general hospital in the UK. METHODS: Comparative analysis to assess hip fracture patients treated at this Trust between 1 April to 31 May 2019 and 1 April to 31 May 2020 was undertaken. The primary outcome measures appraised were 30 and 60-day mortality and the secondary outcome measure included time to surgery. RESULTS: There was a higher 30 and 60-day mortality rate in the first lockdown period at 8.1% and 13.5%, respectively, compared to 1.96% and 5.88% in 2019. A significantly lower proportion of hip fracture patients at 59.46% were operated within the 36h target time frame during the first lockdown. CONCLUSION: In our Trust, hip fractures were treated as obligatory injuries. However, the mortality was higher in the 2020 cohort with a significant reduction in patients achieving the recommended '36 hours' time to surgery target and accruement of Best Practice Tariff. Enhanced infection control strategies have prepared us for the future.

Planning and analysing 'Green' post-COVID-19 orthopaedic perioperative recovery pathway.

The effect of the severe acute respiratory syndrome coronavirus 2 pandemic on the National Health Service in the United Kingdom has been profound and unprecedented with suspension of most elective surgeries. As we are emerging from lockdown now, restarting elective surgical procedures in a safe and effective manner is an expected challenge. Many perioperative factors including patient prioritisation, risk assessment, health infrastructure and infection prevention strategies need to be considered for patient safety. The British Orthopaedic Association, along with the National Health Service, have provided recent guidelines for restarting non-urgent and orthopaedic care in the United Kingdom. In this article we review the current guidelines and literature to provide some clarity for clinical practice.