Abstract
Abstract Background The Coronavirus disease (COVID-19) pandemic has contributed to over 900,000 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. Method Data were extrapolated retrospectively from two separate six-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.
Highlights
The Coronavirus disease 2019 (COVID-19) global pandemic has infected over 20 million people and contributed to over 1,000,000 deaths worldwide as of September 18th 2020 [1]
The number of orthopaedic admissions has declined during the COVID-19 pandemic [3], there is a paucity of evidence describing the impacts of hospital reforms on both the management and outcomes of orthopaedic injuries
When we looked at whether the COVID-19 pandemic was associated with longer waiting times from presentation to operation, we found a mean waiting time of 4.91 days (SD 4.55) in 2020 and 2.94 days (SD 7.92) in 2019
Summary
The Coronavirus disease 2019 (COVID-19) global pandemic has infected over 20 million people and contributed to over 1,000,000 deaths worldwide as of September 18th 2020 [1]. For trauma and orthopaedic departments, this response has included redeployment of trainees, conversion to virtual or telephone clinic appointments, routine use of full personal protective equipment (PPE) for operations, and cancellation of non-essential and elective procedures. Despite such extensive reforms in practice, hospitals have been required to deliver substantive ongoing trauma and orthopaedic emergency care. The number of orthopaedic admissions has declined during the COVID-19 pandemic [3] , there is a paucity of evidence describing the impacts of hospital reforms on both the management and outcomes of orthopaedic injuries These data are essential for informing and updating clinical guidelines to optimise care during such an unpredictable and challenging climate.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
