Abstract
In response to the COVID-19 pandemic, many hospital systems were forced to reduce operating room capacity and reallocate resources. The outcomes of these policies on the care of injured patients and the maintenance of emergency services have not been adequately reported. To evaluate whether the COVID-19 pandemic was associated with delays in urgent fracture surgery beyond national time-to-surgery benchmarks. This retrospective cohort study used data collected in the Program of Randomized Trials to Evaluate Preoperative Antiseptic Skin Solutions in Orthopaedic Trauma among at 20 sites throughout the US and Canada and included patients who sustained open fractures or closed femur or hip fractures. COVID-19-era operating room restrictions were compared with pre-COVID-19 data. Surgery within 24 hours after injury. A total of 3589 patients (mean [SD] age, 55 [25.4] years; 1913 [53.3%] male) were included in this study, 2175 pre-COVID-19 and 1414 during COVID-19. A total of 54 patients (3.1%) in the open fracture cohort and 407 patients (21.8%) in the closed hip/femur fracture cohort did not meet 24-hour time-to-surgery benchmarks. We were unable to detect any association between time to operating room and COVID-19 era in either open fracture (odds ratio [OR], 1.40; 95% CI, 0.77-2.55; P = .28) or closed femur/hip fracture (OR, 1.01; 95% CI, 0.74-1.37; P = .97) cohorts. In the closed femur/hip fracture cohort, there was no association between time to operating room and regional COVID-19 prevalence (OR, 1.07; 95% CI, 0.70-1.64; P = .76). In this cohort study, there was no association between meeting time-to-surgery benchmarks in either open fracture or closed femur/hip fracture during the COVID-19 pandemic compared with before the pandemic. This is counter to concerns that the unprecedented challenges associated with managing the COVID-19 pandemic would be associated with clinically significant delays in acute management of urgent surgical cases and suggests that many hospital systems within the US were able to effectively implement policies consistent with time-to-surgery standards for orthopedic trauma in the context of COVID-19-related resource constraints.
Highlights
Since December 2019, the novel SARS-CoV-2 virus has led to more than 123 million worldwide infections and has claimed the lives of more than 2 million people.[1,2] In response to the COVID-19 pandemic, hospital systems were forced to reduce operating room capacity and reallocate resources
We were unable to detect any association between time to operating room and COVID-19 era in either open fracture or closed femur/hip fracture (OR, 1.01; 95% CI, 0.74-1.37; P = .97) cohorts
In the closed femur/hip fracture cohort, there was no association between time to operating room and regional COVID-19 prevalence (OR, 1.07; 95% CI, 0.70-1.64; P = .76)
Summary
Since December 2019, the novel SARS-CoV-2 virus has led to more than 123 million worldwide infections and has claimed the lives of more than 2 million people.[1,2] In response to the COVID-19 pandemic, hospital systems were forced to reduce operating room capacity and reallocate resources. The outcomes of these policies on a hospital’s ability to care for patients with COVID-19 and maintain emergency services have not been adequately reported. We hypothesized that COVID-19 policies would be associated with a lower proportion of acutely injured patients receiving care within this national guideline and that this association would vary depending on the rate of regional COVID-19 cases
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