Abstract
ABSTRACT BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic is taxing South Africa's already over-burdened healthcare system. Orthopaedics is not exempt; patients present with COVID-19 and musculoskeletal pathology and so surgeons should be familiar with the current evidence to best manage patients and themselves. The aims of this scoping review were firstly to inform peri-operative decision-making for COVID-positive patients as well as the routine orthopaedic milieu during the pandemic; secondly to assess the outcomes of orthopaedic patients managed in endemic areas; and Anally to determine the effect the pandemic has had on our orthopaedic peers METHODS: A scoping review was conducted following the PRISMA-ScR guidelines of 2018. The search terms 'Orthopaedics' or 'Orthopedics' and 'COVID-19' or 'Coronavirus' were used to perform the search on Scopus, PubMed and Cochrane databases. All peer-reviewed articles utilising evidence-based methodology and addressing one of the objectives were eligible. A thematic approach was used for qualitative data synthesis RESULTS: Seventeen articles were identified for inclusion. All articles represented level 4 and 5 evidence and comprised ten review-type articles, one consensus statement, two web-based surveys and four observational studies. Most articles (n=11) addressed the objective of peri-operative considerations covering the stratification and testing of patients, theatre precautions and personal protective equipment (PPE). Evidence suggests that patients should be stratified for surgery according to the urgency of their procedure, their risk of asymptomatic disease (related to the community prevalence of COVID-19) and their comorbidities. The consensus is that all patients should be screened (asked a set of standardised questions with regard their symptoms and contacts). Only symptomatic patients and those asymptomatic patients from high prevalence areas or those with high-risk contacts should be tested. Healthcare workers (HCWs) in theatre should maintain safety precautions considering every individual is a potential contact. In the operating room in addition to the standard orthopaedic surgery PPE, if a patient is COVID positive, surgeons should don an N95 respirator. The three articles that addressed the effects on the orthopaedic surgeon showed a significant redeployment rate, effects on monetary renumeration of specialists and also effects on surgeons in training causing negative emotional ramifications. Of the surgeons who have contracted the illness and have been investigated, all showed mild symptomatology and recovered fully. The final three articles concentrated on orthopaedic patient considerations; they all showed high mortality rates in the vulnerable patient populations investigated, but had significant limitations CONCLUSION: Orthopaedics is significantly affected by the COVID pandemic but there remains a dearth of high-quality evidence to guide the specialty Level of evidence: Level 3 Keywords: COVID-19, SARS-CoV-2, coronavirus, orthopaedic, surgery
Highlights
The first case of COVID-19 illness in South Africa (SA), caused by the severe acute respiratory syndrome coronavirus-2 (SARSCoV-2), was diagnosed on 5 March 2020
We conducted a scoping review following the PRISMA-ScR guidelines of 2018.3 Peer-reviewed articles pertaining to orthopaedic surgery and COVID-19 were considered eligible for inclusion
The majority (n=9) of the articles were published in May, reflecting a surge in publications immediately post-epidemiological peaks in Europe and America respectively
Summary
The first case of COVID-19 illness in South Africa (SA), caused by the severe acute respiratory syndrome coronavirus-2 (SARSCoV-2), was diagnosed on 5 March 2020. South Africa faces many of the healthcare challenges experienced globally, such as a shortage of test reagent and acquisition of personal protective equipment (PPE) to name a few. It is encumbered with the greatest human immunodeficiency virus (HIV) burden in the world, and the strain of 80% of the population reliant on the public service for care.[1]. Orthopaedics is not exempt; patients present with COVID-19 and musculoskeletal pathology and so surgeons should be familiar with the current evidence to best manage patients and themselves. Most articles (n=11) addressed the objective of peri-operative considerations covering the stratification and testing of patients, theatre precautions and personal protective equipment (PPE). Conclusion: Orthopaedics is significantly affected by the COVID pandemic but there remains a dearth of high-quality evidence to guide the specialty
Sign-in/Register to view highlights & summary 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
