Abstract
PurposeThe primary aim of our study was to investigate elective orthopaedic care during the first wave government-imposed COVID-19 lockdown and at four weeks and 21 weeks after resuming elective care. The secondary aim of our study was to evaluate the implementation of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) COVID-19 Guidelines and Recommendations for Resuming Elective Surgery in the clinical practice of Belgian knee surgeons.MethodsWe sent three anonymous online surveys to 102 Belgian Knee Society members (BKS) at times mentioned above. Addressed topics were: (1) participant demographics, (2) elective surgeries, (3) outpatient visits, (4) ESSKA Guidelines, (5) patient and surgeon safety.ResultsDuring the COVID-19 lockdown, there was a decrease of 97% in elective knee surgeries and 91% in outpatient visits. At four and 21 weeks after resuming elective care, volumes were respectively 67% and 89% for elective surgeries and 81% and 91% for outpatient visits. Regarding ESSKA guidelines, 91% of surgeons had no COVID-19 testing prior to resuming elective care. Ninety-two per cent reported preoperative (< 72 h) patient PCR testing, and 45% gave preference to young patients without comorbidities. Seventy-two per cent did not use additional personal protective equipment (PPE) if a patient PCR test was negative. Forty-nine per cent continued to give preference to general anaesthesia.ConclusionOur study shows that elective surgeries and outpatient visits were almost completely interrupted during the COVID-19 lockdown and were still below normal at four and 21 weeks after resuming elective care. Regarding ESSKA COVID-19 guidelines, our study observes good compliance in preoperative patient COVID-19 testing, but lower compliance for preoperative health care personnel testing, patient selection, use of PPE, and locoregional anaesthesia.Level of EvidenceV
Highlights
The COVID-19 outbreak has impacted all health care systems across Europe
In the fourth week after resuming elective care, the available operation room (OR) time increased; Fig. 1 Amount of elective knee surgeries per week during: pre-COVID-19 times (March- April 2019); COVID-19 lockdown (March–April 2020); 4 weeks after resuming elective orthopaedic care (May 2020); 21 weeks after resuming elective care (September 2020; corresponding to 6 months after the introduction of first wave COVID-19 lockdown) only 14% of participants had 100% OR time compared to pre-COVID-19 lockdown times
Our study shows that elective surgeries and outpatient visits were almost completely interrupted during the COVID-19 lockdown and were still largely below normal numbers at four and 21 weeks after resuming elective care
Summary
The COVID-19 outbreak has impacted all health care systems across Europe. In March 2020, many governments across Europe ordered a shutdown on elective surgeries and regular non-urgent outpatient visits, including primary and revision knee arthroplasty and other non-urgent orthopaedic care [2, 9, 15].Since May 2020, most European countries slowly restarted elective activities, as new COVID-19 cases and intensive care unit (ICU) admissions gradually reduced.At the same time, multiple guidelines and recommendations have been developed to aid orthopaedic surgeons to safely restart activities after the first wave COVID-19 lockdown [3, 7, 12, 13].Data on the recovery of elective orthopaedic care after the first COVID-19 wave has remained sparse; Liebensteiner et al conducted a survey directly after the COVID-19 first wave peak, reporting that approximately 90% of surgeons experienced substantial reductions in surgical caseload and patient contact [10].As many European orthopaedic departments are currently facing new uncertainties as a result of a second COVID-19 wave, the collection of data on orthopaedic performance is important [4]. The COVID-19 outbreak has impacted all health care systems across Europe. Since May 2020, most European countries slowly restarted elective activities, as new COVID-19 cases and intensive care unit (ICU) admissions gradually reduced. Multiple guidelines and recommendations have been developed to aid orthopaedic surgeons to safely restart activities after the first wave COVID-19 lockdown [3, 7, 12, 13]. Data on the recovery of elective orthopaedic care after the first COVID-19 wave has remained sparse; Liebensteiner et al conducted a survey directly after the COVID-19 first wave peak, reporting that approximately 90% of surgeons experienced substantial reductions in surgical caseload and patient contact [10]. As many European orthopaedic departments are currently facing new uncertainties as a result of a second COVID-19 wave, the collection of data on orthopaedic performance is important [4]
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