Resumption Of Elective Surgery Research Articles

An Increase in Same Day Discharge After Total Joint Arthroplasty During the COVID-19 Pandemic Does Not Influence Patient Outcomes: a Retrospective Cohort Analysis.

The COVID-19 pandemic caused major transitions in total joint arthroplasty (TJA), notably with the increased utilization of same-day discharge (SDD) pathways. This study assessed the effect of accelerated discharge pathways following the resumption of elective cases during the COVID-19 pandemic on SDD rates, adverse events, and characteristics associated with successful SDD following total hip (THA) and total knee arthroplasty (TKA). This retrospective study split patients into cohorts; TJA prior to COVID-19 (pre-COVID, July 2019-December 2019) and TJA following resumption of elective surgery (post-COVID, July 2020-December 2020). Patient characteristics such as age, sex, body mass index (BMI), ASA score and pertinent comorbidities were analyzed, and length-of-stay (LOS), 30-day emergency department (ED) visit rates, readmissions and reoperations were compared. 1333 patients met inclusion criteria that were divided into pre-COVID (692) and post-COVID (641) cohorts. The pre-COVID group had a median age of 69 years (IQR 63-76) and the post-COVID group had a median age of 68 years (IQR 61-75) (P=0.024). SDD increased from 0.1% to 28.9% (P<0.001) and LOS decreased from 1.3 days to 0.89 days (P<0.001). There was no change in 30-day ED visits, readmissions, or reoperations (P=0.817, P=0.470, P=0.643 respectively). There was no difference in ED visits, readmissions, or reoperations in SDD patients. The odds of SDD were associated with age (P<0.001, OR=0.94), BMI (P=0.006, OR=0.95), male sex (P<0.001, OR=1.83), and history of tobacco use (P<0.001, OR=1.87). At our institution, the COVID-19 pandemic accelerated utilization of SDD pathways without increasing ED visits, readmissions or reoperations.

Comparison of total joint arthroplasty care patterns prior to the Covid-19 pandemic and after resumption of elective surgery during the Covid-19 Outbreak: A retrospective, large urban academic center study

BackgroundAfter the suspension of elective surgeries was lifted in June 2020 in New York State, challenges remained regarding coordination of total joint arthroplasty (TJA) cases. Using the experience from a high-volume health system in New York City, we aimed to describe patterns of care after resumption of elective TJA. MethodsWe retrospectively assessed 7,699 TJAs performed before and during the COVID-19 pandemic. Perioperative characteristics and clinical outcomes were compared between TJAs based on time period of performance: 1) pre-pandemic (PP, June 8th–December 8th, 2019), 2) initial period post-resumption of elective surgeries (IR, June 8th–September 8th, 2020), and 3) later period post-resumption (LR, September 9th–December 8th, 2020). ResultsLOS > 2 days (83%, 67%, 70% for PP, IR, LR periods respectively) and discharge rates to post-acute care (PAC) facilities were lower during the pandemic periods (ORIR vs. PP: 0.48, 95% CI: 0.40–0.59, p < 0.001; ORLR vs. PP: 0.63, 95% CI: 0.53–0.75, p < 0.001). Compared to the pre-pandemic period, the risk for 30-day readmission was lower during the IR period (OR: 0.62, 95% CI: 0.40–0.98, p = 0.041) and similar during the LR period (OR: 0.96, 95% CI: 0.65–1.41, p = 0.832). ConclusionsDespite decreased LOS and discharge to PAC for TJAs performed during the pandemic, 30-day readmissions did not increase. Given the increased costs and lack of superior functional outcomes associated with discharge to PAC, these findings suggest that discharge to PAC facilities need not return to pre-pandemic levels.

Comparison of Total Joint Arthroplasty Care Patterns Prior to the COVID-19 Pandemic and after Resumption of Elective Surgery During the COVID-19 Outbreak: A Retrospective, Large Urban Academic Center Study

Comparison of Total Joint Arthroplasty Care Patterns Prior to the COVID-19 Pandemic and after Resumption of Elective Surgery During the COVID-19 Outbreak: A Retrospective, Large Urban Academic Center Study

Usual and Unusual Musculoskeletal Sequalae of COVID 19!

Today the orthopedic world with respect to COVID remains focused on resumption of elective surgery and impact of the pandemic on scientific activities. However, it is equally important that we keep our eyes on the phenomenon that is quietly unraveling in front of the eyes. The phenomenon of post-COVID musculoskeletal sequelae may become a major orthopedic public health problem in coming months and needs to be investigated in depth. The usual post-COVID symptoms include arthralgia and myalgia that are common in many viral diseases. It is the unusual symptoms like occurrence of primary septic joint infection and elevated rates of post-operative infections that warrant attention and further investigation. Could this be attributed to immune consumption leading to a phase of temporary immunosuppression is a matter of speculation and hypothesizing. A short communication here reveals a glimpse of musculoskeletal sequalae that COVID may bring in coming months. These could be usual arthralgia or myalgia which are self-limiting but could also be more sinister like spontaneous osteonecrosis and primary joint infections.

The Effectiveness of the Malaysian Guidelines for Pre-operative COVID-19 Screening in ORL Patients Undergoing Elective Surgery

The Coronavirus disease 2019 (COVID-19) pandemic is a devastating global pandemic affecting many countries worldwide. It has a huge impact on the country’s healthcare system as well as its socio-economic wellbeing. Majority of elective surgery was deferred in order to provide beds, resources and treat COVID-19 cases. Resumption of elective surgery requires a well-planned process and adherence to standard guidelines to protect both the healthcare providers and patients. Pre-operative COVID-19 screening will be one of the new norms for patients undergoing surgery. This study was aimed to evaluate the pre-operative COVID-19 screening for elective surgery among Otorhinolaryngology (ORL) patients in Hospital Ampang based on the current Malaysian guidelines for undertaking surgery during COVID-19 pandemic and highlight the screening protocols implemented by the Ministry of Health. This retrospective review was conducted in ORL Department, Hospital Ampang. We reviewed the surgical registry of 117 patients who underwent elective surgeries under general anaesthesia from June till September 2020. There were 62 patients (53%) below 18 years old and 55 patients (47%) above 18 years old. There were 76 cases (65%) involving aerosol-generating procedures. A total of 23 patients (19.7%) had COVID-19 screening done pre-operatively based on the Malaysian guidelines patient selection and all results were negative. None of the patients experienced any symptoms, complications or morbidities related to SARS-CoV-2 infection post-operatively. The Malaysian guideline on pre-operative screening for COVID-19 is applicable for institutions with low to moderate local transmission of SARS-CoV-2. Targeted group or risk-based protocols are beneficial for improving cost-effectiveness and reducing workload burden during the critical period. As the pandemic evolved, the guidelines have to be revised based on the prevailing situation to suit the best clinical practice for the benefit of patients and healthcare personnel without disrupting the surgical services.

Financial Decisions and Reopening a Practice During the COVID-19 Pandemic: A Survey of California Plastic Surgeons.

On March 11, 2020, the World Health Organization declared COVID-19 as a global pandemic. As a response, the United States shut down public gatherings and businesses in an effort to quarantine. This included the stopping of elective operations, which greatly affected plastic surgeons and their practices during the initial shutdown. We aim to study the early impact of COVID-19 on the financial implications and practice patterns of plastic surgeons in the state of California during the initial shutdown of elective surgery and provide guidelines for effective management during future crises. A 20-question survey was sent using Qualtrics XM software to 851 surgeon members of the California Society of Plastic Surgeons. The survey was open from May 13, 2020, to May 29, 2020. Standard statistical analysis was completed to compare private practice and nonprivate practice plastic surgeons. We had a total of 140 respondents to our survey for a 16.5% response rate. The majority (77.1%) of the respondents were in a private practice setting. Private practice plastic surgeons reported a higher financial impact with a 79% reduction in financial income compared with nonprivate practice plastic surgeons at a 37% reduction (P < 0.0001). Additionally, private practice plastic surgeons demonstrated a higher reduction in case volume and were more likely to lay off or furlough staff, close their practice, and apply for loans (P < 0.001). Our survey study showed that private practice plastic surgeons in the state of California faced the most financial hardship during the early shutdown of the COVID-19 pandemic. It serves as a valuable snapshot in our economic history and depicts the heavy financial impact of the stopping of elective surgery. Since the reopening of practices, new guidelines have been implemented to maintain safe elective surgery while the pandemic continues. Further follow-up studies on both the state and national level need to be completed to see the continued financial effects on private and nonprivate plastic surgery practices since the reopening and resumption of elective surgery.

Impact of COVID-19 pandemic and national lockdown in an orthopaedic and traumatology department—a comparison with the homologous period of 2019

Background:The coronavirus disease-2019 pandemic has forced health systems to undergo dynamic changes. This study aims to evaluate the impact of the pre-lockdown and of the lockdown period on the surgical activity of a Portuguese Orthopaedic and Traumatology Department and to compare it with the homologous period of 2019.Methods:The surgical activity between March 2 and May 2, 2020 and that of the homologous period of 2019 were analyzed and compared. Additionally, the impact of national and institutional measures was analyzed.Results:There was a decrease in elective surgeries, from 587 to 100. In 2020, 59.3% of all surgeries were urgent and 48.4% were trauma whereas in 2019 there were 25.5% urgent and 23.0% trauma surgeries (P < .001 and P < .001, respectively). There was no difference in the mean of proximal hip fractures operated per week (P = .310), even when analyzing only the lockdown period (P = .102). However, proximal hip fractures corresponded to significantly higher proportion of surgeries in 2020 (P = .04). Hand and tendon injuries significantly reduced in 2020, as were sports-related trauma surgeries. Mean number of days until surgery was significantly lower in 2020 (2020:1.6 ± 2.1, 2019: 2.2 ± 2.5, P = .012).Conclusion:Governmental and institutional measures had high impact on the production and on the epidemiology of trauma. While resumption of elective surgery is needed, lessons from these measures may help in the response to a possible second wave.

Preoperative Considerations in Order to Resume Elective Surgery During COVID-19 Pandemic

Abstract The alarming spread of the novel Coronavirus necessitated the cessation of elective therapeutic procedures in most health-care facilities. This strategy has limited the spread of the virus, but with a huge socio-economic impact. For this reason, the resumption of elective surgery in the context of the coronavirus pandemic is a difficult, but necessary process. Addressing this delicate situation requires interdisciplinary collaboration, so as to ensure high quality medical care for all patients, with consideration to protection of the staff involved in the care of the surgical patient.

Resumption of Elective Surgery following COVID-19 Outbreak, Guideline for Female Pelvic Medicine and Surgery

Division of Female Pelvic Medicine and Surgery, Department of Obstetrics and Gynecology, Emam Khomeini Hospital, Tehran University of medical sciences proposed a clinically relevant algorithm to guide appropriate decision making based on underlying risk stratification and resource utilization in order to resume elective surgeries, following COVID-19 pandemic crisis. The consequence of standardized decision-making factors and transparency of the principles will provide more assurance, consistency, and reliability on both sides, care providers and the patient. It also will decrease ethical dilemmas and moral criticism for surgeons. Eventually, this approach is applicable in any other disaster preparedness as a logical stratification of surgical indications for the female pelvic floor surgical procedures.

Resumption of elective surgery during the COVID-19 pandemic: what lessons can we apply?

Resumption of elective surgery during the COVID-19 pandemic: what lessons can we apply?

Surgery during the COVID-19 pandemic

The COVID-19 pandemic has impacted health-care systems worldwide, mandating novel measures to protect patients and health-care workers. In addition to the stratification of risks in terms of patient, anesthesia, and surgery, surgeons will now have to consider infectious risks associated with the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus in their preoperative assessment. It is imperative that surgeons adapt to this new challenge, which is likely to be a part of the foreseeable future. This review aims to guide the operating surgeon to make informed decisions regarding risks associated with the virus, and how to best prepare for the same. It is a collation of the current knowledge in the field and covers (a) SARS-CoV-2 epidemiology, clinical characteristics, and testing; (b) strategies for stratification of surgeries; (c) preoperative testing; (d) preoperative considerations; (e) intraoperative concerns; (f) precautions to be followed in the performance of open as well as laparoscopic surgery; and (e) issues related to resumption of elective surgery.