Post-COVID-19 return to elective orthopaedic surgery-is rescheduling just a reboot process? Which timing for tests? Is chest CT scan still useful? Safety of the first hundred elective cases? How to explain the "new normality health organization" to patients?
- 1 October 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Orthopaedics
- Vol. 44 (10), 1905-1913
- https://doi.org/10.1007/s00264-020-04728-1
Abstract
Purpose The long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health care institutions when patients return to elective surgery. Methods A retrospective review of the first adult elective cases performed between May 18, 2020 and June 14, 2020, after the end of lockdown was analysed in Belgium to answer the following questions: (1) for the 236 cancelled patients during the outbreak, how easy was rescheduling? (2) How useful was universal RT-PCR testing and chest CT scan for the 211 orthopaedic and trauma admissions? (3) How were surgical difficulty category, number of operations and complications different when compared to the pre-COVID period? (4) How would patients balance the benefit of surgery against the unknown risk of developing COVID-19? Results Before surgery, blood tests for anaesthesiology and imaging related to the surgical procedure were scheduled prior to universal testing (COVID-19 PCR and chest CT) performed 72-120 hours before surgery. Among the 211 asymptomatic patients who were tested before surgery, six had positive PCR, while no abnormality was found on the chest CT scan of all the patients. With this timing for tests, the 104 patients included in the current study for elective surgery were free of disease before undergoing surgery and remained without COVID-19 after surgery. Among the 366 cancelled patients during the outbreak, only 12% of the patients accepted to proceed with rescheduling immediately. Therefore, this resulted in a 70% reduction for elective surgery and in a 50% reduction for arthroplasties as compared to pre-COVID period. The rate of complications was not increased during the post-COVID period. A portion of patients have confused idea of screening and have difficulty to perceive the new rules of health organization. Conclusions Resumption of elective surgical procedures appears more difficult for patients than for surgeons with a low percentage of cancelled patients accepting to reschedule surgery. Universal testing allowed securing patients; however, surgeons must explore better patient perceptions regarding COVID-19 to facilitate a fully informed decision in the current period.This publication has 21 references indexed in Scilit:
- Changes of clinical activities in an orthopaedic institute in North Italy during the spread of COVID-19 pandemic: a seven-week observational analysisInternational Orthopaedics, 2020
- Maximizing virtual meetings and conferences: a review of best practicesInternational Orthopaedics, 2020
- The COVID-19 outbreak in Italy: perspectives from an orthopaedic hospitalInternational Orthopaedics, 2020
- A Review of State Guidelines for Elective Orthopaedic Procedures During the COVID-19 OutbreakJournal of Bone and Joint Surgery, 2020
- Practice Management During the COVID-19 PandemicJournal of the American Academy of Orthopaedic Surgeons, 2020
- The pulmonary sequalae in discharged patients with COVID-19: a short-term observational studyRespiratory Research, 2020
- Coagulation abnormalities and thrombosis in patients with COVID-19The Lancet Haematology, 2020
- Returning to orthopaedic business as usual after COVID-19: strategies and optionsKnee Surgery, Sports Traumatology, Arthroscopy, 2020
- Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in ChinaJAMA, 2020
- Predicting Elective Orthopaedic Sports Medicine Surgical Cancellations Based on Patient DemographicsArthroscopy, Sports Medicine, and Rehabilitation, 2020