30-day outcome after orthopaedic surgery in patients assessed as negative for COVID-19 at the time of surgery during the peak of the pandemic

Abstract

Introduction The aim of this study is to report the 30 day COVID-19 related morbidity and mortality of patients assessed as SARS-CoV-2 negative who underwent emergency or urgent orthopaedic surgery in the NHS during the peak of the COVID-19 pandemic. Method A retrospective, single centre, observational cohort study of all patients undergoing surgery between 17 March 2020 and 3May 2020 was performed. Outcomes were stratified by British Orthopaedic Association COVID-19 Patient Risk Assessment Tool. Patients who were SARS-CoV-2 positive at the time of surgery were excluded. Results Overall, 96 patients assessed as negative for SARS-CoV-2 at the time of surgery underwent 100 emergency or urgent orthopaedic procedures during the study period. Within 30 days of surgery 9.4% of patients (n = 9) were found to be SARS-CoV-2 positive by nasopharyngeal swab. The overall 30 day mortality rate across the whole cohort of patients during this period was 3% (n = 3). Of those testing positive for SARS-CoV-2 66% (n = 6) developed significant COVID-19 related complications and there was a 33% 30-day mortality rate (n = 3). Overall, the 30-day mortality in patients classified as BOA low or medium risk (n = 69) was 0%, whereas in those classified as high or very high risk (n = 27) it was 11.1%. Conclusion Orthopaedic surgery in SARS-CoV-2 negative patients who transition to positive within 30 days of surgery carries a significant risk of morbidity and mortality. In lower risk groups, the overall risk of becoming SARS-CoV-2 positive, and subsequently developing a significant postoperative related complication, was low even during the peak of the pandemic. In addition to ensuring patients are SARS-CoV-2 negative at the time of surgery it is important that the risk of acquiring SARS-CoV-2 is minimized through their recovery. Cite this article: Bone Joint Open 2020;1-8:474–480.

Low 30-day mortality in South African orthopaedic patients undergoing surgery at an academic hospital during the first wave of the COVID-19 pandemic: It was safe to perform orthopaedic procedures at our hospital during the first COVID-19 peak

“…We have summarised and described the findings in Table 2. The low 30-day mortality rate of our patient cohort during the first COVID-19 peak is similar to figures published by Sobti et al, [10] Karayiannis et al, [11] Price et al, [12] Hope et al [13] and Giorgi et al [14] (2.3% v. 4.3%, 1.9%, 3%, 4% and 4.6%, respectively), and is considerably lower than mortality rates reported in other regions in the UK and other developing countries (11.76% -53%). [5,[7][8][9]13] The specific reasons for this lower mortality rate are not clear from our study, but may be attributed to an overall younger population undergoing surgery in our academic hospital and many lower-risk procedures being performed during this timeframe.…”

“…The research for this study was done in partial fulfulment of the requirements for RW's PhD degree at the University of Cape Town. Price et al [12] Retrospective, single-centre observational cohort study Hope et al [13] Retrospective review 23 March -4 April 2020 76 10 ( 13) 3 ( 4)…”

“…[11] At the Nuffield Orthopaedic Centre in the UK, 9.4% of patients who underwent orthopaedic procedures as SARS-CoV-2-negative (n=9) contracted SARS-CoV-2 within 30 days postoperatively. [12] Of these patients, 66% (n=6) developed significant COVID-19related complications postoperatively, and there was a 33% (n=3) 30-day mortality rate.…”

Careful return to elective orthopaedic surgery in an acute hospital during the COVID-19 pandemic shows no increase in morbidity or mortality

“…Price et al 17 investigated 30-day mortality in orthopaedic patients who underwent urgent or emergency surgery. They report of the 96 patients initially assessed as COVID-19-negative on admission, 9.4% (n = 9) subsequently tested positive within 30 days.…”

“…In addition to ensuring that patients do not have COVID-19 at the time of surgery, the authors state that specific attention should be placed on the postoperative pathway to include minimizing inpatient stay, minimizing healthcare contacts, and recommending isolation in the immediate postoperative period. 17 …”