A Call to Arms: Emergency Hand and Upper-Extremity Operations During the COVID-19 Pandemic

Abstract

Limited data exist regarding volumetric trends and management of upper-extremity emergencies during periods of social restriction and duress, such as the coronavirus disease 2019 pandemic. We sought to study the effect of shelter-in-place orders on emergent operative upper-extremity surgery. Methods: All patients undergoing emergent and time-sensitive operations to the finger(s), hand, wrist, and forearm were tracked over an equal number of days before and after shelter-in-place orders at 2 geographically distinct Level I trauma centers. Surgical volume and resources, patient demographics, and injury patterns were compared before and after official shelter-in-place orders. Results: A total of 58 patients underwent time-sensitive or emergent operations. Mean patient age was 42 years; mean injury severity score was 9 and median American Society of Anesthesiologist score was 2. There was a 40% increase in volume after shelter-in-place orders, averaging 1.4 cases/d. Indications for surgery included high-energy closed fracture (60%), traumatic nerve injury (19%), severe soft tissue infection (15%), and revascularization of the arm, hand, or digit(s) (15%). High-risk behavior, defined as lawlessness, assault, and high-speed auto accidents, was associated with a significantly greater proportion of operations after shelter-in-place orders (40% vs 12.5%; P < .05). Each institution dedicated an average of 3 inpatient beds and one intensive care unitecapable bed to upper-extremity care daily. Resources used included an average of 115 minutes of daily operating room time and 8 operating room staff or personnel per case. Conclusions: Hand and upper-extremity operative volume increased after shelter-in-place orders at 2 major Level I trauma centers across the country, demanding considerable hospital resources. The rise in volume was associated with an increase in high-risk behavior. Type of study/level of evidence: Therapeutic IV.

Effects of COVID‐19 lockdown measures on emergency plastic and reconstructive surgery presentations

“…These findings were similar to other studies from European countries 8,9 . Contrary to other descriptions, another study demonstrated significant increase in the number of hand and wrist injuries requiring operative management 10 . Interestingly, none of the cited studies detailed the adjustment in presentation patterns or correlations with the behavioural changes resulting from the imposed lockdown measures.…”

The global burden of trauma during the COVID-19 pandemic: A scoping review

“…During lockdown a reported increase in injuries from deliberate self-harm (DSH) was found in Paris (2.9% v 2.0%), 19 the UK, 38 , 49 Australia 47 , 50 and the US. 40 , 52 A large reduction was reported in diamond et al‘s US centre 29 (0 v 8%), with a milder reduction in Murphy et al‘s UK centre 54 (0.2% v 1%, p = 1.0). In the US Sherman et al reported an increase in the rate of non-accidental injury (NAI) during the pandemic, 55 and an increase in domestic violence was observed in Rhode's centre.…”

“…The mean age was reported for 3236 patients and was 43.7 years. 13 , 18 , 19 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 An average of 54.8% were male.…”

“… 34 , 40 , 49 , 50 , 51 However, 2 centres in the United States (US) reported an increase in presenting ISS of 13.7–33%. 29 , 52 …”

“…Reductions of between 18.9 and 44.2% were reported in centres in the UK, 54 , 66 US 11 , Europe 36 , 39 , 60 , 67 and Hong Kong. 58 However, increases in the proportion of patients managed operatively were noted in the UK, 10 Paris, 19 the US, 29 , 32 Australia 50 and India. 53 …”