A clinical pathway for pre-operative screening of COVID-19 and its influence on clinical outcome in patients with traumatic fractures

Abstract

Purpose Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. The toughest issue traumatic orthopaedic surgeons are faced with is how to maintain a balance between adequate COVID-19 screening and timely surgery. In this study, we described our experience with pre-operative COVID-19 screening in patients with traumatic fractures. Furthermore, we analysed the clinical results of fracture patients undergoing confined or emergency surgery during the COVID-19 outbreak. Methods This was a case series study. Patients with traumatic fractures who were admitted to our hospital for surgery were enrolled in this study during the COVID-19 outbreak from March to April 2020. All patients were enrolled and managed using the standardized clinical pathway we designed for preoperative COVID-19 screening. Clinical, laboratory and outcome data were analysed. Results The average surgery waiting time from injury to surgery was 8.7 ± 3.4 days. The average waiting time from admission to surgery was 5.3 ± 2.8 days. These average waiting times were increased by 4.1 days and 2.0 days, respectively, compared with 2019 data. Cardiovascular complications, venous thromboembolism and pneumonia occurred in one, two and one patient, respectively. Three and two patients developed pre-operative and postoperative fevers, respectively. Conclusions We introduced a novel clinical pathway for pre-operatively screening of COVID-19 in traumatic orthopaedic patients. The delay in surgery caused by COVID-19 screening was minimized to a point at which reasonable and acceptable clinical outcomes were achieved. Doctors should pay more attention to perioperative complications, such as cardiovascular complications, venous thromboembolism, pneumonia and fever.

Nosocomial infection with SARS-CoV-2 and main outcomes after surgery within an orthopaedic surgery department in a tertiary trauma centre in Spain

“…Spain is currently expected to be the country with the most elderly population in the world by 2040 [9]. As it has been already reported, despite the contingency plans and lockdown measures, the incidence of osteoporotic hip fractures seemed to remain stable during the State of Emergency (implementation of stringent lockdown measures for the population) [10,11]. In the present study, proximal femoral fracture was the most common reason for admission (33.8%).…”

Pandemic preparedness of dentists against coronavirus disease: A Saudi Arabian experience

“…The findings of this study are alarming, as about onethird of sampled dentists reported that there was no work plan, or they were unaware that there was a work plan for COVID-19 patient screening and dental management in their practices. Proper channeling of patients using a clear work plan for COVID-19 was an essential element in guidelines proposed by some international health organizations [29,30]. It has been recommended to use tele-screening for patients to avoid contact with patients who could be a source of infection to the dental office staff and other patients [18,29,31].…”

“…Proper channeling of patients using a clear work plan for COVID-19 was an essential element in guidelines proposed by some international health organizations [29,30]. It has been recommended to use tele-screening for patients to avoid contact with patients who could be a source of infection to the dental office staff and other patients [18,29,31]. It is not surprising that more than half of the participating dentists in this study responded that their practices did not employ tele-screening for patients before their dental visits, as it requires extra-staff with special training to conduct such tasks.…”

Perioperative management of patients with suspected or confirmed COVID-19: review and recommendations for perioperative management from a retrospective cohort study

“…This is already happening in some places, and although preoperative screening will potentially increase the time between admission and surgery, initial evidence suggests that this risk can be minimised to the point that it can be balanced against the potential risk of performing surgical procedures in COVID-19 patients. 51 Further research is necessary to establish whether the testing pathway is of more clinical benefit than not having it. In patients with suspected or confirmed COVID-19, the COVID-19 status of newborns should also be taken into account where relevant.…”