Hand surgery during the COVID-19 pandemic: Clinical care best practices

Bartoletta, John J.; Rhee, Peter C.

doi:10.1016/j.hansur.2021.05.011

Cited by 5 publications

(8 citation statements)

References 10 publications

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“…Mass screening for healthcare workers can reduce both unnecessary quarantine and the “silent” spread of mild or asymptomatic cases, avoiding workforce depletion and reducing intrahospital transmission [ 33 ]. Screening of hospital staff is therefore essential, as is the use of personal protective equipment (PPE) and the adoption of appropriate programming criteria, which also make use of the aid of telemedicine [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement

Cortegiani

Tripodi

Castioni

et al. 2022

J Anesth Analg Crit Care

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Background The appropriate timing of surgery and perioperative management of patients with previous SARS-CoV-2 infection are open issues. The purpose of this document is to support the clinical decision-making process regarding the patient with previous Sars-CoV-2 infection to undergo elective surgery. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient’s surgical process. Methods The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) selected 11 experts to reach a consensus on key aspects of this theme in adult and pediatric population. The methods of this process document were in accordance to the principles of rapid review of the scientific literature and modified Delphi method. The experts produced statements and supporting reasons in the form of an informative text. The overall list of statements was subjected to a vote in order to express the degree of consent. Results Patients should not undergo elective surgery within 7 weeks of infection unless there is the risk of a negative evolution of the disease. To mitigate the risk of postsurgical mortality, a multidisciplinary approach seemed useful in addition to the use of validated algorithms to estimate the risk of perioperative morbidity and mortality; the risk related to SARS-CoV-2 infection should be added. The risk of potential nosocomial contagion from a positive patients should also be considered when deciding to proceed with surgery. Most of the evidence came from previous SARS-CoV-2 variants, so the evidence should be considered indirect. Conclusion A balanced preoperative multidisciplinary risk–benefit evaluation is needed in patients with previous infection by SARS-CoV-2 for elective surgery.

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Section: Resultsmentioning

confidence: 99%

Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement

Cortegiani

Tripodi

Castioni

et al. 2022

J Anesth Analg Crit Care

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“…Thus, the dynamics between science and policy often requires postestablishment verification (19). It is obvious that the policy of COVID-19 virus nucleic acid testing normalization has shocked the conventional emergency, surgical, and other medical practices because of prolonged preoperative waiting (6). Patients under life-threatening emergent circumstances, such as acute myocardial infarction and strangulated intestinal obstruction, cannot bear such a long wait, while patients with other emergent situations, including ruptured intracranial aneurysm, were reported to tolerate the wait and exhibit similar outcomes as patients without the wait for result of virus nuclei acid detection (20)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

“…The COVID-19 pandemic and related policies have also shed impact on the frequency and disease distribution of emergency department visit because of the geographic restriction and changes in daily activities (4). As for hand trauma, although the incidence of emergency visit decreased globally in the first wave of the pandemic, the rate of emergency operation was reported unchanged and eventually the incidence returned to normal and remained unaffected by the following pandemic waves (5)(6)(7)(8). Replantation of severed digits represents a hallmark in hand surgery, and survival rate of the digits has been increasing thanks to advances in microsurgery (9).…”

Section: Introductionmentioning

confidence: 99%

Influence on emergency digit replantation and outcome assessment after COVID-19 virus nucleic acid testing normalization

Zhang

et al. 2023

Front. Surg.

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ObjectiveThe study aims to compare the implementation and prognosis of emergency digit replantation surgery before and after normalized corona virus disease 2019 (COVID-19) nucleic acid testing for patients taking emergency operation and to explore the influence of normalized COVID-19 nucleic acid testing on replantation surgery.MethodNormalized COVID-19 nucleic acid testing for patients taking emergency operation has been carried out since 1 August 2021 at our hospital, which means each patient who needs emergency surgical treatment has to obtain either positive or negative results of COVID-19 nucleic acid before entering the operating room. This research reviewed and compared the prognosis of the injured extremity that had emergency severed digit replantation between June and September 2021, at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and analyzed the impact of normalized COVID-19 nucleic acid testing on the outcome of the replanted fingers of different severity using disability of arm-shoulder-hand (DASH) and hand injury severity scoring (HISS) scoring systems.ResultsA total of 54 cases with 74 severed replanted phalanges were included replanted by the research group between 1 August and 30 September 2021, without any COVID-19 suspected/confirmed case detected. Compared with previous period (1 June to 31 July, 2021), although the interval between emergency visits and emergency replantation did increase significantly after normalized COVID-19 nucleic acid testing [(3.83 ± 0.94) to (1.77 ± 0.67) h, P < 0.05], we observed no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively (P = 0.538) nor in the complication rate (P = 0.344). Moreover, there was no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively in patients with different traumatic severities before and after normalized COVID-19 nucleic acid testing (moderate P = 0.269, severe P = 0.055, major P = 0.149).ConclusionDespite the preoperative delay, the policy of COVID-19 nucleic acid testing normalization does not have explicit influence on the short-term outcomes of emergency digit replantation surgery. With this evidence, microsurgeons could pay attention to the patients' anxiety and spend more effort in comforting them during the prolonged preoperative wait. These insights may have implications for other emergency department resource management whenever a social crisis occurs.

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“…The SARS-CoV-2 pandemic has significantly influenced the previous routines of preoperative risk assessment. 9 10 Due to the reported increases in perioperative morbidity and mortality in those afflicted with coronavirus disease 2019 (COVID-19), several recommendations have been modified to delay their surgery. 2 11 Previous studies have listed postsurgical pulmonary complications as high as 50% and mortality at 30% following orthopaedic surgery.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Complications and Mortality in Patients with SARS-CoV-2 Undergoing Elective and Emergent Hand Surgery

Adams

Dohse

Miller

et al. 2023

Journal of Hand and Microsurgery

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Background Patients acutely infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have increased risk for postsurgical pulmonary complications and mortality, particularly with general anesthesia. Surgery is often delayed to mitigate risk; however, excessive delays may result in morbidity. Optimal criteria for delaying surgery in patients with or without symptoms are unknown. This study aimed to evaluate any complications following hand surgery in patients testing positive for SARS-CoV-2. Methods We retrospectively reviewed patients with a positive polymerase chain reaction test within 60 days before or after hand surgery between March 31, 2020 and March 31, 2021. Patients were telephoned also to supplement records. Type of surgery, type of anesthesia, comorbidities, timing of surgery, onset of symptoms, and complications were recorded. Results We identified 21 patients undergoing 26 procedures, of which 21 (81%) were emergency procedures and 5 (19%) were elective. Mean age was 37 years (range: 17–71). General anesthesia was used in 88% of cases, with mean duration of 110 minutes. SARS-CoV-2 was diagnosed on average 6 days preoperatively (range: 39 days preop–14 days postop). Positive tests were usually identified preoperatively (50%), versus day-of-surgery (25%) or postoperatively (25%). Patients were symptomatic in only 27% of cases, and completely asymptomatic in 73%. No asymptomatic patients developed complications. One patient suffered a fracture malunion after delayed surgery. Pulmonary complications were noted in 3 patients; all had prior pulmonary disease and underwent emergency surgeries under general anesthesia. Overall mortality rate was 0%. Conclusion Pulmonary complications and mortality are low following hand surgery in asymptomatic patients with a positive SARS-CoV-2 test.

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Hand surgery during the COVID-19 pandemic: Clinical care best practices

Cited by 5 publications

References 10 publications

Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement

Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement

Influence on emergency digit replantation and outcome assessment after COVID-19 virus nucleic acid testing normalization

Pulmonary Complications and Mortality in Patients with SARS-CoV-2 Undergoing Elective and Emergent Hand Surgery

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