How Much has COVID-19 Pandemic Affected Indian Orthopaedic Practice? Results of an Online Survey

International Orthopaedics (SICOT)

2021

Purpose In an observational study, we studied the impact of COVID-19 pandemic on our clinical practice of trauma and orthopaedics, in tertiary care hospital of New Delhi. Methods We collated the hospital data for 2019 and 2020 and analyzed and compared it extensively. We looked for the effects of the COVID-19 pandemic on several important clinical practice parameters like outpatient attendance, inpatients admissions, and surgery. The correlation of the number of surgeries done during the pandemic time was done with the number of positive cases in Delhi, monthwise. A trend of recovery was also observed. Results During the pandemic period, the attendance of outpatients fell by 71.93%, admissions by 59.35%, and surgery by 55.78%. Adult trauma surgery was the least affected (42.21%), followed by arthroscopic surgery (49.81%). Fragility hip fractures requiring bipolar hip arthroplasty were reduced by 34.15%. The maximum adverse impact of the pandemic was seen on arthroplasty surgery (hip > knee), followed by on the paediatric orthopaedic cases, and spinal surgery. We notice a “lazy V-shaped” recovery after the lockdown period. Conclusion COVID-19 pandemic has had a severe impact on all aspects of orthopaedics and trauma’s clinical practice in our setup. These adverse effects were maximally seen during the lockdown period, with a reduction of 90.77% in the outpatients, 84.63% in the admissions, and 86.67% in the surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-021-05021-5.

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on the practice of orthopaedics and trauma—an epidemiological study of the full pandemic year of a tertiary care centre of New Delhi

Vaishya

Vaish

International Orthopaedics (SICOT)

2021

“…However, 38% surgeons in our study were inclined to follow advice of professional bodies that highlights the need for better communication and support system among our fraternity and mechanisms to mitigate stress. The economic burden of an intense lockdown on a surgeon can manifest with rising anxiety levels, primarily due to the impact on elective surgical practice that eventually culminates in reduced income, 30,31 occasionally predisposing the anxious surgeon to resume practice in an ill-prepared manner. The impact of fellowship training or a senior post is another significant stressor that remains inconclusive.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 pandemic on orthopaedic surgeons in terms of anxiety, sleep outcomes and change in management practices: A cross-sectional study from India

Sharma¹,

J Orthop Surg (Hong Kong)

Gupta

et al. 2021

Purpose: The aim of this study was to assess the effects of the COVID-19 pandemic on anxiety, sleep outcomes and change in clinical management practices among orthopaedic surgeons following a nation-wide lockdown. Methods: We conducted an online cross-sectional study using piloted structured questionnaires with self-reported responses from Indian orthopaedic surgeons. Study participants were identified through social networking sites: Facebook and WhatsApp. The extent of anxiety and sleep quality was assessed by the standardised seven-item Generalised Anxiety Disorder (GAD-7) scale, single-item sleep quality scale, questions on unavailability of personal protective equipment, training module on COVID-19 and change in orthopaedic patient management. Results: One hundred male orthopaedic surgeons responded to the survey with majority (79%) in 30–44 years age group. Severe anxiety scores were observed in 8%; moderate, mild and minimal anxiety was observed in 12%, 27% and 53% surgeons respectively. Changes in management practice due to the pandemic was admitted by 65% respondents. We also observed an association between higher anxiety among surgeons and primary or secondary level of healthcare facility: (p = 0.04). Sleep disturbance was significantly associated with change in management practice to non-operative procedures (p = 0.03). Conclusion: Anxiety among orthopaedic surgeons during the COVID-19 pandemic is related to factors like younger age group, working in a primary or secondary healthcare facility. Early recognition of anxiety is essential to prevent serious psychological sequelae.

“…Scenario in India was no different. Kumar et al in a survey reported that 64% orthopaedic surgeons stopped elective surgeries during the COVID pandemic [ 20 ]. Mi et al reported the clinical impact and outcome of 10 Chinese fracture patients with COVID-19.…”

Section: Impact On Orthopaedicsmentioning

confidence: 99%

Covid-19 Pandemic: Resumption of Orthopedic Care and Medical Education

Shah

Johari³

et al. 2021

IJOO

Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China (December 2019). The disease rapidly crossed the barrier of countries, continents and spread globally. Non-pharmaceutical measures such as social distancing, face mask, frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease. OPD, IPD admissions, elective O. Ts were curtailed. Orthopedic care was only limited to emergency and semi-urgent procedures like necrotizing fasciitis, open fracture, and compartment syndrome. These measures were taken to preserve infrastructure and manpower to manage covid-19 pandemic. The children were thought to have a low susceptibility to covid-19 as compared to an adult. Deferring the patient during pandemic has led to high orthopedic disease burden, morbidity and disease-related sequelae, hence elective care must be resumed with modified hospital infrastructure. Resumption of elective/emergent orthopedic care should be slow, phasic and strategic, much similar to unlocking. Cases must be stratified depending on covid status and severity. Dedicated O.Ts with neutral/negative pressure and HEPA filter for covid positive and suspected patients are to be used. All symptomatic and suspected patients should be investigated for covid-19 by RT-PCR, blood counts and CT scan. Regional anaesthesia should be preferred to General anaesthesia. Power drill/saw/burr/pulse lavage should be minimized to avoid aerosol generation. Postoperatively continuous surveillance and monitoring to be done for covid related symptoms. Medical institutes rapidly shifted to the online mode of education. Blended learning (virtual & physical) and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years.