Post-COVID-19 return to elective orthopaedic surgery—is rescheduling just a reboot process? Which timing for tests? Is chest CT scan still useful? Safety of the first hundred elective cases? How to explain the “new normality health organization” to patients?

Abstract

Purpose The long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health care institutions when patients return to elective surgery. Methods A retrospective review of the first adult elective cases performed between May 18, 2020 and June 14, 2020, after the end of lockdown was analysed in Belgium to answer the following questions: (1) for the 236 cancelled patients during the outbreak, how easy was rescheduling? (2) How useful was universal RT-PCR testing and chest CT scan for the 211 orthopaedic and trauma admissions? (3) How were surgical difficulty category, number of operations and complications different when compared to the pre-COVID period? (4) How would patients balance the benefit of surgery against the unknown risk of developing COVID-19? Results Before surgery, blood tests for anaesthesiology and imaging related to the surgical procedure were scheduled prior to universal testing (COVID-19 PCR and chest CT) performed 72-120 hours before surgery. Among the 211 asymptomatic patients who were tested before surgery, six had positive PCR, while no abnormality was found on the chest CT scan of all the patients. With this timing for tests, the 104 patients included in the current study for elective surgery were free of disease before undergoing surgery and remained without COVID-19 after surgery. Among the 366 cancelled patients during the outbreak, only 12% of the patients accepted to proceed with rescheduling immediately. Therefore, this resulted in a 70% reduction for elective surgery and in a 50% reduction for arthroplasties as compared to pre-COVID period. The rate of complications was not increased during the post-COVID period. A portion of patients have confused idea of screening and have difficulty to perceive the new rules of health organization. Conclusions Resumption of elective surgical procedures appears more difficult for patients than for surgeons with a low percentage of cancelled patients accepting to reschedule surgery. Universal testing allowed securing patients; however, surgeons must explore better patient perceptions regarding COVID-19 to facilitate a fully informed decision in the current period.

A look at the global impact of SARS CoV-2 on orthopedic services

“…Nine centers reported the number of elective orthopedic procedures performed both before and during the COVID-19 pandemic. 9 , 10 , 16 , 17 , 20 , 29 , 36 , 38 , 39 Cumulatively, the number of elective surgeries decreased by 80% (2013/17400, 0.20, CI: 0.12 to 0.29) ( Fig. 2 ).…”

“…A comparison of trauma surgery numbers was reported in nine centers, 16 , 17 , 20 , 24 , 28 , 29 , 36 , 38 , 39 of which six were reported as major trauma centers. Seven centers observed a lower volume of trauma procedures during the pandemic, as compared to pre-pandemic times, amounting to an overall decrease of 47% (3887/17561, 0.53, CI: 0.37 to 0.69) ( Fig.…”

Self-quarantine programme and pre-operative SARS-CoV-2 PCR screening for orthopaedic elective surgery: experience from Japan

“…Computed tomography (CT) screening for urgent elective surgery in the United Kingdom reported findings suggestive of COVID-19 in 13/156 (8%) patients, and COVID-19 was confirmed in two of these patients with an additional PCR test [ 13 ]. Although CT provides the most accurate diagnosis for COVID-19 pneumonia, the use of CT for universal screening may be impractical due to its high cost and radiation exposure [ 12 , 14 ]. Other screening methods use antibody tests, but the presence of antibodies was <40% among patients within one week of onset [ 15 ].…”

Orthopaedic Services during Nationwide COVID-19 Lockdown: Dhulikhel Hospital, Kathmandu University Hospital Experience and Review

“…The guidelines are changing as evidence develops, and now there are many studies and recommendations on performing elective surgeries in "new normal." 13,[46][47][48] The larger number of people holding back their non-urgent ailments could overwhelm our capacity when the "normal" days start in our hospital. We are bracing ourselves for such future events.…”