The COVID-19 Pandemic: The effect on open lower limb fractures in a London major trauma centre - a plastic surgery perspective

Campbell, Ewan; Zahoor, Ubaid; Payne, Anna; Popova, Dardan; Welman, Ted; Pahal, Gurjinderpal Singh; Sadigh, Parviz

doi:10.1016/j.injury.2020.11.047

Cited by 11 publications

(15 citation statements)

References 4 publications

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“…However, Campbell et al reported only a minimal decrease in open lower limb fractures during the first lockdown period in the United Kingdom. 20 Sweden, where the present study comes from, has had fewer restrictions than other countries, and used restrictions have only been recommended, but not considered mandatory. Furthermore, no curfews have been used; therefore, no reduction in trauma cases is expected.…”

Section: Discussionmentioning

confidence: 99%

The COVID-19 Pandemic Consequences on Microsurgical Reconstructions: A Single Center’s Shift of Indications

Zindrou

Halle

Jakobsson

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Since its outbreak, the COVID-19-pandemic has had a tremendous impact on healthcare systems worldwide. We conducted a comparative study to analyze the pandemic's consequence on microsurgical reconstructions at a reconstructive plastic surgery center in Sweden. Method: All free flaps performed at a single center between March 2019 and 2021 were analyzed. The patient cohort was divided into two groups, with a period of 1 year in each group: non-COVID-19 year and COVID-19 year. The periods were compared regarding the number and type of surgeries and patient characteristics. Results: In the year prior to the pandemic, 123 free flap surgeries were performed, compared with 103 surgeries during the COVID-19 year. There was a significant shift in the most common site for free flap reconstruction: from the breast [which decreased by 42% (66-38)] to head and neck [which increased by 22% (41-50); OR 0.53 (P = 0.02)]. This was also reflected by a significant increase in hospital stay for free flap patients during the COVID-19 year (P = 0.02). Conclusions: During the COVID-19 pandemic, a shift was seen from breast reconstructions toward head and neck reconstructions as the most common free flap procedure performed. An increasing backlog of elective breast reconstructions demands increased resources and tougher priorities, which challenge the healthcare system in the post-COVID-19 era.

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Section: Discussionmentioning

confidence: 99%

The COVID-19 Pandemic Consequences on Microsurgical Reconstructions: A Single Center’s Shift of Indications

Zindrou

Halle

Jakobsson

2022

Plastic and Reconstructive Surgery - Global Open

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“…Despite this and despite a strict lockdown in London, our trauma workload persisted and, as we have demonstrated in this study, our open fracture workload remained similar to pre-COVID times. 12 , 13 The prediction was therefore, that the quality of care for open fractures was compromised due to the number of pressures placed on our service provision.…”

Section: Discussionmentioning

confidence: 99%

“…The results of this study support the findings of other recent publication on the same subject. 13 The clear impact on open fracture management will no doubt be reflected in all aspects of trauma management and further studies looking into this will contribute to service planning for future COVID-19 waves or new disease pandemics.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the management of open fractures in a major trauma centre

O’Hagan

Drummond

Lin

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Introduction The Coronavrius-19 (COVID-19) pandemic has presented the biggest challenge that the National Health Service (NHS) has ever seen. As one of the worst affected regions, Orthopaedic service provision and delivery in London, changed dramatically. Our hypothesis is that these restrictions adversely impacted the care of open fractures in our major trauma unit in London. Methods This is a prospective case control study comparing the management of patients presenting pre-COVID, to those presenting during the height of the COVID pandemic in London. The pre-COVID, control cohort presented between the 1st October and the November 30, 2019. The COVID cohort presented between the April 1, 2020 and the May 31, 2020. Data was collected that related to the 11 clinical domains of the British Orthopaedic Association Standards of Trauma (BOAST) 4 guidance, as well as early complications. Results Of the 11 domains, 100 % compliance was achieved in 6 components, across both groups where applicable. During pre-COVID times, the timing to initial debridement was within 12 h for High energy trauma in 16/28 (57.1 %), dropping to 7/22 (31.8 %) during COVID, (p = 0.004). Definitive soft tissue closure within 72 h If not achievable at initial debridement dropped from 9/10 (90.0%) to 4/6 (66.7 %), (p = 0.006). There was no significant difference in early complication rates. Conclusion Coronavirus has changed the landscape of healthcare worldwide and impacted open fracture care by increasing time to theatre. This had no effect on early complication rate but longer term effects remain to be seen.

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“…Three studies were identified, all published in 2020; Campbell et al (Royal London Hospital, East London), Gupta et al (Government Medical College, Chandigarh) and Berner et al (a multicentre study comparing results from 15 centres across 9 countries). [5][6][7] Our study compares patients admitted over a 305-day period in 2020 to a similar period in 2019, significantly more than the 48-day period seen in the Campbell study, 5 months in the Berner multicentre study, and the 118 days in the Gupta study, though unlike the Berner study we only reviewed patients in a single centre.…”

Section: Discussionmentioning

confidence: 99%

Management of open fractures of the lower limb during the COVID-19 pandemic: are the standards of treatment being maintained? A study from a major trauma centre in England

Choudhary¹,

Gupta

Huq

et al. 2021

Int J Res Orthop

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Background: Coronavirus disease 2019 (COVID 19) has created an immense strain on the NHS. During the height of the pandemic, trauma services were affected by redeployment, reduced theatre capacity and staff illness, and COVID BOAST guidelines were introduced.Methods: This retrospective study aimed to evaluate the standards of management of open fractures of the lower limb at a Major Trauma Centre in the United Kingdom during the COVID-19 pandemic and compare the same with the pre-pandemic period. Patient demographics, mechanism of injury, timing and mechanism of initial debridement and definitive soft tissue and skeletal fixation were noted. Outcomes including duration of hospital stay, 30 day and 1 year mortality were also assessed.Results: There was an overall 21% reduction in admissions with open lower limb fractures during the pandemic period with a 48% reduction during the first lockdown. There was a significant reduction in time taken from Emergency Department presentation to first debridement as well as a notable increase in operating outside of regular theatre hours. There was little difference in operative technique used for skeletal or soft tissue management at initial and definitive surgery, though fewer cases were performed as a two stage procedure. There was no difference in amputation rate in the two years. Length of stay was reduced from 21 days to 17, and 30 day mortality remained the same.Conclusions: Our study shows this Major Trauma Centre was able to provide a trauma service in accordance to the BOAST4 guidelines despite the increased pressures of the COVID-19 pandemic.

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The COVID-19 Pandemic: The effect on open lower limb fractures in a London major trauma centre - a plastic surgery perspective

Cited by 11 publications

References 4 publications

The COVID-19 Pandemic Consequences on Microsurgical Reconstructions: A Single Center’s Shift of Indications

The COVID-19 Pandemic Consequences on Microsurgical Reconstructions: A Single Center’s Shift of Indications

Impact of the COVID-19 pandemic on the management of open fractures in a major trauma centre

Management of open fractures of the lower limb during the COVID-19 pandemic: are the standards of treatment being maintained? A study from a major trauma centre in England

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