The impact of COVID-19 pandemic on bone and soft tissue tumor treatment: a single institution study

Abstract

Background: The spread of coronavirus disease 2019 (COVID-19) has caused severe damage to routine medical care. This study aimed to investigate the impact of COVID-19 on bone and soft tissue tumor treatment at a single center. Methods: A retrospective comparative study was conducted between two groups of patients who received treatment at Osaka City University Hospital during the peak of the COVID-19 pandemic (February-December 2020, Group C) and during the same period the previous year (February to December 2019, Group NC). Clinical data, including patient's age, sex, tumor site, type of neoplasms, number of surgical cases for inpatients and outpatients, operation time, use of implant, length of hospital stay, inpatient hospitalization costs, number of inpatients receiving anticancer drugs, and postoperative complications in these two groups were retrospectively evaluated. Results: The number of cases of malignant bone and soft tissue tumors that were resected during hospitalization was predominantly higher in Group C than in Group NC ( P =0.01). There were no significant differences in operation time, use of implant, and postoperative complications between Groups C and NC; however, there were significant differences in the length of hospital stay and hospitalization cost ( P <0.001). Conclusions: Globally, COVID-19 has affected several areas adversely. The present study showed that the COVID-19 pandemic had an impact on the hospitalization cost and length of hospital stay during the treatment of bone and soft tissue tumor.

Impact of the COVID-19 on the surgical management of bone and soft tissue sarcoma: A systematic review

“…Ban et al reported a significantly longer period of hospital stay due to the requirement of performing CT scan prior to patient admissions and/or surgeries which have greatly impacted the Japanese economic footing. 7 Although a similar recommendation is being imposed in France, CT scan was not as practical to be regularly performed in real life. 28 …”

“…Due to personnel limitation within the operating theater, this practice was unavailable which further restricted the type of surgery options. 7 Furthermore, in attempting to control COVID-19 transmission, maximum surgery duration in some medical centers had been limited and had surgeons to re-evaluate their treatment approach for malignant sarcoma patients. 5 , 20…”

“…Several studies have reported amputation to be preferred compared to limb-salvage procedure, 9 , 20 , 24 while some still reported higher limb-salvage surgeries. 7 , 12 , 25 Amputation was preferred in some centers due to shorter time spent in the operating theater, require simpler reconstruction and provide better control of malignancy 18 , 20 , 24 . As mentioned earlier, malignant primary bone and soft tissue tumors are prioritized to have surgical treatment as needed, setting aside elective surgeries such as arthroplasties or arthroscopies.…”

“… 26 Compared to the pre-pandemic period, there seemed to be no difference, and rather, an increased number of malignant primary tumor resection performed since the COVID-19 outbreak. 6 , 7 , 12 Research conducted by the Global Health Research Group on Children's Non-Communicable Disease Collaborative (2022) found that the number of pediatric cancer patients having their choice of operation changed was 8 times more frequent in low-middle income countries. These findings are describing possible underlying factors of variety changes seen in surgery types performed for sarcoma patients during the COVID-19 pandemic.…”

“…The most basic change implemented had been the postponement of elective surgery and only continuing treatment for a limited number of urgent cases. 5 , 6 , 7 Delays that have occurred were due to manpower limitation through reallocation of health workers and prioritization of medical equipment such as ventilators reserved for COVID-positive patients. 8 Unfortunately, not all clinicians manifest the same understanding when classifying the urgency of a case where surgery must be performed regardless of the pandemic and this has caused differences in the management of bone and soft tissue sarcoma.…”