Abstract:Purpose Timing of surgery for orthopaedic injuries continues to evolve, as an improved understanding of biology, healing, and technological advances continues to challenge historical norms. With the growing COVID-19 pandemic stretching limited healthcare resources, postponing surgery becomes an inevitable and unenviable task for most orthopaedic surgeons, and a shift in outpatient paradigms is required to mitigate poor outcomes in patients. Methods A scoping review of five databases on surgical timing and orth… Show more
“…The distribution in level of evidence was as follows: 14% (n = 4) of articles were level 3, 8 , 10 , 12 , 30 14% (n = 4) were level 4, 13 , 16 , 18 , 31 and 72% (n = 21) of articles were level 5. 1 - 7 , 14 , 15 , 17 , 19 - 29 The majority of studies were categorized as expert opinion/societal guidelines (55%). The most common theme among articles was general management recommendations on the resumption of elective arthroplasty and sports medicine surgery (n = 11 articles).…”
Section: Resultsmentioning
confidence: 99%
“… 23 Tables 2 and 3 summarize the time sensitivities of arthroplasty and musculoskeletal soft tissue disorders requiring surgery, respectively, based on the recommendations in the articles included in this scoping review. 2 , 6 , 7 , 12 , 13 , 19 , 22 , 23 , 25 …”
Section: Discussionmentioning
confidence: 99%
“…During the onset of the COVID-19 pandemic, elective orthopaedic surgery was quickly deemed nonessential and postponed, with the intent to mitigate risk to the patient and surgical team, conserve personal protective equipment (PPE), and remain cautious given the uncertain trajectory of COVID-19 transmission. 2 , 31 Several reports showed a decrease of 74% in arthroplasty and 84% in sports medicine cases in the United States, with a similar reduction in arthroplasty and arthroscopy procedures globally, creating a backlog of patients awaiting surgery. 3 , 7 , 9 , 16 One study predicted between 77,000 (best-case scenario) and 372,000 (worst-case scenario) primary total hip arthroplasty and total knee arthroplasty cases in the United States would require rescheduling, with projections of catch-up time ranging from 9.09 months (best-case scenario) to 34.75 months (worst-case scenario).…”
Background: The onset of the coronavirus disease 2019 (COVID-19) pandemic has presented unforeseeable challenges to the orthopaedic community, especially arthroplasty and sports medicine subspecialities, as many surgeries were deemed nonessential and delayed. Although there is a glimpse of hope with the approval and distribution of vaccines, daily case numbers and death tolls continue to rise at the time of this review. Purpose: To summarize the available literature on the management of elective sports medicine and arthroplasty procedures in the outpatient setting to gather a consolidated source of information. Study Design: Scoping review; Level of evidence, 5. Methods: A scoping review of 3 databases (PubMed, Embase, and OVID Medline) was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. All retrospective and prospective analyses, systematic reviews and meta-analyses, expert opinions, and societal guidelines were included for review, with 29 articles meeting the inclusion criteria. Results: Guidance for resumption of elective arthroplasty and sports medicine surgery and patient selection during the COVID-19 pandemic focuses on resource availability, patient fitness, and time sensitivity of the procedure, with patient and surgical team safety as the highest priority. Telemedicine and other innovative technology can be used to continue patient care during periods of delayed surgery through monitoring disease progression and offering nonoperative management options. Conclusion: While the current societal recommendations provide guidance on safety protocols and patient prioritization, each orthopaedic practice must consider its unique situation and use evidence-based medicine when determining surgical timing and patient selection.
“…The distribution in level of evidence was as follows: 14% (n = 4) of articles were level 3, 8 , 10 , 12 , 30 14% (n = 4) were level 4, 13 , 16 , 18 , 31 and 72% (n = 21) of articles were level 5. 1 - 7 , 14 , 15 , 17 , 19 - 29 The majority of studies were categorized as expert opinion/societal guidelines (55%). The most common theme among articles was general management recommendations on the resumption of elective arthroplasty and sports medicine surgery (n = 11 articles).…”
Section: Resultsmentioning
confidence: 99%
“… 23 Tables 2 and 3 summarize the time sensitivities of arthroplasty and musculoskeletal soft tissue disorders requiring surgery, respectively, based on the recommendations in the articles included in this scoping review. 2 , 6 , 7 , 12 , 13 , 19 , 22 , 23 , 25 …”
Section: Discussionmentioning
confidence: 99%
“…During the onset of the COVID-19 pandemic, elective orthopaedic surgery was quickly deemed nonessential and postponed, with the intent to mitigate risk to the patient and surgical team, conserve personal protective equipment (PPE), and remain cautious given the uncertain trajectory of COVID-19 transmission. 2 , 31 Several reports showed a decrease of 74% in arthroplasty and 84% in sports medicine cases in the United States, with a similar reduction in arthroplasty and arthroscopy procedures globally, creating a backlog of patients awaiting surgery. 3 , 7 , 9 , 16 One study predicted between 77,000 (best-case scenario) and 372,000 (worst-case scenario) primary total hip arthroplasty and total knee arthroplasty cases in the United States would require rescheduling, with projections of catch-up time ranging from 9.09 months (best-case scenario) to 34.75 months (worst-case scenario).…”
Background: The onset of the coronavirus disease 2019 (COVID-19) pandemic has presented unforeseeable challenges to the orthopaedic community, especially arthroplasty and sports medicine subspecialities, as many surgeries were deemed nonessential and delayed. Although there is a glimpse of hope with the approval and distribution of vaccines, daily case numbers and death tolls continue to rise at the time of this review. Purpose: To summarize the available literature on the management of elective sports medicine and arthroplasty procedures in the outpatient setting to gather a consolidated source of information. Study Design: Scoping review; Level of evidence, 5. Methods: A scoping review of 3 databases (PubMed, Embase, and OVID Medline) was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. All retrospective and prospective analyses, systematic reviews and meta-analyses, expert opinions, and societal guidelines were included for review, with 29 articles meeting the inclusion criteria. Results: Guidance for resumption of elective arthroplasty and sports medicine surgery and patient selection during the COVID-19 pandemic focuses on resource availability, patient fitness, and time sensitivity of the procedure, with patient and surgical team safety as the highest priority. Telemedicine and other innovative technology can be used to continue patient care during periods of delayed surgery through monitoring disease progression and offering nonoperative management options. Conclusion: While the current societal recommendations provide guidance on safety protocols and patient prioritization, each orthopaedic practice must consider its unique situation and use evidence-based medicine when determining surgical timing and patient selection.
“…6 Ding et al performed a review specifically on timing to surgery for traumatic soft tissue injuries in order to prevent negative outcomes. 8 Testing patients for SARS-CoV-2 is considered to be necessary for a myriad of reasons. First, there is a high proportion of asymptomatic patients shedding viral matter (estimates vary across a wide range, from 5 to 80%).…”
Section: Patient Operative Urgency Grading Testing and Risk Stratifimentioning
confidence: 99%
“…• All HCWs and patients are to practise hand hygiene and wear surgical masks. 6,8,9,18,20 • All staff should practise social distancing. 6,8 • Regular decontamination of personal items such as stethoscopes and cellphones is to be done.…”
BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic is taxing South Africa's already over-burdened healthcare system. Orthopaedics is not exempt; patients present with COVID-19 and musculoskeletal pathology and so surgeons should be familiar with the current evidence to best manage patients and themselves. The aims of this scoping review were firstly to inform peri-operative decision-making for COVID-positive patients as well as the routine orthopaedic milieu during the pandemic; secondly to assess the outcomes of orthopaedic patients managed in endemic areas; and Anally to determine the effect the pandemic has had on our orthopaedic peers METHODS: A scoping review was conducted following the PRISMA-ScR guidelines of 2018. The search terms 'Orthopaedics' or 'Orthopedics' and 'COVID-19' or 'Coronavirus' were used to perform the search on Scopus, PubMed and Cochrane databases. All peer-reviewed articles utilising evidence-based methodology and addressing one of the objectives were eligible. A thematic approach was used for qualitative data synthesis RESULTS: Seventeen articles were identified for inclusion. All articles represented level 4 and 5 evidence and comprised ten review-type articles, one consensus statement, two web-based surveys and four observational studies. Most articles (n=11) addressed the objective of peri-operative considerations covering the stratification and testing of patients, theatre precautions and personal protective equipment (PPE). Evidence suggests that patients should be stratified for surgery according to the urgency of their procedure, their risk of asymptomatic disease (related to the community prevalence of COVID-19) and their comorbidities. The consensus is that all patients should be screened (asked a set of standardised questions with regard their symptoms and contacts). Only symptomatic patients and those asymptomatic patients from high prevalence areas or those with high-risk contacts should be tested. Healthcare workers (HCWs) in theatre should maintain safety precautions considering every individual is a potential contact. In the operating room in addition to the standard orthopaedic surgery PPE, if a patient is COVID positive, surgeons should don an N95 respirator. The three articles that addressed the effects on the orthopaedic surgeon showed a significant redeployment rate, effects on monetary renumeration of specialists and also effects on surgeons in training causing negative emotional ramifications. Of the surgeons who have contracted the illness and have been investigated, all showed mild symptomatology and recovered fully. The final three articles concentrated on orthopaedic patient considerations; they all showed high mortality rates in the vulnerable patient populations investigated, but had significant limitations CONCLUSION: Orthopaedics is significantly affected by the COVID pandemic but there remains a dearth of high-quality evidence to guide the specialty Level of evidence: Level 3 Keywords: COVID-19, SARS-CoV-2, coronavirus, orthopaedic, surgery
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