Timeline and Procedures on Restarting Non-Emergent Arthroplasty Care in the US Epicenter of the COVID-19 Pandemic

Boettner, Friedrich; Bostrom, Mathias P.; Figgie, Mark P.; Valle, Alejandro González Della; Haas, Steven B.; Mayman, David J.; Padgett, Douglas E.

doi:10.1007/s11420-020-09801-4

Cited by 7 publications

(11 citation statements)

References 30 publications

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“…As rates of COVID-19 illness fell in New York City, elective surgical procedures at our highvolume specialty musculoskeletal center resumed. Presurgical screening was adjusted to test for serum antibodies to SARS-CoV-2 [10]. In addition, all patients underwent nasopharyngeal PCR screening within three days prior to admission, and elective surgery on PCR-positive patients was postponed in accordance with regulatory guidance.…”

Section: Introductionmentioning

confidence: 99%

History of COVID-19 Was Not Associated With Length of Stay or In-Hospital Complications After Elective Lower Extremity Joint Replacement

et al. 2022

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Section: Introductionmentioning

confidence: 99%

History of COVID-19 Was Not Associated With Length of Stay or In-Hospital Complications After Elective Lower Extremity Joint Replacement

et al. 2022

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“…Many elements of the COI Pivot Plan have also been incorporated by other institutions faced with restarting non-emergent arthroplasty during the ongoing pandemic. Screening and testing for COVID-19 prior to surgery, streamlining the presurgical process by limiting in-person contact, stringently utilizing PPE, practicing social distancing, prioritizing patients based on COVID-19 risk, and adapting the pre-and perioperative environment to limit the risk of infection are some of the elements shared in common with plans put forth by other institutions [14][15]. The present report adds to the evidence base of sound practices in proceeding with elective surgeries during a pandemic and could inform the efforts of other institutions seeking to restart non-emergent surgeries during similarly trying times in the future.…”

Section: Discussionmentioning

confidence: 99%

A COVID-19 Pivot Plan to Resume Elective Surgeries at the Hartford Healthcare Connecticut Orthopaedic Institute

Vaidya¹,

Berluti²,

Irving³

et al. 2021

Cureus

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BackgroundThe Connecticut Orthopaedic Institute (COI) conceptualized a Pivot Plan during an elective surgery moratorium at the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic with the goal of planning and executing orthopedic procedures safely. With the resumption of elective surgeries and the continued planning of surgical recovery over the months (and possibly years) to follow, facilities must brace themselves for repeat waves of COVID-19. Thereby, herein we share the Pivot Plan, its implementation process, evaluation of patient safety, and program performance during a pandemic. This could inform the efforts of other institutions seeking to restart non-emergent surgeries during similarly trying times in the future. MethodsThe COI formed a multidisciplinary team of leaders that met weekly to design a Pivot Plan and a dashboard to guide the resumption of surgeries and assess the performance of the Pivot Plan. The plan revolved around four domains: safety, space, staff, and supplies. It was implemented in two COI-affiliated facilities: MidState Medical Center (MMC) and St. Vincent's Medical Center (SVMC). Monthly metrics from May to November 2020 were compared to the six-month averages for the pre-pandemic baseline period from September 2019 to February 2020. ResultsThe total number (N) of elective orthopaedic cases prior to the pandemic pre-COVID averaged 372 cases per month for MMC and 197 cases for SVMC. During the pandemic post-COVID, N averaging at 361 for MMC and 243 for SVMC illustrates COI was able to perform elective surgeries amid a worsening pandemic. Sameday (SD) discharge rates for total joint arthroplasty (TJA) pre-COVID averaged 8% for MMC and 3% for SVMC. Post-COVID, the SD average was 16.7% for MMC and 11.4% for SVMC. This data indicates that orthopaedic providers were cognizant of length of stay in order to reduce the risk of in-hospital exposure to COVID-19. The 30-day readmission (30R) rate for TJA pre-COVID averaged 1.4% for MMC and 2.7% for SVMC. A high level of care and follow-up is reflected in a lower average 30R post-COVID, 1.1% for both MMC and SVMC. Transitions for TJA patients to their home settings after surgery also reflect the quality of care and the efficiency of the patient throughput process with necessary precautions in place. Post-COVID, the patient transition to home (T) averaged 98.1% for MMC and 97.5% for SVMC compared to T = 96.8% for MMC and 88% for SVMC pre-COVID. No patients experienced deep vein thrombosis or pulmonary embolism during the time period of the project. Positive COVID-19 diagnosis 23 days after discharge was 0% at MMC and 0.2% at SVMC. ConclusionThe COI Pivot Plan was successfully implemented at two different hospitals offering elective orthopaedic surgeries to a varied patient population. The precautions taken by COI were effective in controlling the spread of the SARS-CoV-2 virus while returning to elective orthopaedic surgery. Furthermore, data collected before and after the onset of the COVID-19 pandemic indicated ...

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“…15 The surgical management of orthopaedic affections, that is, trauma, arthroplasty, or spinal disorders, took a hard hit during the pandemic. [15][16][17][18] We identified and categorized the pandemic era into the three phases of Covid-19. We elaborate on the guidelines during each step with an assessment of the utility of Th-CT for an orthopaedic surgeon.…”

Section: Introductionmentioning

confidence: 99%

Surgical management during three phases of covid-19 pandemic with changing role of thoracic computerized tomography imaging in orthopaedic patient management: Lessons learned by orthopaedic surgeon

Govil

Tomar

Dhawan

2023

IJOR

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The coronavirus (Covid-19) pandemic has ravaged the whole world. It had affected the allied surgical branches that had to reinvent the protocols for patient management. Trauma being inevitable, needed urgent attention. The changing perspectives had a defining role in the direction of arthroplasty too.The pandemic has been considered into three different phases: 1. The acute phase of the lockdown; 2. The intermediate phase of surgical prioritization; 3. The late phase of surgical management post-vaccination.We deliberate on the impact of the pandemic on orthopaedic surgery and the role of Thoracic computerized tomography (Th-CT) imaging during Covid-19 on the surgical practice of orthopaedic surgeons. Th-CT had been useful imaging during the acute phase of lockdown in the pandemic to identify the asymptomatic Covid-19 infection and to gauge the severity of viral infection. We reviewed the guidelines formulated during each step and identified the lessons learned by the practicing orthopaedic surgeon. We further elaborate on the changes in the usage of Th-CT in the subsequent intermediate and late phases of the pandemic for orthopaedic surgeons. The critical consideration remained to achieve an uneventful recovery during the orthopaedic surgical management, to avoid the transmissibility of infection to the surgeon, and to protect the patient from the high morbidity and mortality of Covid-19 related illness. The Covid-19 pandemic has instigated orthopaedists to develop a holistic approach to deal with the new challenges during this pandemic era.

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Timeline and Procedures on Restarting Non-Emergent Arthroplasty Care in the US Epicenter of the COVID-19 Pandemic

Abstract: Brainstorming the Return to Non-Emergent Surgery After cancelling all elective surgery, the ARJR service was divided into three groups of attending surgeons and trainees. The groups functioned as autonomous cells to take care of orthopedic emergencies in our own patients HSSJ

Cited by 7 publications

References 30 publications

History of COVID-19 Was Not Associated With Length of Stay or In-Hospital Complications After Elective Lower Extremity Joint Replacement

History of COVID-19 Was Not Associated With Length of Stay or In-Hospital Complications After Elective Lower Extremity Joint Replacement

A COVID-19 Pivot Plan to Resume Elective Surgeries at the Hartford Healthcare Connecticut Orthopaedic Institute

Surgical management during three phases of covid-19 pandemic with changing role of thoracic computerized tomography imaging in orthopaedic patient management: Lessons learned by orthopaedic surgeon

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