Trauma surgery at a designated COVID-19-free site during the pandemic

Abstract

Aims Elective operating was halted during the COVID-19 pandemic to increase the capacity to provide care to an unprecedented volume of critically unwell patients. During the pandemic, the orthopaedic department at the Aneurin Bevan University Health Board restructured the trauma service, relocating semi-urgent ambulatory trauma operating to the isolated clean elective centre (St. Woolos’ Hospital) from the main hospital receiving COVID-19 patients (Royal Gwent Hospital). This study presents our experience of providing semi-urgent trauma care in a COVID-19-free surgical unit as a safe way to treat trauma patients during the pandemic and a potential model for restarting an elective orthopaedic service. Methods All patients undergoing surgery during the COVID-19 pandemic at the orthopaedic surgical unit (OSU) in St. Woolos’ Hospital from 23 March 2020 to 24 April 2020 were included. All patients that were operated on had a telephone follow-up two weeks after surgery to assess if they had experienced COVID-19 symptoms or had been tested for COVID-19. The nature of admission, operative details, and patient demographics were obtained from the health board’s electronic record. Staff were assessed for sickness, self-isolation, and COVID-19 status. Results A total of 58 surgical procedures were undertaken at the OSU during the study period; 93% (n = 54) of patients completed the telephone follow-up. Open reduction and internal fixation of ankle and wrist fractures were the most common procedures. None of the patients nor members of their households had developed symptoms suggestive of COVID-19 or required testing. No staff members reported sick days or were advised by occupational health to undergo viral testing. Conclusion This study provides optimism that orthopaedic patients planned for surgery can be protected from COVID-19 nosocomial transmission at separate COVID-19-free sites. Cite this article: Bone Joint Open 2020;1-6:302–308.

Initial assessment of framework for delivery of elective orthopaedic surgery in the United Kingdom following the COVID-19 pandemic

“…At the time of the study, routine COVID-19 testing was not available and instead patients were screened for symptoms of COVID-19 at presentation and again on admission. All patients included were asymptomatic at the time of follow-up telephone consultation which is largely in keeping with our own results and supports our suggestion that our protocol is a safe approach to providing elective orthopaedic services [ 14 ]. That said, Lei et al .…”

“…However, a limitation is that our patients did not undergo routine post-operative COVID-19 testing. That said, this approach has also had no negative implications in other studies which used targeted COVID-19 testing for symptomatic staff members only [ 14 ].…”

The rate of patient deferral and barriers to going forward with elective orthopaedic surgery during the COVID-19 pandemic

“…Lazizi et al 26 and Clough et al 27 have both demonstrated low rates of postoperative COVID-19 after hip and general trauma surgery on “cold” and elective sites of 4% and 0.9%, respectively. Gonzi et al 28 also demonstrated a zero rate of postoperative COVID-19 in a cohort of 58 patients undergoing orthopaedic surgery, the majority being related to trauma, at a COVID-19 free site. Zahra et al 3 described their “green” COVID-19 free elective orthopaedic pathway which demonstrated a high rate of patient satisfaction and a low rate of postoperative COVID-19, with only one of their 100 patients developing asymptomatic SARS-CoV-2 infection.…”

Insights into patient preferences for elective surgery during the COVID-19 pandemic

“…10 However, there are little data available about change in patient preferences and how private ("COviD-light") hospitals may influence these decisions. 11,12 in the UK, patients have been identified by nHs england and their general practitioners as either 'moderate risk' or 'high risk' based on their age and medical history. 13 patients classified as 'high risk' were advised to limit faceto-face contact as much as possible.…”