Pooling of neglected and delayed trauma patients – Consequences of ‘lockdown’ and ‘Unlock’ phases of COVID-19 pandemic- A retrospective cohort analysis from a tertiary centre

BACKGROUND: The COVID-19 pandemic resulted in nationwide lockdown and quarantine strategies to break the chain of transmission of the SARS-CoV-2 virus in India. Management of patients with trauma has been particularly challenging across the country. AIMS: To evaluate the effect of delay in surgery in patients with traumatic injuries along with the peri-operative outcomes during the ‘Lockdown’ and ‘Unlock’ phases of the COVID-19 pandemic at a Level I Trauma centre in the National Capital Region (NCR) of India. METHODS: This retrospective, observational cohort study included 488 patients. Comparative analysis to assess patient characteristics, mechanism of trauma, clinical outcomes in patients managed operatively during ‘Lockdown period’ (24 March 2020 to 31 May 2020) Group A with Group B, who presented during ‘Unlock phases’ (01 June 2020 to 31 December 2020). RESULTS: The average delay in surgery, surgical time and hospital stay was significantly increased in group B patients (p-value <0.05). The average blood loss, stay in the Intensive Care Unit (ICU) and blood transfusion requirement were clinically higher in group B but these differences were not statistically significant (p-value >0.05). Only in group B; 9.01% patients (42 out of 466) required bone grafting. CONCLUSION: ‘Neglect’ and delay in receiving operative management of orthopaedic trauma has led to unprecedented rise in number of complications of fractures, such as mal-union, delayed union or non-union during COVID-19 Pandemic. Patients have had to undergo longer surgical procedures with increased risk of intra-operative blood loss, need of peri-operative blood transfusion and bone grafting supplementation to facilitate union. Diligent attention to achieve the most optimal configuration of fractures should be planned in conservatively managed injuries during the pandemic to minimize future intra-operative difficulties.