Cargando…

Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative

OBJECTIVE: This is the first British multicentre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak. DESIGN: A longitudinal, multicentre, retrospective, observational, cohort study was conducted during...

Descripción completa

Detalles Bibliográficos
Autores principales: Sugand, Kapil, Aframian, Arash, Park, Chang, Sarraf, Khaled M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771810/
https://www.ncbi.nlm.nih.gov/pubmed/35042707
http://dx.doi.org/10.1136/bmjopen-2021-054919
_version_ 1784635696293609472
author Sugand, Kapil
Aframian, Arash
Park, Chang
Sarraf, Khaled M
author_facet Sugand, Kapil
Aframian, Arash
Park, Chang
Sarraf, Khaled M
author_sort Sugand, Kapil
collection PubMed
description OBJECTIVE: This is the first British multicentre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak. DESIGN: A longitudinal, multicentre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from 17 March 2020 compared with the same period in 2019. SETTING: Hospitals from six major urban cities were recruited around the UK, including London. PARTICIPANTS: A total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia used. RESULTS: During the COVID-19 period, there was a 34% reduction in acute orthopaedic trauma referrals compared with 2019 (1792 down to 1183 referrals), and a 29.5% reduction in surgical interventions (993 down to 700 operations). The mortality rate was more than doubled for both risk and odds ratios during the COVID-19 period for all referrals (1.3% vs 3.8%, p=0.0005) and for those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-19-related complications (vs non-COVID-19 causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID-19, there was an increase in odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters, as well as doubled odds of a consultant acting as the primary surgeon. CONCLUSION: Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared with the same time interval 1 year ago.
format Online
Article
Text
id pubmed-8771810
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-87718102022-01-20 Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative Sugand, Kapil Aframian, Arash Park, Chang Sarraf, Khaled M BMJ Open Surgery OBJECTIVE: This is the first British multicentre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak. DESIGN: A longitudinal, multicentre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from 17 March 2020 compared with the same period in 2019. SETTING: Hospitals from six major urban cities were recruited around the UK, including London. PARTICIPANTS: A total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia used. RESULTS: During the COVID-19 period, there was a 34% reduction in acute orthopaedic trauma referrals compared with 2019 (1792 down to 1183 referrals), and a 29.5% reduction in surgical interventions (993 down to 700 operations). The mortality rate was more than doubled for both risk and odds ratios during the COVID-19 period for all referrals (1.3% vs 3.8%, p=0.0005) and for those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-19-related complications (vs non-COVID-19 causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID-19, there was an increase in odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters, as well as doubled odds of a consultant acting as the primary surgeon. CONCLUSION: Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared with the same time interval 1 year ago. BMJ Publishing Group 2022-01-18 /pmc/articles/PMC8771810/ /pubmed/35042707 http://dx.doi.org/10.1136/bmjopen-2021-054919 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Surgery
Sugand, Kapil
Aframian, Arash
Park, Chang
Sarraf, Khaled M
Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative
title Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative
title_full Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative
title_fullStr Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative
title_full_unstemmed Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative
title_short Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative
title_sort impact of covid-19 on acute trauma and orthopaedic referrals and surgery in the uk during the first wave of the pandemic: a multicentre observational study from the covid emergency-related trauma and orthopaedics (covert) collaborative
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771810/
https://www.ncbi.nlm.nih.gov/pubmed/35042707
http://dx.doi.org/10.1136/bmjopen-2021-054919
work_keys_str_mv AT sugandkapil impactofcovid19onacutetraumaandorthopaedicreferralsandsurgeryintheukduringthefirstwaveofthepandemicamulticentreobservationalstudyfromthecovidemergencyrelatedtraumaandorthopaedicscovertcollaborative
AT aframianarash impactofcovid19onacutetraumaandorthopaedicreferralsandsurgeryintheukduringthefirstwaveofthepandemicamulticentreobservationalstudyfromthecovidemergencyrelatedtraumaandorthopaedicscovertcollaborative
AT parkchang impactofcovid19onacutetraumaandorthopaedicreferralsandsurgeryintheukduringthefirstwaveofthepandemicamulticentreobservationalstudyfromthecovidemergencyrelatedtraumaandorthopaedicscovertcollaborative
AT sarrafkhaledm impactofcovid19onacutetraumaandorthopaedicreferralsandsurgeryintheukduringthefirstwaveofthepandemicamulticentreobservationalstudyfromthecovidemergencyrelatedtraumaandorthopaedicscovertcollaborative
AT impactofcovid19onacutetraumaandorthopaedicreferralsandsurgeryintheukduringthefirstwaveofthepandemicamulticentreobservationalstudyfromthecovidemergencyrelatedtraumaandorthopaedicscovertcollaborative