Ambrosio Luca, Vadalà Gianluca, Russo Fabrizio, Papalia Rocco, Denaro Vincenzo
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.
J Exp Orthop. 2020 May 27;7(1):35. doi: 10.1186/s40634-020-00255-5.
The current coronavirus disease 2019 (COVID-19) pandemic has revolutionized global healthcare in an unprecedented way and with unimaginable repercussions. Resource reallocation, socioeconomic confinement and reorganization of production activities are current challenges being faced both at the national and international levels, in a frame of uncertainty and fear. Hospitals have been restructured to provide the best care to COVID-19 patients while adopting preventive strategies not to spread the infection among healthcare providers and patients affected by other diseases. As a consequence, the concept of urgency and indications for elective treatments have been profoundly reshaped. In addition, several providers have been recruited in COVID-19 departments despite their original occupation, resulting in a profound rearrangement of both inpatient and outpatient care. Orthopaedic daily practice has been significantly affected by the pandemic. Surgical indications have been reformulated, with elective cases being promptly postponed and urgent interventions requiring exceptional attention, especially in suspected or COVID-19 patients. This has made a strong impact on inpatient management, with the need of a dedicated staff, patient isolation and restrictive visiting hour policies. On the other hand, outpatient visits have been limited to reduce contacts between patients and the hospital personnel, with considerable consequences on post-operative quality of care and the human side of medical practice.In this review, we aim to analyze the effect of the COVID-19 pandemic on the orthopaedic practice. Particular attention will be dedicated to opportune surgical indication, perioperative care and safe management of both inpatients and outpatients, also considering repercussions of the pandemic on resident education and ethical implications.
当前的2019冠状病毒病（COVID-19）大流行以前所未有的方式彻底改变了全球医疗保健，并带来了难以想象的影响。资源重新分配、社会经济限制以及生产活动的重组是国家和国际层面目前在不确定性和恐惧背景下面临的挑战。医院已进行重组，以便为COVID-19患者提供最佳护理，同时采取预防策略，防止感染在医护人员和患有其他疾病的患者之间传播。因此，紧急情况的概念以及择期治疗的适应症已被深刻重塑。此外，尽管一些医护人员原本从事其他工作，但还是被招募到了COVID-19科室，这导致住院和门诊护理都发生了深刻的重新安排。骨科的日常业务受到了大流行的显著影响。手术适应症已重新制定，择期病例被迅速推迟，紧急干预需要格外关注，尤其是在疑似或确诊COVID-19的患者中。这对住院管理产生了重大影响，需要专门的工作人员、患者隔离以及限制探视时间的政策。另一方面，门诊就诊受到限制，以减少患者与医院工作人员之间的接触，这对术后护理质量和医疗实践的人文方面产生了相当大的影响。在本综述中，我们旨在分析COVID-19大流行对骨科实践的影响。将特别关注适当的手术适应症、围手术期护理以及住院患者和门诊患者的安全管理，同时考虑大流行对住院医师教育的影响和伦理问题。
