Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos, 2, 28040, Madrid, Spain.
Int Orthop. 2020 Aug;44(8):1557-1564. doi: 10.1007/s00264-020-04647-1. Epub 2020 May 30.
SARS-CoV-2's new scenario has forced health systems to work under extreme stress urging to perform a complete reorganization of the way our means and activities were organized. The orthopaedic and trauma units have rescheduled their activities to help SARS-CoV-2 units, but trauma patients require also treatment, and no standardized protocols have been established.
A single-centre cross-sectional study was performed in a tertiary hospital. Two different periods of time were analyzed: a two week period of time in March 2019 (pre-SARS-CoV-2) and the same period in March 2020 (SARS-CoV-2 pandemic time). Outpatient's data, emergency activity, surgical procedures, and admissions were evaluated. Surgeons' and patient's opinion was also evaluated using a survey.
A total of ~ 16k (15,953) patients were evaluated. Scheduled clinical appointments decreased by ~ 22%. Urgent consultations and discharge from clinics also descended (~ 37% and ~ 20% respectively). Telemedicine was used in 90% of outpatient clinical evaluations. No elective surgical procedures during SARS-CoV-2 time were scheduled, and subtracting the effect of elective surgeries, there was a reduction of inpatient surgeries, from ~ 85% to ~ 59%. Patients delayed trauma assistance more than 48 hours in 13 cases (35%). Pre-operative admission for hip fractures decreased in ten hours on average. Finally, surveys stated that patients were more in favour than surgeons were to this new way to evaluate orthopaedic and trauma patients based strongly on telemedicine.
Detailed protocols should be standardized for surgical departments during the pandemic. This paper offers a general view in how this virus affects an orthopaedic unit and could serve as a protocol and example for orthopaedic and trauma units. Even in the worst scenario, an orthopaedic and trauma unit could offer an effective, efficient, and quality service. SARS-CoV-2 will set up a new paradigm for health care in orthopaedics and trauma.
SARS-CoV-2 的新情况迫使卫生系统在极端压力下工作，迫切需要对我们的手段和活动的组织方式进行全面重组。骨科和创伤单位已经调整了他们的活动以帮助 SARS-CoV-2 单位，但创伤患者也需要治疗，而且尚未制定标准化的协议。
在一家三级医院进行了一项单中心横断面研究。分析了两个不同的时间段：2019 年 3 月的两周时间（SARS-CoV-2 前）和 2020 年 3 月的同一时期（SARS-CoV-2 大流行期间）。评估了门诊患者的数据、急诊活动、手术程序和入院情况。还使用调查评估了外科医生和患者的意见。
共评估了约 16k（15953）名患者。预约的临床就诊减少了约 22%。紧急咨询和从诊所出院的人数也下降了（分别约为 37%和 20%）。90%的门诊临床评估都采用了远程医疗。SARS-CoV-2 期间没有安排任何择期手术，减去择期手术的影响，住院手术减少，从约 85%降至约 59%。13 例患者（35%）延迟创伤援助超过 48 小时。髋部骨折的术前入院时间平均减少了 10 小时。最后，调查表明，患者比外科医生更支持这种基于远程医疗评估骨科和创伤患者的新方法。
在大流行期间，外科部门应制定详细的协议。本文提供了一种病毒如何影响骨科单位的总体看法，并可作为骨科和创伤单位的协议和范例。即使在最坏的情况下，骨科和创伤单位也可以提供有效、高效和高质量的服务。SARS-CoV-2 将为骨科和创伤的医疗保健建立一个新的范例。
