Karayiannis Paul N, Roberts Veronica, Cassidy Roslyn, Mayne Alistair I W, McAuley Daryl, Milligan David J, Diamond Owen
Trauma and Orthopaedics, Craigavon Area Hospital, Craigavon, UK.
Craigavon Area Hospital, Craigavon, UK.
Bone Jt Open. 2020 Nov 2;1(7):392-397. doi: 10.1302/2633-1462.17.BJO-2020-0075.R1. eCollection 2020 Jul.
Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing orthopaedic surgery during the peak of the pandemic within our region.
This multicentre study reviewed data on all patients undergoing trauma and orthopaedic surgery in a region from 18 March 2020 to 27 April 2020. Information was collated from regional databases. Patients were COVID-19-positive if they had positive laboratory testing and/or imaging consistent with the infection. 30-day mortality was assessed for all patients. Secondly, 30-day mortality in fracture neck of femur patients was compared to the same time period in 2019.
Overall, 496 operations were carried out in 484 patients. The overall 30-day mortality was 1.9%. Seven out of nine deceased patients underwent surgery for a fractured neck of femur. In all, 27 patients contracted COVID-19 in the peri-operative period; of these, four patients died within 30 days (14.8%). In addition, 21 of the 27 patients in this group had a fractured neck of femur, 22 were over the age of 70 years (81.5%). Patients with American Society of Anesthesiologists (ASA) grade > 3 and/or age > 75 years were at significantly higher risk of death if they contracted COVID-19 within the study period.
Overall 30-day postoperative mortality in trauma and orthopaedic surgery patients remains low at 1.9%. There was no 30-day mortality in patients ASA 1 or 2. Patients with significant comorbidities, increasing age, and ASA 3 or above remain at the highest risk. For patients with COVID-19 infection, postoperative 30-day mortality was 14.8%. The reintroduction of elective services should consider individual patient risk profile (including for ASA grade). Effective postoperative strategies should also be employed to try and reduce postoperative exposure to the virus.Cite this article: 2020;1-7:392-397.
鉴于我们正处于新冠疫情的减速阶段，重点已转向如何安全恢复择期手术。特定地区和专业的数据对于指导这一决策过程很重要。本研究旨在回顾本地区疫情高峰期所有接受骨科手术患者的30天死亡率。
这项多中心研究回顾了2020年3月18日至2020年4月27日期间该地区所有接受创伤和骨科手术患者的数据。信息从地区数据库整理而来。如果患者实验室检测呈阳性和/或影像学检查结果与感染相符，则判定为新冠阳性。评估所有患者的30天死亡率。其次，将股骨颈骨折患者的30天死亡率与2019年同期进行比较。
总体而言，484例患者共进行了496台手术。总体30天死亡率为1.9%。9例死亡患者中有7例接受了股骨颈骨折手术。共有27例患者在围手术期感染新冠；其中4例患者在30天内死亡（14.8%）。此外，该组27例患者中有21例为股骨颈骨折，22例年龄超过70岁（81.5%）。如果在研究期间感染新冠，美国麻醉医师协会（ASA）分级>3级和/或年龄>75岁的患者死亡风险显著更高。
创伤和骨科手术患者术后30天总体死亡率仍较低，为1.9%。ASA 1级或2级患者无30天死亡率。合并症严重、年龄增加以及ASA 3级及以上的患者风险最高。对于感染新冠的患者，术后30天死亡率为14.8%。恢复择期手术应考虑个体患者风险状况（包括ASA分级）。还应采用有效的术后策略，试图减少术后接触病毒的机会。引用本文：2020;1 - 7:392 - 397。
