Chang Justin S, Wignadasan Warran, Pradhan Raj, Kontoghiorghe Christina, Kayani Babar, Haddad Fares S
Department of Trauma and Orthopaedic Surgery, University College London, London, UK.
The Princess Grace Hospital, London, UK.
Bone Jt Open. 2020 Sep 14;1(9):562-567. doi: 10.1302/2633-1462.19.BJO-2020-0110.R1. eCollection 2020 Sep.
The safe resumption of elective orthopaedic surgery following the peak of the COVID-19 pandemic remains a significant challenge. A number of institutions have developed a COVID-free pathway for elective surgery patients in order to minimize the risk of viral transmission. The aim of this study is to identify the perioperative viral transmission rate in elective orthopaedic patients following the restart of elective surgery.
This is a prospective study of 121 patients who underwent elective orthopaedic procedures through a COVID-free pathway. All patients underwent a 14-day period of self-isolation, had a negative COVID-19 test within 72 hours of surgery, and underwent surgery at a COVID-free site. Baseline patient characteristics were recorded including age, American Society of Anaesthesiologists (ASA) grade, body mass index (BMI), procedure, and admission type. Patients were contacted 14 days following discharge to determine if they had had a positive COVID-19 test (COVID-confirmed) or developed symptoms consistent with COVID-19 (COVID-19-presumed).
The study included 74 females (61.2%) and 47 males (38.8%) with a mean age of 52.3 years ± 17.6 years (18 to 83 years). The ASA grade was grade I in 26 patients (21.5%), grade II in 70 patients (57.9%), grade III in 24 patients (19.8%), and grade IV in one patient (0.8%). A total of 18 patients (14.9%) had underlying cardiovascular disease, 17 (14.0%) had pulmonary disease, and eight (6.6%) had diabetes mellitus. No patients (0%) had a positive COVID-19 test in the postoperative period. One patient (0.8%) developed anosmia postoperatively without respiratory symptoms or a fever. The patient did not undergo a COVID-19 test and self-isolated for seven days. Her symptoms resolved within a few days.
The development of a COVID-free pathway for elective orthopaedic patients results in very low viral transmission rates. While both surgeons and patients should remain vigilant, elective surgery can be safely restarted using dedicated pathways and procedures.Cite this article: 2020;1-9:562-567.
在新型冠状病毒肺炎（COVID-19）疫情高峰过后，安全恢复择期骨科手术仍是一项重大挑战。许多机构已为择期手术患者制定了无COVID-19路径，以尽量降低病毒传播风险。本研究的目的是确定择期骨科手术重新开展后，围手术期病毒传播率。
这是一项对121例通过无COVID-19路径接受择期骨科手术患者的前瞻性研究。所有患者均进行了为期14天的自我隔离，在手术72小时内COVID-19检测呈阴性，并在无COVID-19的地点接受手术。记录患者的基线特征，包括年龄、美国麻醉医师协会（ASA）分级、体重指数（BMI）、手术方式和入院类型。出院14天后联系患者，以确定他们的COVID-19检测是否呈阳性（COVID确诊）或是否出现与COVID-19一致的症状（疑似COVID-19）。
该研究纳入74名女性（61.2%）和47名男性（38.8%），平均年龄为52.3岁±17.6岁（18至83岁）。ASA分级为I级的患者有26例（21.5%），II级70例（57.9%），III级24例（19.8%），IV级1例（0.8%）。共有18例患者（14.9%）患有基础心血管疾病，17例（14.0%）患有肺部疾病，8例（6.6%）患有糖尿病。术后无患者（0%）COVID-19检测呈阳性。1例患者（0.8%）术后出现嗅觉丧失，无呼吸道症状或发热。该患者未进行COVID-19检测，自我隔离7天。其症状在数天内缓解。
为择期骨科患者制定无COVID-19路径可使病毒传播率极低。虽然外科医生和患者都应保持警惕，但使用专门的路径和程序可以安全地重新开展择期手术。引用本文：2020；1 - 9：562 - 567。
