Liow Ming Han Lincoln, Tay Kenny Xian Khing, Yeo Nicholas Eng Meng, Tay Darren Keng Jin, Goh Seo Kiat, Koh Joyce Suang Bee, Howe Tet Sen, Tan Andrew Hwee Chye
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
Bone Jt Open. 2020 Jun 9;1(6):222-228. doi: 10.1302/2633-1462.16.BJO-2020-0036.R1. eCollection 2020 Jun.
The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges to healthcare systems worldwide. Orthopaedic departments have adopted business continuity models and guidelines for essential and non-essential surgeries to preserve hospital resources as well as protect patients and staff. These guidelines broadly encompass reduction of ambulatory care with a move towards telemedicine, redeployment of orthopaedic surgeons/residents to the frontline battle against COVID-19, continuation of education and research through web-based means, and cancellation of non-essential elective procedures. However, if containment of COVID-19 community spread is achieved, resumption of elective orthopaedic procedures and transition plans to return to normalcy must be considered for orthopaedic departments. The COVID-19 pandemic also presents a moral dilemma to the orthopaedic surgeon considering elective procedures. What is the best treatment for our patients and how does the fear of COVID-19 influence the risk-benefit discussion during a pandemic? Surgeons must deliberate the fine balance between elective surgery for a patient's wellbeing versus risks to the operating team and utilization of precious hospital resources. Attrition of healthcare workers or Orthopaedic surgeons from restarting elective procedures prematurely or in an unsafe manner may render us ill-equipped to handle the second wave of infections. This highlights the need to develop effective screening protocols or preoperative COVID-19 testing before elective procedures in high-risk, elderly individuals with comorbidities. Alternatively, high-risk individuals should be postponed until the risk of nosocomial COVID-19 infection is minimal. In addition, given the higher mortality and perioperative morbidity of patients with COVID-19 undergoing surgery, the decision to operate must be carefully deliberated. As we ramp-up elective services and get "back to business" as orthopaedic surgeons, we have to be constantly mindful to proceed in a cautious and calibrated fashion, delivering the best care, while maintaining utmost vigilance to prevent the resurgence of COVID-19 during this critical transition period. Cite this article: 2020;1-6:222-228.
2019年冠状病毒病（COVID-19）大流行给全球医疗系统带来了前所未有的挑战。骨科部门采用了业务连续性模式以及针对必要和非必要手术的指导方针，以保护医院资源，并保护患者和工作人员。这些指导方针大致包括减少门诊护理并转向远程医疗、将骨科医生/住院医师重新部署到抗击COVID-19的一线、通过网络手段继续开展教育和研究，以及取消非必要的择期手术。然而，如果实现了对COVID-19社区传播的控制，骨科部门必须考虑恢复择期骨科手术以及恢复正常的过渡计划。COVID-19大流行也给考虑进行择期手术的骨科医生带来了道德困境。对我们的患者而言，最佳治疗方案是什么，以及对COVID-19的恐惧如何在大流行期间影响风险效益讨论？外科医生必须仔细权衡为了患者健康进行择期手术与对手术团队的风险以及宝贵医院资源的利用之间的微妙平衡。医护人员或骨科医生因过早或以不安全方式重新开展择期手术而流失，可能会使我们在应对第二波感染时准备不足。这凸显了在高风险、患有合并症的老年患者进行择期手术前，制定有效的筛查方案或进行术前COVID-19检测的必要性。或者，高风险个体应推迟手术，直到医院感染COVID-19的风险降至最低。此外，鉴于接受手术的COVID-19患者死亡率和围手术期发病率较高，必须谨慎考虑手术决策。当我们作为骨科医生增加择期服务并“恢复业务”时，我们必须始终谨慎行事，以谨慎和适度的方式推进，提供最佳护理，同时在这个关键的过渡时期保持高度警惕，防止COVID-19卷土重来。引用本文：2020；1 - 6：222 - 228。
