From the Department of Orthopedic Surgery, University of Minnesota, and M Health Fairview Hospitals, Minneapolis, MN.
J Am Acad Orthop Surg. 2021 Nov 1;29(21):e1078-e1086. doi: 10.5435/JAAOS-D-20-00631.
The current COVID-19 disease pandemic has delayed nonurgent orthopaedic procedures to adequately care for those affected by the severe acute respiratory syndrome coronavirus 2, resulting in a backlog in orthopaedic surgical care. As the capacity for orthopaedic surgeries expands or contracts, allocation of limited resources in a manner that adequately reflects medical necessity and urgency is paramount. An orthopaedic surgery-specific prioritization schema with proven reliability is lacking. The primary aim of this study was to assess the reliability of a newly developed prioritization list used for the phased reinstatement of orthopaedic surgical procedures during the COVID-19 pandemic and afterward. The secondary aim was to report its implementation.
A consensus-based, orthopaedic surgery-specific, tiered prioritization list reflecting various levels of urgency was created by a committee of orthopaedic surgeons covering all subspecialties and representing academic, multispecialty, and private community practices. Reliability was tested for 63 randomized cases representing all orthopaedic subspecialties. Four raters evaluated the cases independently at two separate time points, at least one week apart. Fleiss kappa was used to assess intrarater and interrater agreement. Implementation were assessed by surveying both surgeons and the surgery scheduling administrative personnel at each surgical facility within a large health system for any adoption issues.
Case distributions within tiers 1, 2, 3, and 4 were 35%, 14%, 27%, and 24%, respectively. Interrater agreement ranged from 0.63 (95% confidence interval [CI] 0.57 to 0.69) to 0.72 (95% CI 0.66 to 0.78) for the ratings. Intrarater reliability ranged from 0.62 to 1.0. The highest levels of agreement were in tiers 1, 4, and the subspecialties oncology and foot/ankle. The time from development to full scale adoption and implementation by all orthopaedic surgeons was rapid.
This tiered prioritization list for orthopaedic procedures is both adoptable and reliable during the phased reinstatement of procedures during the COVID-19 pandemic and afterward. Further refinements may enhance utility.
Reliability study: Level I (Evid Based Spine Care J 2014 October;5(2):166. doi: 10.1055/s-0034-1394106).
当前的 COVID-19 疾病大流行延迟了非紧急的矫形手术，以便为受严重急性呼吸系统综合征冠状病毒 2 影响的患者提供充分的治疗，从而导致矫形外科手术治疗积压。随着矫形外科手术能力的扩大或缩小，以充分反映医疗必要性和紧迫性的方式分配有限的资源至关重要。缺乏经过验证的可靠性的特定于矫形外科的优先级方案。本研究的主要目的是评估在 COVID-19 大流行期间以及之后逐步恢复矫形外科手术期间使用的新开发的优先级列表的可靠性。次要目的是报告其实施情况。
一个由涵盖所有亚专业的骨科医生组成的委员会创建了一个基于共识的、特定于矫形外科的、分层的优先级列表，反映了不同级别的紧迫性。通过至少相隔一周的两个独立时间点，由四名评估者对代表所有矫形亚专业的 63 个随机病例进行评估。使用 Fleiss kappa 评估内部和外部评估者之间的一致性。通过在一个大型卫生系统内的每个外科设施中调查外科医生和手术调度行政人员，评估实施情况，以了解任何采用问题。
第 1、2、3 和 4 层的病例分布分别为 35%、14%、27%和 24%。评分的组间一致性范围为 0.63（95%置信区间 [CI] 0.57 至 0.69）至 0.72（95% CI 0.66 至 0.78）。内部评估者可靠性范围为 0.62 至 1.0。在第 1、4 层和肿瘤学和足踝亚专业的最高水平的一致性。从制定到所有骨科医生全面采用和实施的时间很快。
该分级优先级列表可用于在 COVID-19 大流行期间和之后逐步恢复手术程序，并且可靠。进一步改进可能会提高实用性。
可靠性研究：I 级（Evid Based Spine Care J 2014 年 10 月；5(2)：166。doi：10.1055/s-0034-1394106）。
