Logishetty Kartik, Edwards Thomas C, Subbiah Ponniah Hariharan, Ahmed Marriam, Liddle Alexander D, Cobb Justin, Clark Callum
MSk lab, Imperial College London, London, UK.
Frimley Health NHS Foundation Trust, Frimley, UK.
Bone Jt Open. 2021 Feb;2(2):134-140. doi: 10.1302/2633-1462.22.BJO-2020-0200.R1.
Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites.
A multidisciplinary surgical prioritization committee developed the SPAG, incorporating procedural urgency, shared decision-making, patient safety, and biopsychosocial factors; and applied it to 1,142 adult patients awaiting orthopaedic surgery. Patients were stratified into four priority groups and underwent surgery at three COVID-free sites, including one with access to a high dependency unit (HDU) or intensive care unit (ICU) and specialist resources. Safety was assessed by the number of patients requiring inpatient postoperative HDU/ICU admission, contracting COVID-19 within 14 days postoperatively, and mortality within 30 days postoperatively.
A total of 1,142 patients were included, 47 declined surgery, and 110 were deemed high-risk or requiring specialist resources. In the ten-week study period, 28 high-risk patients underwent surgery, during which 68% (13/19) of Priority 2 (P, surgery within one month) patients underwent surgery, and 15% (3/20) of P (< three months) and 16% (11/71) of P (> three months) groups. Of the 1,032 low-risk patients, 322 patients underwent surgery. Overall, 21 P and P patients were expedited to 'Urgent' based on biopsychosocial factors identified by the SPAG. During the study period, 91% (19/21) of the Urgent group, 52% (49/95) of P, 36% (70/196) of P, and 26% (184/720) of P underwent surgery. No patients died or were admitted to HDU/ICU, or contracted COVID-19.
Our widely generalizable model enabled the restart of planned surgery during the COVID-19 pandemic, without compromising patient safety or excluding high-risk or complex cases. Patients classified as Urgent or P were most likely to undergo surgery, including those deemed high-risk. This model, which includes assessment of biopsychosocial factors alongside disease severity, can assist in equitably prioritizing the substantial list of patients now awaiting planned orthopaedic surgery worldwide. Cite this article: 2021;2(2):134-140.
在新冠疫情期间重启计划性手术是一项临床和社会优先事项，但能否安全进行以及是否纳入高风险或复杂病例尚不清楚。我们制定了一份手术优先级和分配指南（SPAG）。在此，我们在无新冠病毒的地点验证其有效性和安全性。
一个多学科手术优先级委员会制定了SPAG，纳入了手术紧迫性、共同决策、患者安全以及生物心理社会因素；并将其应用于1142名等待骨科手术的成年患者。患者被分为四个优先级组，并在三个无新冠病毒的地点接受手术，其中一个地点可使用高依赖病房（HDU）或重症监护病房（ICU）以及专业资源。通过术后需要入住HDU/ICU的患者数量、术后14天内感染新冠病毒的患者数量以及术后30天内的死亡率来评估安全性。
共纳入1142名患者，47名拒绝手术，110名被视为高风险或需要专业资源。在为期十周的研究期间，28名高风险患者接受了手术，在此期间，2级（P，一个月内手术）患者中有68%（13/19）接受了手术，<三个月的P组中有15%（3/20），>三个月的P组中有16%（11/71）。在1032名低风险患者中，322名患者接受了手术。总体而言，根据SPAG确定的生物心理社会因素，21名P组和P组患者被加快列为“紧急”。在研究期间，紧急组中有91%（19/21）、P组中有52%（49/95）、P组中有36%（70/196）、P组中有26%（184/720）接受了手术。没有患者死亡、入住HDU/ICU或感染新冠病毒。
我们的广泛适用模型使得在新冠疫情期间能够重启计划性手术，同时不影响患者安全，也不排除高风险或复杂病例。被列为紧急或P级的患者最有可能接受手术，包括那些被视为高风险的患者。该模型除了评估疾病严重程度外，还包括对生物心理社会因素的评估，有助于公平地对目前全球等待计划性骨科手术的大量患者进行优先级排序。引用本文：2021；2（2）：134 - 140。
