Fitzgerald Michael J, Goodman Howard J, Kenan Samuel, Kenan Shachar
Department of Orthopaedics, North Shore-Long Island Jewish Hospital, Northwell Health Medical Center, New Hyde Park, New York, USA.
Bone Jt Open. 2021 Apr;2(4):236-242. doi: 10.1302/2633-1462.24.BJO-2021-0005.R1.
The aim of this study was to assess orthopaedic oncologic patient morbidity resulting from COVID-19 related institutional delays and surgical shutdowns during the first wave of the pandemic in New York, USA.
A single-centre retrospective observational study was conducted of all orthopaedic oncologic patients undergoing surgical evaluation from March to June 2020. Patients were prioritized as level 0-IV, 0 being elective and IV being emergent. Only priority levels 0 to III were included. Delay duration was measured in days and resulting morbidities were categorized into seven groups: prolonged pain/disability; unplanned preoperative radiation and/or chemotherapy; local tumour progression; increased systemic disease; missed opportunity for surgery due to progression of disease/lost to follow up; delay in diagnosis; and no morbidity.
Overall, 25 patients met inclusion criteria. There were eight benign tumours, seven metastatic, seven primary sarcomas, one multiple myeloma, and two patients without a biopsy proven diagnosis. There was no priority level 0, two priority level I, six priority level II, and 17 priority level III cases. The mean duration of delay for priority level I was 114 days (84 to 143), priority level II was 88 days (63 to 133), and priority level III was 77 days (35 to 269). Prolonged pain/disability and delay in diagnosis, affecting 52% and 40%,respectively, represented the two most frequent morbidities. Local tumour progression and increased systemic disease affected 32% and 24% respectively. No patients tested positive for COVID-19.
COVID-19 related delays in surgical management led to major morbidity in this studied orthopaedic oncologic patient population. By understanding these morbidities through clearer hindsight, a thoughtful approach can be developed to balance the risk of COVID-19 exposure versus delay in treatment, ensuring optimal care for orthopedic oncologic patients as the pandemic continues with intermittent calls for halting surgery. Cite this article: 2021;2(4):236-242.
本研究旨在评估美国纽约第一波疫情期间，因新冠疫情相关的机构延误和手术暂停而导致的骨科肿瘤患者的发病率。
对2020年3月至6月期间所有接受手术评估的骨科肿瘤患者进行了一项单中心回顾性观察研究。患者被分为0-IV级，0级为择期手术，IV级为急诊手术。仅纳入0至III级患者。延误时间以天为单位进行测量，由此导致的发病率分为七组：疼痛/残疾时间延长；计划外的术前放疗和/或化疗；局部肿瘤进展；全身疾病加重；因疾病进展/失访而错过手术时机；诊断延误；以及无发病情况。
总体而言，25例患者符合纳入标准。其中有8例良性肿瘤、7例转移性肿瘤、7例原发性肉瘤、1例多发性骨髓瘤，以及2例未经活检确诊的患者。无0级病例，2例I级病例，6例II级病例，17例III级病例。I级患者的平均延误时间为114天（84至143天），II级为88天（63至133天），III级为77天（35至269天）。疼痛/残疾时间延长和诊断延误分别影响了52%和40%的患者，是最常见的两种发病情况。局部肿瘤进展和全身疾病加重分别影响了32%和24%的患者。没有患者新冠病毒检测呈阳性。
新冠疫情相关的手术管理延误导致了本研究中骨科肿瘤患者群体出现严重发病情况。通过更清晰的事后分析了解这些发病情况，可以制定出一种周全的方法，以平衡新冠病毒暴露风险与治疗延误风险，在疫情持续且不时呼吁暂停手术的情况下，确保为骨科肿瘤患者提供最佳治疗。引用本文：2021；2(4):236-242。
