Batko Brian D, Hreha Jeremy, Potter James S, Guinand Luis, Reilly Mark C, Sirkin Michael S, Vosbikian Michael M, Adams Mark R
Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
J Clin Orthop Trauma. 2021 Jul;18:181-186. doi: 10.1016/j.jcot.2021.04.023. Epub 2021 May 2.
The Coronavirus disease-2019 (COVID-19) placed unprecedented pressure on the healthcare system. Many institutions implemented a government-mandated restructured set of safety and administrative protocols to treat urgent orthopaedic trauma patients. The objective of this study was to compare two cohorts of patients, a COVID group and non-COVID control group, and to evaluate the effectiveness of safety measures outlined in the Rutgers Orthopaedic Trauma Patient Safety Protocol (ROTPSP). Secondary outcomes were to elucidate risk factors for complications associated with fractures and COVID-19.
Patients treated for orthopaedic traumatic injuries were retrospectively identified between March and May 2020, and compared to a series of patients from the same time period in 2018. Main outcome measures included surgical site infections (SSI), length of stay (LOS), post-operative LOS (poLOS), presentation to OR time (PORT), and length of surgery.
After review, 349 patients (201 non-COVID, 148 COVID) undergoing 426 surgeries were included. Average LOS (11.91 days vs. 9.27 days, p = 0.04), poLOS (9.68 days vs. 7.39 days, p = 0.03), and PORT (30.56 vs. 25.59 h, p < 0.01) was significantly shorter in the COVID cohort. There were less SSI in the COVID group (5) compared to the non-COVID group (14) (p = 0.03). Overall complications were significantly lower in the COVID group. Patients receiving Cepheid tests had significantly shorter LOS and poLOS compared to patients receiving the RNA and DiaSorin tests (p < 0.01 and p < 0.01, respectively). The Cepheid test carried the best benefit-to-cost ratio, 0.10, p < 0.05.
The restructuring of care protocols caused by COVID-19 did not negatively impact perioperative complication rates, PORT or LOS. Cepheid COVID test type administered upon admission plays an integral role in a patient's hospital course by reducing both length of stay and hospital costs. This information demonstrates we can continue to treat orthopaedic trauma patients safely during the COVID-19 pandemic by utilizing strict safety protocols.
2019年冠状病毒病（COVID-19）给医疗系统带来了前所未有的压力。许多机构实施了政府强制规定的一套重组后的安全和管理协议，以治疗紧急骨科创伤患者。本研究的目的是比较两组患者，即COVID组和非COVID对照组，并评估罗格斯骨科创伤患者安全协议（ROTPSP）中概述的安全措施的有效性。次要结果是阐明与骨折和COVID-19相关的并发症的危险因素。
回顾性确定2020年3月至5月期间接受骨科创伤治疗的患者，并与2018年同期的一系列患者进行比较。主要结局指标包括手术部位感染（SSI）、住院时间（LOS）、术后住院时间（poLOS）、进入手术室时间（PORT）和手术时间。
经过审查，纳入了349例接受426例手术的患者（201例非COVID患者，148例COVID患者）。COVID组的平均住院时间（11.91天对9.27天，p = 0.04）、术后住院时间（9.68天对7.39天，p = 0.03）和进入手术室时间（30.56对25.59小时，p < 0.01）明显更短。与非COVID组（14例）相比，COVID组的手术部位感染更少（5例）（p = 0.03）。COVID组的总体并发症明显更低。与接受RNA和DiaSorin检测的患者相比，接受Cepheid检测的患者的住院时间和术后住院时间明显更短（分别为p < 0.01和p < 0.01）。Cepheid检测的效益成本比最佳，为0.10，p < 0.05。
COVID-19导致的护理协议重组并未对围手术期并发症发生率、进入手术室时间或住院时间产生负面影响。入院时进行的Cepheid COVID检测类型通过缩短住院时间和降低医院成本，在患者的住院过程中发挥着不可或缺的作用。这些信息表明，在COVID-19大流行期间，通过采用严格的安全协议，我们可以继续安全地治疗骨科创伤患者。
