Patel B A, Green S F, Henessy C, Adamu-Biu F, Davda K, Chennagiri R, Kankate R, Ghani Y
Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK.
Health Education Thames Valley, Oxford School of Surgery, Oxford, OX4 2GX UK.
Indian J Orthop. 2021 May 18;55(4):1037-1045. doi: 10.1007/s43465-021-00419-0. eCollection 2021 Aug.
The Coronavirus disease (COVID-19) pandemic has contributed to over 1,000,000 deaths worldwide. Hospitals responded by expanding services to accommodate the forecasted rise in COVID-19-related admissions. We describe the effects these changes had on management of orthopaedic trauma and patient outcomes at a district general hospital in Southern England.
Data were extrapolated retrospectively from two separate 6-week periods in 2019 and 2020 (1st April-13th May) using electronic records of patients referred to the orthopaedic team. Soft tissue injuries were included where a confirmed diagnosis was made with radiological evidence. Patients were excluded if no orthopaedic intervention was required. Data were compared between the two time periods.
There were fewer attendances to hospital in 2020 compared with 2019 (178 vs. 328), but time from presentation to surgery significantly increased in 2020 (2.94 days vs. 4.91 days, = 0.009). There were fewer operative complications in 2020 (36/145 vs. 11/88, < 0.001). However, ordinal logistic regression analysis found a significantly greater complication severity in 2020 including death ( = 0.039). Complication severity was unrelated to COVID-19 status.
Restructuring of orthopaedic services in response to the COVID-19 pandemic has been associated with significant delays to surgery and higher post-operative complication severity. Our results demonstrate the need for fast-track emergency operative orthopaedic services in UK district general hospitals whilst the COVID-19 pandemic continues.
冠状病毒病（COVID-19）大流行已导致全球超过100万人死亡。医院通过扩大服务来应对预计中与COVID-19相关入院人数的增加。我们描述了这些变化对英格兰南部一家地区综合医院骨科创伤管理及患者预后的影响。
使用转诊至骨科团队患者的电子记录，回顾性地从2019年和2020年（4月1日至5月13日）两个独立的6周时间段中提取数据。有放射学证据确诊的软组织损伤也包括在内。若无需骨科干预则将患者排除。对两个时间段的数据进行比较。
与2019年相比，2020年到医院就诊的人数更少（178例对328例），但2020年从就诊到手术的时间显著增加（2.94天对4.91天，P = 0.009）。2020年手术并发症更少（36/145对11/88，P < 0.001）。然而，有序逻辑回归分析发现2020年并发症严重程度显著更高，包括死亡（P = 0.039）。并发症严重程度与COVID-19状态无关。
为应对COVID-19大流行而对骨科服务进行的重组与手术的显著延迟及术后并发症更高的严重程度相关。我们的结果表明，在COVID-19大流行持续期间，英国地区综合医院需要快速通道的骨科急诊手术服务。
