Orthopaedic Research Unit, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2021 Aug 2;111(8):747-752. doi: 10.7196/SAMJ.2021.v111i8.15766.
Initial local and global evidence suggests that SARS-CoV-2-infected patients who undergo surgery, and those who become infected perioperatively, have an increased mortality risk post surgery.
To analyse and describe the 30-day mortality, presurgical COVID-19 status and hospital-acquired SARS-CoV-2 infection rates of patients, both SARS-CoV-2-positive and negative, undergoing orthopaedic surgery at a tertiary academic hospital in South Africa (SA) during the first COVID-19 peak.
This single-centre, observational, prospective study included patients who underwent orthopaedic procedures from 1 April 2020 (beginning of the COVID-19 case increase in SA) to 31 July 2020 (first COVID-19 peak in SA). All patients were screened for COVID-19 and were confirmed positive if they had a positive laboratory quantitative polymerase chain reaction test for SARS-CoV-2 RNA on a nasopharyngeal or oral swab. Thirty-day mortality, presurgical COVID-19 status and hospital-acquired SARS-CoV-2 infection were assessed.
Overall, a total of 433 operations were performed on 346 patients during the timeframe. Of these patients, 65.9% (n=228) were male and 34.1% (n=118) were female. The mean (standard deviation) age was 42.5 (16.8) years (range 9 - 89). Of the patients, 5 (1.4%) were identified as COVID-19 patients under investigation (PUI) on admission and tested positive for SARS-CoV-2 before surgery, and 1 (0.3%) contracted SARS-CoV-2 perioperatively; all survived 30 days post surgery. Twenty-nine patients were lost to follow-up, and data were missing for 6 patients. The final analysis was performed excluding these 35 patients. Of the 311 patients included in the final 30-day mortality analysis, 303 (97%) had a follow-up observation ≥30 days after the operation. The overall 30-day mortality for these patients was 2.5% (n=8 deaths). None of the recorded deaths were of screened COVID-19 PUI.
We report a low 30-day mortality rate of 2.5% (n=8) for patients undergoing orthopaedic surgery at our hospital during the first COVID-19 peak. None of the deaths were COVID-19 related, and all patients who tested SARS-CoV-2-positive, before or after surgery, survived. Our overall 30-day mortality rate correlates with several other reports of orthopaedic centres analysing over similar timeframes during the first peak of the COVID-19 pandemic. Regarding mortality and SARS-CoV-2 infection risk, we can conclude that with the appropriate measures taken, it was safe to undergo orthopaedic procedures at our hospital during the first peak of the COVID-19 pandemic in SA.
初步的本地和全球证据表明，接受手术的 SARS-CoV-2 感染患者和围手术期感染的患者，术后死亡率增加。
分析和描述南非一家三级学术医院在 COVID-19 疫情第一波高峰期接受骨科手术的患者（包括 SARS-CoV-2 阳性和阴性患者）的 30 天死亡率、术前 COVID-19 状态和医院获得性 SARS-CoV-2 感染率。
这是一项单中心、观察性、前瞻性研究，纳入了 2020 年 4 月 1 日（南非 COVID-19 病例增加开始）至 2020 年 7 月 31 日（南非 COVID-19 第一波高峰）期间接受骨科手术的患者。所有患者均接受 COVID-19 筛查，如果鼻咽或口腔拭子的 SARS-CoV-2 RNA 定量聚合酶链反应检测呈阳性，则确诊为 COVID-19 阳性。评估 30 天死亡率、术前 COVID-19 状态和医院获得性 SARS-CoV-2 感染。
总体而言，在研究期间共对 346 名患者进行了 433 次手术。这些患者中，65.9%（n=228）为男性，34.1%（n=118）为女性。平均（标准差）年龄为 42.5（16.8）岁（范围 9-89）。患者中，有 5 名（1.4%）入院时被确认为 COVID-19 待调查患者（PUI），手术前 SARS-CoV-2 检测阳性，1 名（0.3%）围手术期感染 SARS-CoV-2；所有患者术后 30 天存活。29 名患者失访，6 名患者数据缺失。排除这 35 名患者后，对 311 名患者进行最终分析。在最终的 30 天死亡率分析中，311 名患者中有 303 名（97%）在手术后 30 天以上进行了随访观察。这些患者的总体 30 天死亡率为 2.5%（n=8 例死亡）。没有记录的死亡与筛查 COVID-19 PUI 有关。
我们报告了在南非 COVID-19 疫情第一波高峰期，在我院接受骨科手术患者的 30 天死亡率为 2.5%（n=8），死亡率较低。没有死亡与 COVID-19 相关，所有术前或术后 SARS-CoV-2 检测呈阳性的患者均存活。我们的总体 30 天死亡率与其他几家在 COVID-19 大流行第一波高峰期分析类似时间段的骨科中心的报告一致。关于死亡率和 SARS-CoV-2 感染风险，我们可以得出结论，在南非 COVID-19 疫情第一波高峰期，在我院接受骨科手术是安全的，只要采取适当的措施。
