Malhotra Karan, Mangwani Jitendra, Houchen-Wollof Linzy, Mason Lyndon W
Trauma and Orthopaedic Consultant, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
Trauma and Orthopaedic Consultant, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK.
Foot Ankle Surg. 2022 Oct;28(7):1055-1063. doi: 10.1016/j.fas.2022.02.017. Epub 2022 Feb 25.
The primary aim was to determine the differences in COVID-19 infection rate and 30-day mortality in patients undergoing foot and ankle surgery between different treatment pathways over the two phases of the UK-FALCON audit, spanning the first and second UK national lockdowns.
This was an ambispective (retrospective Phase 1 and prospective Phase 2) national audit of foot and ankle procedures in the UK in 2020 completed between 13th January 2020 and 30th November 2020.
All adult patients undergoing foot and ankle surgery in an operating theatre during the study period were included from 46 participating centres in England, Scotland, Wales and Northern Ireland. Patients were categorised as either a green pathway (designated COVID-19 free) or blue pathway (no protocols to prevent COVID-19 infection).
10,846 patients were included, 6644 from phase 1 and 4202 from phase 2. Over the 2 phases the infection rate on a blue pathway was 1.07% (69/6470) and 0.21% on a green pathway (9/4280). In phase 1, there was no significant difference in the COVID-19 perioperative infection rate between the blue and green pathways in any element of the first phase (pre-lockdown (p = .109), lockdown (p = .923) or post-lockdown (p = .577)). However, in phase 2 there was a significant reduction in perioperative infection rate when using the green pathway in both the pre-lockdown (p < .001) and lockdown periods (Odd's Ratio 0.077, p < .001). There was no significant difference in COVID-19 related mortality between pathways.
There was a five-fold reduction in the perioperative COVID-19 infection rate when using designated COVID-19 green pathways over the whole study period; however the success of the pathways only became significant in phase 2 of the study, where there was a 13-fold reduction in infection rate. The study shows a developing success to using green pathways in reducing the risk to patients undergoing foot and ankle surgery.
主要目的是在英国-FALCON审计的两个阶段，即涵盖英国第一次和第二次全国封锁期间，确定不同治疗途径下接受足踝手术患者的新冠病毒感染率和30天死亡率的差异。
这是一项2020年在英国进行的足踝手术的双视角（回顾性第1阶段和前瞻性第2阶段）全国审计，于2020年1月13日至2020年11月30日完成。
在研究期间，来自英格兰、苏格兰、威尔士和北爱尔兰的46个参与中心的所有在手术室接受足踝手术的成年患者均被纳入。患者被分为绿色途径（指定无新冠病毒感染）或蓝色途径（无预防新冠病毒感染的方案）。
共纳入10846例患者，第1阶段6644例，第2阶段4202例。在两个阶段中，蓝色途径的感染率为1.07%（69/6470），绿色途径为0.21%（9/4280）。在第1阶段，蓝色和绿色途径在第一阶段的任何时期（封锁前（p = 0.109）、封锁期间（p = 0.923）或封锁后（p = 0.577））的新冠病毒围手术期感染率均无显著差异。然而，在第2阶段，在封锁前（p < 0.001）和封锁期间使用绿色途径时，围手术期感染率均显著降低（优势比为0.077，p < 0.001）。不同途径之间的新冠病毒相关死亡率无显著差异。
在整个研究期间，使用指定的新冠病毒绿色途径时，围手术期新冠病毒感染率降低了五倍；然而，这些途径的成功仅在研究的第2阶段变得显著，该阶段感染率降低了13倍。该研究表明，使用绿色途径在降低接受足踝手术患者的风险方面取得了越来越大的成功。
