Dixon Joseph, Mirtorabi Negin, Cutteridge Joseph, Karia Monil, Pollard Thomas
Trauma and Orthopaedics, Nuffield Orthopaedic Centre, Oxford, GBR.
Trauma and Orthopaedics, University of Oxford, Oxford, GBR.
Cureus. 2022 Feb 17;14(2):e22339. doi: 10.7759/cureus.22339. eCollection 2022 Feb.
Introduction The COVID-19 pandemic has caused mass disruption to all aspects of society, with elective orthopaedics not spared. The pandemic has the potential to cause a tsunami of health burden in the community if elective services are not resumed to pre-pandemic levels of activity. Studies have shown that elective orthopaedics can be safely carried out in a COVID-19 free hospital. This study reviewed the transition in operating at an independent COVID-19 free hospital to an NHS hospital concurrently treating patients with COVID-19. Methods A strategy of phased relaxation of clinical comorbidity criteria was followed. Patients from the orthopaedic waiting list were selected according to these criteria and observed recommended preoperative isolation protocols. Operations were undertaken in the independent sector under the COVID-19 contract and the NHS site. Patients were assessed from all phases in the resumption of services. In-hospital and post-operative complications with specific enquiries regarding the development of COVID-19 symptoms or the need and outcome for COVID-19 testing at 14 days and six weeks was recorded. Results This study included 263 patients, of which 155 were female. The mean age of patients was 52.45. The mean BMI of all patients was 29.1 kg/m2. Additionally, 124 patients were American Society of Anesthesiologists (ASA) grade 1, 117 ASA grade 2 and 22 ASA grade 3 and 167 patients underwent a major operation, with total hip replacement being the most common operation. There were no in-hospital complications. No patients had a positive test result or symptoms of COVID-19 in the six-week post-operative period. Conclusion In summary, we demonstrated that elective orthopaedic surgery can be safely undertaken via a green pathway in a higher risk patient cohort when COVID-19 is prevalent in the community.
新冠疫情对社会的各个方面都造成了大规模破坏，择期骨科手术也未能幸免。如果择期手术服务不能恢复到疫情前的活动水平，疫情有可能在社区引发健康负担的海啸。研究表明，择期骨科手术可以在无新冠病毒的医院安全进行。本研究回顾了在一家独立的无新冠病毒医院与一家同时治疗新冠患者的国民保健服务（NHS）医院之间的手术过渡情况。
遵循逐步放宽临床合并症标准的策略。根据这些标准从骨科等候名单中选择患者，并遵守推荐的术前隔离方案。手术在独立部门按照新冠合同和NHS地点进行。对服务恢复的各个阶段的患者进行评估。记录住院期间和术后并发症，特别询问新冠症状的发展情况或术后14天和6周时新冠检测的需求及结果。
本研究纳入263例患者，其中155例为女性。患者的平均年龄为52.45岁。所有患者的平均体重指数（BMI）为29.1kg/m²。此外，124例患者为美国麻醉医师协会（ASA）1级，117例为ASA 2级，22例为ASA 3级，167例患者接受了大手术，全髋关节置换是最常见的手术。没有住院并发症。在术后六周内，没有患者新冠检测呈阳性或出现新冠症状。
总之，我们证明，在社区新冠疫情流行时，通过绿色通道可以在高风险患者队列中安全地进行择期骨科手术。
