Post-COVID-19 return to elective orthopaedic surgery-is rescheduling just a reboot process? Which timing for tests? Is chest CT scan still useful? Safety of the first hundred elective cases? How to explain the "new normality health organization" to patients?

Int Orthop. 2020 Oct;44(10):1905-1913. doi: 10.1007/s00264-020-04728-1. Epub 2020 Jul 19.

Abstract

Purpose: The long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health care institutions when patients return to elective surgery.

Methods: A retrospective review of the first adult elective cases performed between May 18, 2020 and June 14, 2020, after the end of lockdown was analysed in Belgium to answer the following questions: (1) for the 236 cancelled patients during the outbreak, how easy was rescheduling? (2) How useful was universal RT-PCR testing and chest CT scan for the 211 orthopaedic and trauma admissions? (3) How were surgical difficulty category, number of operations and complications different when compared to the pre-COVID period? (4) How would patients balance the benefit of surgery against the unknown risk of developing COVID-19?

Results: Before surgery, blood tests for anaesthesiology and imaging related to the surgical procedure were scheduled prior to universal testing (COVID-19 PCR and chest CT) performed 72-120 hours before surgery. Among the 211 asymptomatic patients who were tested before surgery, six had positive PCR, while no abnormality was found on the chest CT scan of all the patients. With this timing for tests, the 104 patients included in the current study for elective surgery were free of disease before undergoing surgery and remained without COVID-19 after surgery. Among the 366 cancelled patients during the outbreak, only 12% of the patients accepted to proceed with rescheduling immediately. Therefore, this resulted in a 70% reduction for elective surgery and in a 50% reduction for arthroplasties as compared to pre-COVID period. The rate of complications was not increased during the post-COVID period. A portion of patients have confused idea of screening and have difficulty to perceive the new rules of health organization.

Conclusions: Resumption of elective surgical procedures appears more difficult for patients than for surgeons with a low percentage of cancelled patients accepting to reschedule surgery. Universal testing allowed securing patients; however, surgeons must explore better patient perceptions regarding COVID-19 to facilitate a fully informed decision in the current period.

Keywords: Chest CT scan; Elective surgery; Ethics; Fracture; Hip arthroplasty; Post-COVID-19; Psychological burden; Surgery cancellation.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Belgium
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections*
  • Elective Surgical Procedures*
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Orthopedic Procedures*
  • Pandemics*
  • Pneumonia, Viral*
  • Retrospective Studies
  • SARS-CoV-2
  • Tomography, X-Ray Computed
  • Young Adult