Andrew Stone1, Mina Derias1*, David Ricketts1, Benedict Rogers1,2 and Joideep Phadnis1,2
1Department of Trauma and Orthopedics Surgery, Brighton and Sussex University Hospitals, UK 2Brighton & Sussex Medical School, UKFulltext PDF
Background: The objectives of this study were to establish the incidence of contracting perioperative SARS-CoV-2 infection in a cohort of unscreened asymptomatic patients undergoing orthopedic trauma surgery, better understand the implications of contracting the virus in the post-operative period and risk stratify for future surgery. Methods: Data on 301 consecutive adult patients undergoing orthopedic trauma surgery in a UK major trauma centre was collected prospectively over a 13-week lockdown period at the height of the first wave of the pandemic. Results: A total of 134 patients were treated for a fractured neck of femur, 17 were treated for poly trauma and 151 were treated for isolated trauma or infection. 217 (72.1%) were unscreened preoperatively and 84 (27.9%) had a SARS-CoV-2 test. 34 patients (11.3%) showed evidence of contracting SARS-CoV-2 in the post-operative period. There were 27 mortalities (9%) in the postoperative period. This was significantly higher than for the same time period in 2019 (p<0.0001). Mortality was attributable to COVID-19 in 13 patients (4.3%). The mortality rate in ASA1 or 2 patients aged <70 yrs (n=125) was 0% and the overall incidence of SARS-CoV-2 infection was 5.6%. In comparison, the mortality rate of ASA3 or 4 patients aged >70 years (n=112) was significantly higher (20.5%, 23 patients p<0.0001). In 10 patients (8.9%) this was attributable to SARS-CoV-2. The overall incidence of SARS-CoV-2 infection in this group was 13.4% - also significantly higher (p=0.039). Similarly, Patients admitted for ≤ 1 night (n=55) had a 0% mortality and incidence of SARS-CoV-2 infection of 7.2%. Comparatively, patients admitted for >1 night (n=246) had a mortality rate of 11% (5.3% attributed to COVID) and incidence of SARS-CoV-2 infection of 12.6%. Mortality was significantly higher in this group (p=0.01), but infection risk was higher without reaching statistical significance (p=0.265). The study showed no significant difference based on anesthesia type. Conclusion: The risk of post-operative COVID-19 in an unscreened asymptomatic population following orthopedic trauma surgery was negligible in ASA1 and 2 patients <70 years old. There was a positive correlation with low mortality and COVID diagnosis in day-case or single night admissions.
SARS-CoV-2; COVID-19; Coronavirus; Orthopedics; Trauma; Elective surgery
Stone A, Derias M, Ricketts D, Rogers B, Phadnis J. The Incidence and Outcomes of Post-Operative SARS-CoV-2 Infection in Unscreened Orthopedic Patients Treated Surgically at UK Major Trauma Centre - Implications for Resumption of Elective Orthopedic Surgery. 2021;5(1):1022..