Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic
Abstract
:1. Introduction
- (a)
- Hospital reorganization, in terms of flexibility (description of the organizational modifications, workflow and protocols changes), workload (volume and type) in the trauma and orthopedic units; prevalence of COVID-19/SARS-CoV-2 among patients; observance of the standards of care.
- (b)
- Effects on the medical staff: contamination and direct involvement in COVID-19 units, after the reorganization and during lock-down, eventually absence rate (due to contamination or reallocation).
- (c)
- Subjective perception of the pandemic from the orthopedic point of view, through an anonymous questionnaire among the directors of the involved centers.
2. Materials and Methods
2.1. Hospital Reorganization
2.2. Effects on the Medical Staff
2.3. The Orthopedic Point of View
2.4. Statistics
3. Results
3.1. Hospital Reorganization
3.2. Effects on Medical Staff
3.3. The Orthopedic Point of View
Variable | Median | IQR 25–75 |
---|---|---|
Drop in number of beds | −55 | 35–76 |
Drop in activity in operating rooms | −73 | 50–83 |
Drop in outpatients | −80 | 65–90 |
4. Discussion
4.1. Hospital Reorganization
4.2. Effects on the Medical Staff
4.3. The Orthopedic Point of View
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- World Health Organization. Novel Coronavirus (2019-nCov): Situation Report; World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- Alicandro, G.; Remuzzi, G.; La Vecchia, C. Italy’s first wave of the COVID-19 pandemic has ended: No excess mortality in May, 2020. Lancet 2020, 396, e27–e28. [Google Scholar] [CrossRef]
- Nacoti, M.; Ciocca, A.; Giupponi, A.; Brambillasca, P.; Lussana, F.; Pisano, M.; Goisis, G.; Bonacina, D.; Fazzi, F.; Naspro, R.; et al. At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation. Chang. Perspect. Prep. Mitig. 2020, 5. [Google Scholar] [CrossRef]
- Iacorossi, L.; Fauci, A.J.; Napoletano, A.; D’angelo, D.; Salomone, K.; Latina, R.; Coclite, D.; Iannone, P. Triage protocol for allocation of critical health resources during Covid-19 pandemic and public health emergencies. A narrative review. Acta Bio Medica Atenei Parm. 2020, 91, e2020162. [Google Scholar]
- Farrell, S.; Schaeffer, E.K.; Mulpuri, K. Recommendations for the Care of Pediatric Orthopaedic Patients During the COVID-19 Pandemic. J. Am. Acad. Orthop. Surg. 2020, 28, e477–e486. [Google Scholar] [CrossRef] [PubMed]
- Thaler, M.; Khosravi, I.; Hirschmann, M.T.; Kort, N.P.; Zagra, L.; Epinette, J.A.; Liebensteiner, M.C. Disruption of joint arthroplasty services in Europe during the COVID-19 pandemic: An online survey within the European Hip Society (EHS) and the European Knee Associates (EKA). Knee Surg. Sports Traumatol. Arthrosc. 2020, 28, 1712–1719. [Google Scholar] [CrossRef] [PubMed]
- Liang, Z.C.; Wang, W.; Murphy, D.; Hui, J.H.P. Novel Coronavirus and Orthopaedic Surgery. J. Bone Jt. Surg. 2020, 102, 745–749. [Google Scholar] [CrossRef] [PubMed]
- Sarac, N.J.; Sarac, B.A.; Schoenbrunner, A.R.; Janis, J.E.; Harrison, R.K.; Phieffer, L.S.; Quatman, C.E.; Ly, T.V. A Review of State Guidelines for Elective Orthopaedic Procedures during the COVID-19 Outbreak. J. Bone Jt. Surg. 2020, 102, 942–945. [Google Scholar] [CrossRef] [PubMed]
- Nioi, M.; Napoli, P.E.; Lobina, J.; Fossarello, M.; D’Aloja, E. COVID-19 and Italian Healthcare Workers from the Initial Sacrifice to the mRNA Vaccine: Pandemic Chrono-History, Epidemiological Data, Ethical Dilemmas, and Future Challenges. Front. Public Health 2021, 8, 591900. [Google Scholar] [CrossRef]
- Haffer, H.; Schömig, F.; Rickert, M.; Randau, T.; Raschke, M.; Wirtz, D.; Pumberger, M.; Perka, C. Impact of the COVID-19 Pandemic on Orthopaedic and Trauma Surgery in University Hospitals in Germany: Results of a Nationwide Survey. JBJS 2020, 102, e78. [Google Scholar] [CrossRef]
- Tsang, S.; Royse, C.F.; Terkawi, A.S. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J. Anaesth. 2017, 11, S80–S89. [Google Scholar] [CrossRef]
- Case Mix Index. Available online: https://reimbursement.institute/glossar/case-mix-index (accessed on 23 January 2021).
- Case Mix index. Ministero Della Salute. Available online: http://www.salute.gov.it/portale/temi/p2_6.jsp?id=3669&area=ricoveriOspedalieri&menu=vuot (accessed on 23 January 2021).
- Murphy, T.; Akehurst, H.; Mutimer, J. Impact of the 2020 COVID-19 pandemic on the workload of the orthopaedic service in a busy UK district general hospital. Injury 2020, 51, 2142–2147. [Google Scholar] [CrossRef]
- Stinner, D.J.; Lebrun, C.; Hsu, J.R.; Jahangir, A.A.; Mir, H.R. The Orthopaedic Trauma Service and COVID-19: Practice Considerations to Optimize Outcomes and Limit Exposure. J. Orthop. Trauma 2020, 34, 333–340. [Google Scholar] [CrossRef]
- Luengo-Alonso, G.; Pérez-Tabernero, F.G.-S.; Tovar-Bazaga, M.; Arguello-Cuenca, J.M.; Calvo, E. Critical adjustments in a department of orthopaedics through the COVID-19 pandemic. Int. Orthop. 2020, 44, 1557–1564. [Google Scholar] [CrossRef]
- Benazzo, F.; Rossi, S.M.P.; Maniscalco, P.; Moretti, B.; Vaienti, E.; Ruggieri, P.; Massè, A.; Medici, A.; Formica, A.; Di Maggio, B.; et al. The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: Chronicles of a silent war. Int. Orthop. 2020, 44, 1453–1459. [Google Scholar] [CrossRef] [PubMed]
- Available online: https://www.quotidianosanita.it/allegati/allegato5815138.pdf (accessed on 8 May 2021).
- Available online: https://pne.agenas.it/risultati/tipo1/intr_struasl1_HC.php?ind=38&tipo=1&area=5 (accessed on 8 May 2021).
- Andreata, M.; Faraldi, M.; Bucci, E.; Lombardi, G.; Zagra, L. Operating room efficiency and timing during coronavirus disease 2019 outbreak in a referral orthopaedic hospital in Northern Italy. Int. Orthop. 2020, 44, 2499–2504. [Google Scholar] [CrossRef] [PubMed]
- NHS. Clinical Guide for the Management of Patients Requiring Transfer for Specialist Rehabilitation during the Coronavirus Pandemic; NHS: London, UK, 2020. [Google Scholar]
- DGOU. Empfehlungen dringlicher Operationen. In DGOU: ‘Empfehlungen für den Umgang mit Unfallverletzten und OP-Indikationen’; DGOU: Berlin, Germany, 2020. [Google Scholar]
- Romanini, E.; Tucci, G.; Micheletta, F.; Casella, F.; Zanoli, G. Best Practice per Chirurghi Ortopedici: Revisione Evidence-Based su COVID-19. Versione Italiana 3.0. Available online: siot.it/COVID-19/GLOBE (accessed on 19 January 2021).
- Nuñez, J.H.; Sallent, A.; Lakhani, K.; Guerra-Farfan, E.; Vidal, N.; Ekhtiari, S.; Minguell, J. Impact of the COVID-19 Pandemic on an Emergency Traumatology Service: Experience at a Tertiary Trauma Centre in Spain. Injury 2020, 51, 1414–1418. [Google Scholar] [CrossRef] [PubMed]
- Zagra, L.; Faraldi, M.; Pregliasco, F.; Vinci, A.; Lombardi, G.; Ottaiano, I.; Accetta, R.; Perazzo, P.; D’Apolito, R. Changes of clinical activities in an orthopaedic institute in North Italy during the spread of COVID-19 pandemic: A seven-week observational analysis. Int. Orthop. 2020, 44, 1591–1598. [Google Scholar] [CrossRef]
- Aprato, A.; Bini, N.; Casiraghi, A.; Mezzadri, U.; Mazzacane, M.; Galante, C.; Biancardi, E.; Milano, G.; Capitani, D.; D’Angelo, F.; et al. Trauma Network during COVID19 perspective from the four designed major trauma centres in north-west Italy. Miner. Ortop. Traumatol. 2021. in publishing. [Google Scholar] [CrossRef]
- Cereda, D.; Tirani, M.; Rovida, F.; Demicheli, V.; Ajelli, M.; Poletti, P.; Trentini, F.; Guzzetta, G.; Marziano, V.; Barone, A.; et al. The early phase of the COVID-19 outbreak in Lombardy, Italy. arXiv 2020, arXiv:2003.09320. [Google Scholar]
- Corman, V.M.; Landt, O.; Kaiser, M.; Molenkamp, R.; Meijer, A.; Chu, D.K.; Bleicker, T.; Brünink, S.; Schneider, J.; Schmidt, M.L.; et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Eurosurveillance 2020, 25, 2000045. [Google Scholar] [CrossRef] [Green Version]
- Senni, M. COVID-19 experience in Bergamo, Italy. Eur. Heart J. 2020, 41, 1783–1784. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Vives, J.M.; Jornet-Gibert, M.; Cámara-Cabrera, J.; Esteban, P.L.; Brunet, L.; Delgado-Flores, L.; Camacho-Carrasco, P.; Torner, P.; Marcano-Fernández, F.; Spanish HIP-COVID Investigation Group. Mortality Rates of Patients with Proximal Femoral Fracture in a Worldwide Pandemic: Preliminary Results of the Spanish HIP-COVID Observational Study. J. Bone Joint Surg. Am. 2020, 102, e69. [Google Scholar] [CrossRef]
- Catellani, F.; Coscione, A.; D’Ambrosi, R.; Usai, L.; Roscitano, C.; Fiorentino, G. Treatment of Proximal Femoral Fragility Fractures in Patients with COVID-19 During the SARS-CoV-2 Outbreak in Northern Italy. J. Bone Joint Surg. Am. 2020. [Google Scholar] [CrossRef]
- D’Aloja, E.; Finco, G.; Demontis, R.; Napoli, P.E.; Fossarello, M.; Nioi, M. COVID-19 and medical liability: Italy denies the shield to its heroes. EClinicalMedicine 2020, 25, 100470. [Google Scholar] [CrossRef]
- Oussedik, S.; Zagra, L.; Shin, G.Y.; D’Apolito, R.; Haddad, F.S. Reinstating elective orthopaedic surgery in the age of COVID-19. Bone Jt. J. 2020, 102-B, 807–810. [Google Scholar] [CrossRef]
- Kort, N.P.; Barrena, E.G.; Bédard, M.; Donell, S.; Epinette, J.A.; Gomberg, B.; Hirschmann, M.T.; Indelli, P.; Khosravi, I.; Karachalios, T.; et al. Recommendations for resuming elective hip and knee arthroplasty in the setting of the SARS-CoV-2 pandemic: The European Hip Society and European Knee Associates Survey of Members. Knee Surg. Sports Traumatol. Arthrosc. 2020, 28, 2723–2729. [Google Scholar] [CrossRef]
- Guindani, N.; De Pellegrin, M. DDH screening during the lock-down for COVID-19. Experience from Northern Italy. J. Child. Orthop. in press.
- Randelli, P.S.; Compagnoni, R. Management of orthopaedic and traumatology patients during the Coronavirus disease (COVID-19) pandemic in northern Italy. Knee Surg. Sports Traumatol. Arthrosc. 2020, 28, 1683–1689. [Google Scholar] [CrossRef] [Green Version]
- Available online: https://siot.it/siot-safe (accessed on 8 May 2021).
- Magro, F.; Perazzo, P.; Bottinelli, E.; Possenti, F.; Banfi, G. Managing a Tertiary Orthopedic Hospital during the COVID-19 Epidemic, Main Challenges and Solutions Adopted. Int. J. Environ. Res. Public Health 2020, 17, 4818. [Google Scholar] [CrossRef]
- Ragni, E.; Mangiavini, L.; Viganò, M.; Brini, A.T.; Peretti, G.M.; Banfi, G.; De Girolamo, L. Management of Osteoarthritis During the COVID-19 Pandemic. Clin. Pharmacol. Ther. 2020, 108, 719–729. [Google Scholar] [CrossRef]
- Sabbadini, L.L.; ISTAT. Primi Risultati Dell’indagine di Sieroprevalenza SARS-CoV-2; ISTAT: Rome, Italy, 2020. [Google Scholar]
- GIMBE. Monitoraggio Epidemia Coronavirus Nelle Regioni e Province Italiane. Available online: https://coronavirus.gimbe.org/regioni.it-IT.html (accessed on 8 May 2021).
- Ye, G.; Lin, H.; Chen, S.; Wang, S.; Zeng, Z.; Wang, W.; Zhang, S.; Rebmann, T.; Li, Y.; Pan, Z.; et al. Environmental contamination of SARS-CoV-2 in healthcare premises. J. Infect. 2020, 81, e1–e5. [Google Scholar] [CrossRef] [PubMed]
- Available online: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/weekly-surveillance-report (accessed on 24 January 2021).
- Lezak, B.A.; Cole, P.A.; Schroder, L.K. Global experience of orthopaedic trauma surgeons facing COVID-19: A survey highlighting the global orthopaedic response. Int. Orthop. 2020, 44, 1519–1529. [Google Scholar] [CrossRef] [PubMed]
- Available online: https://www.ilsole24ore.com/art/da-miroglio-menarini-fabbriche-che-si-riconvertono-contro-coronavirus-ADLIFdD (accessed on 24 January 2021).
- WHO. Rational Use of Personal Protective Equipment for Coronavirus Disease 2019 (COVID-19) Interim Guidance; WHO: Geneva, Switzerland, 2020. [Google Scholar]
- Wang, Y.; Zeng, L.; Yao, S.; Zhu, F.; Liu, C.; Di Laura, A.; Henckel, J.; Shao, Z.; Hirschmann, M.T.; Hart, A.; et al. Recommendations of protective measures for orthopedic surgeons during COVID-19 pandemic. Knee Surg. Sports Traumatol. Arthrosc. 2020, 28, 2027–2035. [Google Scholar] [CrossRef]
- Collins, A.P.; Crespo, A.; Couto, P.; Gupta, S.; Avilucea, F.; Kupiszewski, S.; Langford, J.; Lewellyn, B.; Petrie, J.; Zumsteg, J.W.; et al. Medically Necessary Orthopaedic Surgery During the COVID-19 Pandemic: Safe Surgical Practices and a Classification to Guide Treatment. JBJS 2020, 102, e76. [Google Scholar]
- Massey, P.A.; McClary, K.; Zhang, A.S.; Savoie, F.H.; Barton, R.S. Orthopaedic Surgical Selection and Inpatient Paradigms During the Coronavirus (COVID-19) Pandemic. J. Am. Acad. Orthop. Surg. 2020, 28, 436–450. [Google Scholar] [CrossRef]
- Xiao, A.T.; Tong, Y.X.; Zhang, S. False negative of RT-PCR and prolonged nucleic acid conversion in COVID-19: Rather than recurrence. J. Med. Virol. 2020, 92, 1755–1756. [Google Scholar] [CrossRef] [Green Version]
- Woloshin, S.; Patel, N.; Kesselheim, A.S. False Negative Tests for SARS-CoV-2 Infection—Challenges and Implications. N. Engl. J. Med. 2020, 383, e38. [Google Scholar] [CrossRef]
- Giusti, E.M.; Pedroli, E.; D’Aniello, G.E.; Badiale, C.S.; Pietrabissa, G.; Manna, C.; Badiale, M.S.; Riva, G.; Castelnuovo, G.; Molinari, E. The Psychological Impact of the COVID-19 Outbreak on Health Professionals: A Cross-Sectional Study. Front. Psychol. 2020, 11, 1684. [Google Scholar] [CrossRef]
- Sharma, S.; John, R.; Patel, S.; Neradi, D.; Kishore, K.; Dhillon, M.S. Bioaerosols in orthopedic surgical procedures and implications for clinical practice in the times of COVID-19: A systematic review and meta-analysis. J. Clin. Orthop. Trauma 2021, 17, 239–253. [Google Scholar] [CrossRef]
- Gruskay, J.A.; Dvorzhinskiy, A.; Konnaris, M.A.; Lebrun, D.G.; Ghahramani, G.C.; Premkumar, A.; DeFrancesco, C.J.; Mendias, C.L.; Ricci, W.M. Universal Testing for COVID-19 in Essential Orthopaedic Surgery Reveals a High Percentage of Asymptomatic Infections. J. Bone Jt. Surg. 2020, 102, 1379–1388. [Google Scholar] [CrossRef]
- Mugnai, G.; Bilato, C. Covid-19 in Italy: Lesson from the Veneto Region. Eur. J. Intern. Med. 2020, 77, 161–162. [Google Scholar] [CrossRef]
- Oates, J.L. Skills Fade: A Review of the Evidence that Clinical and Professional Skills Fade during Time out of Practice, and of How Skills Fade May Be Measured or Remediated; General Medical Council: London, UK, 2014. [Google Scholar]
- Ruesseler, M.; Weinlich, M.; Müller, M.P.; Byhahn, C.; Marzi, I.; Walcher, F. Simulation training improves ability to manage medical emergencies. Emerg. Med. J. 2010, 27, 734–738. [Google Scholar] [CrossRef]
- ISTAT. Report Annuale. Cap 3. Sanità e Salute. Available online: https://www.istat.it/it/files/2013/12/Cap_3.pdf (accessed on 15 November 2020).
- Dallari, D.; Zagra, L.; Cimatti, P.; Guindani, N.; D’Apolito, R.; Bove, F.; Casiraghi, A.; Catani, F.; D’Angelo, F.; Franceschini, M.; et al. Early outcome in hip fracture patients admitted during first wave of the COVID-19 pandemic in north Italy: A multicentre study. J. Orthop. Traumatol. 2021, 22, 1–8, in press. Accepted on 22 March 2021. (JOOT-D-21-00010R1). [Google Scholar] [CrossRef]
Centre | Type | Medical Staff (Nr) | Volume (No of Procedures) and Fraction with the Same Period in 2019 | ||
---|---|---|---|---|---|
2020 | 2020/2019 | ||||
1 | 3TC | AH | 23 | 111 | 0.36 |
2 | OI | UH/IR | 96 | 302 | 0.10 |
3 | 3TC | UH | 34 | 101 | 0.50 |
4 | 2TC | / | 9 | 15 | 0.20 |
5 | OI | UH/IR | 10 | 95 | 0.10 |
7 | OI | UH | 6 | 50 | 0.70 |
8 | 3TC | UH | 25 | 59 | 0.25 |
9 | 3TC | UH | 17 | 62 | 0.05 |
10 | 3TC | UH/IR | 18 | 137 | 0.50 |
11 | 2TC | / | 13 | 37 | 0.30 |
12 | 3TC | UH | 38 | 137 | 0.50 |
13 | 3TC | UH | 21 | 67 | 0.30 |
Variable | Raw | m or % | s | CI95 |
---|---|---|---|---|
Total No. | 1390 | |||
M/F | 510/1390 | 37% | 34–39 | |
Age | 66 | 19 | 65–67 | |
Femur (all) | 713/1390 | 51% | 49–54 | |
Proximal femur | 477/1390 | 34% | 32–37 | |
Age-proximal femur | 81 | 0.6 | 81.38–81.48 | |
No. of Pediatric a cases | 82/1390 | 6% | 5–7 | |
NF-ST (all) | 667/1390 | 48% | 45–51 | |
Positive NF-ST (all) | 84/667 | 13% | 10–15 | |
NF-ST on admission | 554/1390 | 40% | 37–42 | |
Positive NF-ST on admission | 37/554 | 7% | 5–9 | |
COVID-19 patients | 91/1390 | 7% | 5–8 | |
COVID-19 patients with positive NF-ST | 44/91 | 48% | 38–58 | |
COVID-19 patients in ICU | 13/91 | 14% | 9–23 |
Fracture(s) | Location | Raw | Frequency | CI95 |
---|---|---|---|---|
Humerus | All | 190 | 0.14 | 0.12–0.16 |
Proximal | 68 | 0.05 | 0.04–0.06 | |
Wrist | 49 | 0.04 | 0.03–0.05 | |
Femur | All | 717 | 0.52 | 0.49–0.54 |
Proximal | 551 | 0.40 | 0.37–0.42 | |
Diaphiseal | 49 | 0.04 | 0.03–0.05 | |
Leg | All | 202 | 0.15 | 0.13–0.16 |
Diaphyseal | 27 | 0.02 | 0.01–0.03 | |
Pelvis | Acetabulum | 36 | 0.03 | 0.02–0.04 |
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Aprato, A.; Guindani, N.; Massè, A.; Castelli, C.C.; Cipolla, A.; Antognazza, D.; Benazzo, F.; Bove, F.; Casiraghi, A.; Catani, F.; et al. Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic. Int. J. Environ. Res. Public Health 2021, 18, 5340. https://doi.org/10.3390/ijerph18105340
Aprato A, Guindani N, Massè A, Castelli CC, Cipolla A, Antognazza D, Benazzo F, Bove F, Casiraghi A, Catani F, et al. Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic. International Journal of Environmental Research and Public Health. 2021; 18(10):5340. https://doi.org/10.3390/ijerph18105340
Chicago/Turabian StyleAprato, Alessandro, Nicola Guindani, Alessandro Massè, Claudio C. Castelli, Alessandra Cipolla, Delia Antognazza, Francesco Benazzo, Federico Bove, Alessandro Casiraghi, Fabio Catani, and et al. 2021. "Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic" International Journal of Environmental Research and Public Health 18, no. 10: 5340. https://doi.org/10.3390/ijerph18105340