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Experience of clinical screening for COVID-19 among patients undergoing elective orthopedic surgeries: an alternative
Edwarth Soler1, Sammy Nicolás Farah2, Valeria P Bustos3
1Department of Orthopedics, Keralty Group, Clínica Universitaria Colombia, Bogotá, Colombia. edsp33@yahoo.com.
Insights
A presurgical clinical protocol without COVID-19 testing allowed safe performance of elective orthopedic surgeries during the pandemic. This approach minimized disruptions to essential patient care while maintaining low rates of suspected post-operative infections.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
- Public Health Policy
Background:
- The COVID-19 pandemic caused widespread disruption, including cancellation of non-essential surgeries.
- Colombia faced challenges in managing healthcare services during the pandemic.
- Elective orthopedic surgeries were often postponed due to pandemic-related restrictions.
Purpose of the Study:
- To evaluate the outcomes of a presurgical clinical protocol for elective orthopedic surgeries during the COVID-19 pandemic.
- To assess the feasibility of performing low- and medium-complexity orthopedic procedures without molecular or serological testing.
- To determine the incidence of post-operative COVID-19 in patients undergoing elective orthopedic surgery.
Main Methods:
- A multicenter, observational, retrospective study was conducted in Bogota, Colombia.
- A presurgical clinical protocol included physical examination, symptom survey, and presurgical isolation.
- Data on surgery types, MeNTs scores, and post-operative COVID-19 signs, symptoms, and mortality were collected.
Main Results:
- 179 patients underwent elective orthopedic surgery.
- The post-operative COVID-19 incidence was 2.3%, with no deaths or hospitalizations related to the disease.
- Two patients tested negative for SARS-CoV-2 via RT-PCR after developing symptoms.
Conclusions:
- A presurgical clinical protocol, excluding molecular/serological testing, was effective for elective orthopedic surgeries early in the pandemic.
- This approach facilitated the continuation of essential orthopedic care during the COVID-19 mitigation phase.
- The protocol demonstrated a safe method for managing non-essential orthopedic surgeries amidst the pandemic.
Background:
The coronavirus disease 2019 (COVID-19) pandemic is the largest global event in recent times, with millions of infected people and hundreds of thousands of deaths worldwide. Colombia has also been affected by the pandemic, including by the cancellation of medically necessary surgical procedures that were categorized as nonessential. The objective of this study was to show the results of the program implemented in two institutions in Bogotá, Colombia, in April 2020 to support the performance of elective essential and nonessential low- and medium-complexity orthopedic surgeries during the mitigation phase of the COVID-19 pandemic, which involved a presurgical clinical protocol without serological or molecular testing.
Methods:
This was a multicenter, observational, retrospective, descriptive study of a cohort of patients who underwent elective orthopedic surgery at two institutions in the city of Bogota, Colombia, in April 2020. We implemented a preoperative clinical protocol that did not involve serological or molecular tests; the protocol consisted of a physical examination, a survey of symptoms and contact with confirmed or suspected cases, and presurgical isolation. We recorded the types of surgeries, the patients' scores on the medically necessary, time-sensitive (MeNTs) scale, the presence of signs, symptoms, and mortality associated with COVID-19 developed after the operation.
Results:
A total of 179 patients underwent orthopedic surgery. The average age was 47 years (Shapiro-Wilk, P = 0.021), and the range was between 18 and 81 years. There was a female predominance (61.5%). With regard to the types of surgeries, 86 (48%) were knee operations, 42 (23.5%) were hand surgeries, 34 (19%) were shoulder surgeries, and 17 (9.5%) were foot and ankle surgeries. The average MeNTs score was 44.6 points. During the 2 weeks after surgery, four patients were suspected of having COVID-19 because they developed at least two symptoms associated with the disease. The incidence of COVID-19 in the postoperative period was 2.3%. Two (1.1%) of these four patients visited an emergency department where RT-PCR tests were performed, and they tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). No patients died or were hospitalized for symptoms of COVID-19.
Conclusion:
Through the implementation of a presurgical clinical protocol consisting of a physical examination; a clinical survey inquiring about signs, symptoms, and epidemiological contact with suspected or confirmed cases; and presurgical isolation but not involving the performance of molecular or serological diagnostic tests, positive results were obtained with regard to the performance of low- and medium-complexity elective orthopedic surgeries in an early stage of the COVID-19 pandemic.
Level Of Evidence:
IV.
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