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Challenges and responses of elective orthopaedic surgery during the second wave of COVID-19
Tsuyoshi Nakai1, Haruaki Iwasaki1, Tomoya Nishikawa1
1Department of Orthopaedic Suregery, Itami City Hospital, Itami, Japan.
Insights
Most patients undergoing elective orthopaedic surgery with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are asymptomatic. Universal testing is crucial to prevent in-hospital transmission during the coronavirus disease (COVID-19) pandemic.
Area of Science:
- Orthopaedic Surgery
- Infectious Disease Epidemiology
- Public Health
Background:
- Coronavirus disease (COVID-19) significantly impacted elective orthopaedic surgery scheduling.
- Limited evidence exists on safe protocols for resuming elective orthopaedic surgery post-COVID-19 waves.
- Assessing pre-operative patient screening is vital for surgical resumption.
Purpose of the Study:
- To evaluate the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in patients undergoing elective orthopaedic surgery.
- To identify asymptomatic carriers of SARS-CoV-2 among surgical patients.
- To inform protocols for safe resumption of elective orthopaedic procedures.
Main Methods:
- Retrospective review of elective orthopaedic surgeries from May 15, 2020, to November 20, 2020.
- Utilized screening questionnaires and reverse transcription-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2.
- Assessed immunoglobulin G (IgG) and IgM antibody testing for SARS-CoV-2 in admitted patients.
Main Results:
- Out of 592 patients tested, 21 (3.5%) had positive SARS-CoV-2 tests.
- Asymptomatic patients constituted 95.2% (20/21) of those who tested positive.
- Prevalence of positive RT-PCR, IgG, and IgM antibodies were 2%, 2.2%, and 1.7%, respectively.
Conclusions:
- The majority of elective orthopaedic surgery patients with SARS-CoV-2 are asymptomatic.
- Universal screening and testing for COVID-19 in all patients is recommended.
- Implementing universal testing can prevent in-hospital transmission clusters during COVID-19 surges.
Background:
Elective orthopaedic surgery has been severely curtailed because of coronavirus disease, 2019. There is scant scientific evidence to guide surgeons in assessing the protocols that must be implemented before resuming elective orthopaedic surgery safely after the second wave of the coronavirus disease, 2019.
Methods:
A retrospective review of elective orthopaedic surgeries performed between May 15, 2020, and November 20, 2020, was conducted. A screening questionnaire was used, and reverse transcription-polymerase chain reaction and severe acute respiratory syndrome coronavirus-2 immunoglobulin G and IgM antibodies testing were assessed in all admitted patients. Screening and testing data for coronavirus disease was reviewed for all patients.
Results:
Of 592 patients tested for severe acute respiratory syndrome coronavirus-2 during the study period, 21 (3.5%) tested positive. There were 2 patients (0.3%) with positive reverse transcription-polymerase chain reaction tests, 3 (0.5%) with positive IgG and IgM antibodies, 13 (2.2%) with positive IgG antibodies, and 10 (1.7%) with positive IgM antibodies. Among these 21 patients, 20 (95.2%) were asymptomatic.
Conclusions:
Our findings suggest that most elective orthopaedic surgery patients with severe acute respiratory syndrome coronavirus-2 are asymptomatic. In the second wave of coronavirus disease, 2019, universal testing of all patients should be strongly considered as an important measure to prevent clusters of in-hospital transmission of the disease.
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