Dedicated orthopaedic elective unit: our experience from a district general hospital

Area of Science:

• Orthopaedic Surgery
• Healthcare Management
• Pandemic Preparedness

Background:

• The British Orthopaedic Association and Royal College of Surgeons emphasized ring-fencing orthopaedic beds and protected elective sites.
• The COVID-19 pandemic necessitated the establishment of numerous protected elective surgical setups.
• This study evaluates the performance of a pandemic-instituted orthopaedic protected elective surgical unit (PESU) against pre-pandemic elective services.

Purpose of the Study:

• To compare the operational functioning and efficiency of a pandemic-era PESU with the hospital's pre-pandemic elective orthopaedic service.
• To identify key performance differences, particularly in surgery conversion rates and reasons for cancellation.

Main Methods:

• Retrospective data collection of elective orthopaedic procedures performed in PESU during the pandemic.
• Comparison with a cohort from the routine pre-pandemic elective service.
• A secondary analysis focused on total hip replacements by a single surgeon to minimize confounding factors.

Main Results:

• PESU listed 192 cases versus 339 for the pre-pandemic ward (PPW), but PESU performed more cases due to significantly lower cancellation rates (12.5% vs. >50%).
• Major cancellation reasons for PPW included bed unavailability (49%), emergency case prioritization (17%), and patient unfitness (16%).
• PESU cancellations due to bed unavailability were minimal (3/24). Total hip replacement patients on PESU showed a reduced length of hospital stay (average 3 days).

Conclusions:

• Protected elective surgical units are highly effective in maintaining elective orthopaedic surgery during public health crises.
• PESU significantly improves surgery conversion rates and reduces cancellations, particularly those related to bed shortages.
• The PESU model demonstrates enhanced efficiency and resource utilization for elective orthopaedic procedures.