Surgeon describes how to prioritize surgeries during COVID-19 pandemic
While elective surgeries remain on hold, some procedures involving trauma fractures and malignant musculoskeletal tumors and sarcomas cannot be postponed. These surgeries require careful planning and prioritizing to ensure proper treatment and safety measures are taken, according to an orthopedic specialist in Padova, Italy.
Pietro Ruggieri, MD, PhD, professor and chair of the department of orthopedics at the University of Padova, presented his advice for orthopedic and trauma surgeons amid the COVID-19 pandemic at the EFORT Special Edition Webinar.
Surgeons at the University Hospital of Padova, which Ruggieri described as a large, two-floor hospital with 790 beds (88 for orthopedic/trauma surgeries) and a 24-hour ER, were some of the first to experience this significant change in elective and trauma surgery scheduling, he said in his presentation.
Ruggieri highlighted the various changes in surgical activity from Feb. 24, 2020 to March 31, 2020, and compared activity to the same period of time in 2019.
“We had a reduction of more than half of our beds in our department of orthopedics. We had only 32 available.” Ruggieri said. “In trauma surgery, [for] the traumas that cannot – of course – be postponed, [we saw] the reduction from 148 to 106 fracture [procedures] at a 22% less incidence.”
“Low-energy fractures were almost the same because they mostly occur in house,” he said. “Where you see terrific reduction – 85% less cases – [is in] high-energy fracture, because people of course are forced to stay at home, so we don’t see many of those traumas by car accident.”
Ruggieri and colleagues at the University Hospital of Padova set criteria for identifying which patients needed treatment, while taking necessary precautions to limit the transmission of COVID-19 from patients to health care professionals.
“Of course, our idea is to go into surgery either knowing if the patient is [COVID-19] positive or not.” Ruggieri said. “We had the patients that were admitted through the emergency department always [given] a pharyngeal swab in urgent modality. That means we want to have the result in about 12 hours or less.”
Yet, he said some surgeries that cannot wait for the results of a 12-hour test must proceed.
“If we cannot wait because we need an emergency treatment, then we do surgery anyway,” he said. “Be very cautious during this surgery and be protected – everybody who’s taking part in the procedure.”
“But also, we have to take care of the so-called caregiver, so the parent or the parents. Also, they need to be investigated because they can be close to their son or daughter while they are in our department,” Ruggieri said.
“Anytime a positive case is observed, then we try to identify these [COVID-19] positive [patients] and try to keep them far from new patients and from the other colleagues,” he said. “I think that we need to have such procedures to work as safe as possible, not only in our interests - so doctors, nurses and surgeons - but also in the interest of all the other patients, and I think that is crucial, in fact.” – by Max R. Wursta
Ruggieri P. The cases that cannot be postponed. Presented at: EFORT Webinar Special Edition: Orthopaedic & trauma surgeons in the time of COVID-19; April 6, 2020.
Disclosure: Ruggieri reports he is a consultant for Exactech Inc. and Stryker.