What did the study look at?
During the pandemic, the safety of planned (elective) surgery for patients and staff became a major concern because of possible exposure to and transmission of the virus. The authors note that the risk of transmission during elective orthopaedic sports procedures was largely unknown. The study aimed to determine the safety of elective outpatient sports medicine procedures during the pandemic at a high-volume orthopaedic practice.
How was it done?
This was a retrospective case series (level of evidence IV). All patients scheduled for elective sports medicine surgery at two ambulatory surgery centres in the USA between 1 July and 31 December 2020 were reviewed.
- The centres required a negative preoperative PCR test and applied symptom and temperature screening on entry, visitor restrictions, masks, hand hygiene and social distancing where possible.
- Patients who had surgery were either given a survey about COVID-19 symptoms and contacts at a clinic visit or by phone at least 2 weeks later, or had routine screening questions and a temperature check at their first follow-up visit.
- Operations cancelled because of a positive preoperative test were identified from the records, and monthly cancellations were compared with monthly case numbers in the state of Illinois.
What did it find?
- In total, 1,119 patients (621 men and 498 women; mean age 49 ± 23 years) were scheduled for surgery.
- 39 patients (3.5%) tested positive on preoperative PCR and had surgery cancelled. Of these, 43.6% were scheduled for knee, 38.5% for shoulder, 15.4% for hip and 2.6% for elbow procedures.
- Patients who tested positive were significantly younger than those who tested negative (46 ± 20 vs 51 ± 21 years; P = .002).
- None of the 1,080 patients who had surgery and were followed up reported symptoms suggestive of COVID-19, further testing, or close contact with a positive individual. Mean follow-up for those screened with the routine questionnaire was 7.8 ± 1 days.
- Monthly cancellations correlated significantly with monthly cases in the state (P = .007), peaking in November (12 cancellations), when state cases were highest.
The authors' conclusion
The authors conclude that, using current preoperative screening protocols, elective outpatient orthopaedic surgery in an ambulatory surgery centre was safe in this cohort, with no documented cases of COVID-19 transmission. They also stress the importance of continued preoperative testing, especially in younger patients without symptoms.
Limitations
- The survey had not been validated; patients may have misunderstood questions, and the retrospective design may introduce recall bias.
- Patients diagnosed or treated at another institution after the survey could not be identified.
- Patients questioned at routine follow-up had a mean follow-up of less than 14 days.
- No postoperative testing was done, so asymptomatic infections may have been missed.
- The results relate to ambulatory surgery centres and cannot be extrapolated to hospital-based surgery.
Reference
Singh H, Isak I, Knapik DM, Vadhera AS, Gürsoy S, Cole BJ, Verma NN. 2021. No Patients Having Elective Outpatient Orthopaedic Surgery Performed in an Ambulatory Surgery Center Using Preoperative Screening Protocols During the Coronavirus Pandemic Developed COVID-19. Arthroscopy, Sports Medicine, and Rehabilitation. 3(4):e1141–e1146. Licence: CC BY-NC-ND 4.0.
DOI: 10.1016/j.asmr.2021.05.001
Free full text: PubMed Central PMC8114808
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
