The role of the orthopaedic surgeon in the COVID-19 era: cautions and perspectives

Abstract

The current coronavirus disease 2019 (COVID-19) pandemic has revolutionized global healthcare in an unprecedented way and with unimaginable repercussions. Resource reallocation, socioeconomic confinement and reorganization of production activities are current challenges being faced both at the national and international levels, in a frame of uncertainty and fear. Hospitals have been restructured to provide the best care to COVID-19 patients while adopting preventive strategies not to spread the infection among healthcare providers and patients affected by other diseases. As a consequence, the concept of urgency and indications for elective treatments have been profoundly reshaped. In addition, several providers have been recruited in COVID-19 departments despite their original occupation, resulting in a profound rearrangement of both inpatient and outpatient care. Orthopaedic daily practice has been significantly affected by the pandemic. Surgical indications have been reformulated, with elective cases being promptly postponed and urgent interventions requiring exceptional attention, especially in suspected or COVID-19⁺ patients. This has made a strong impact on inpatient management, with the need of a dedicated staff, patient isolation and restrictive visiting hour policies. On the other hand, outpatient visits have been limited to reduce contacts between patients and the hospital personnel, with considerable consequences on post-operative quality of care and the human side of medical practice.In this review, we aim to analyze the effect of the COVID-19 pandemic on the orthopaedic practice. Particular attention will be dedicated to opportune surgical indication, perioperative care and safe management of both inpatients and outpatients, also considering repercussions of the pandemic on resident education and ethical implications.

Keywords: COVID-19; Coronavirus; Education; Elective surgery; Orthopaedic surgery; PPE; SARS-CoV-2; Surgical algorithm; Surgical indication; Telemedicine.

Fig. 1

Decisional algorithm for guiding surgical indication during the COVID-19 pandemic. *A preoperative nasopharyngeal swab should be obtained and tested for SARS-CoV-2 as soon as reasonably possible without delaying surgery. ^§Elective surgery indication should be judiciously pondered depending on availability of ICU beds, ventilators, PPE, workforce, blood units as well as institutional priorities. ^†Suspected symptoms include fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath [54].^ǂIn case of a pending or undetermined result, consider whether to postpone surgery or to proceed adopting all the precautions for suspected or COVID⁺ patients. ASA: American Society of Anesthesiologists; HT: hypertension; DM: diabetes mellitus; COPD: chronic obstructive pulmonary disease; CHD: cardiac ischemic disease