Global experience of orthopaedic trauma surgeons facing COVID-19: a survey highlighting the global orthopaedic response

Abstract

Background: The COVID-19 (SARS-CoV-2) pandemic has significantly affected all aspects of healthcare, including orthopaedics. Due to the unique challenges presented by COVID-19 as well as the distinct timeframes that it will surge in different geographies, much can be learned from the experiences of orthopaedic professionals in many global settings. The goal of this project is to characterize the preparations, strategies, lessons, and personal experiences of orthopaedic trauma surgeons and departments across the world in combating COVID-19. In doing so, we will shed light on current practices and challenges, which may help us manage the current pandemic in addition to preparing for future global pandemics that may arise.

Methods: A 20-item questionnaire was sent out to 150 orthopaedic trauma surgeons representing 42 countries who were identified based on professional relationships and/or prior involvement in international meetings either led or participated by the senior author.

Results: The questionnaire was completed by 63 orthopaedic trauma surgeons representing 28 countries and 14 US states. The results of this study show that orthopaedic trauma departments across the world have been greatly impacted by COVID-19 with 91% of participating hospitals currently having a reduced case load compared with pre-COVID-19 and only 17% of respondents currently performing elective orthopaedic surgery. Furthermore, 30% of orthopaedic departments have deployed orthopaedic personnel to non-orthopaedic floors in order to help mitigate the increased patient load and 86% of respondents noted at least some shortage of PPE. Lastly 73% of participating orthopedic departments including those in LMICs, have incorporated telemedicine into their practice with a majority stating that it would most likely become a permanent change to their practice post-COVID-19.

Conclusion: To our knowledge, this is the largest data set characterizing global COVID-19 situations and responses of orthopaedic trauma practices around the world. There is much to be learned from each of the participants' responses in order to persevere during the current pandemic, as well as to prepare for future pandemics as it relates specifically to orthopaedic trauma practices.

Keywords: COVID-19; Coronavirus; Global Health; Global surgery; Orthopaedic trauma; Personal protective equipment (PPE); Telemedicine.

Fig. 1

Countries Represented by Survey Participants. Blue indicates a participating country. Dark Grey indicates a country where a questionnaire was sent, but no response was received

Fig. 2

a–c COVID-19 cases by country between February 15, 2020, and April 15, 2020 [11, 12]. Low-income country represented with ***. Lower middle-income country represented with **. Middle-income country represented with *

Fig. 2

a–c COVID-19 cases by country between February 15, 2020, and April 15, 2020 [11, 12]. Low-income country represented with ***. Lower middle-income country represented with **. Middle-income country represented with *

Fig. 3

Orthopaedic procedures performed prior to COVID-19 pandemic and during COVID-19 pandemic. Many orthopaedic departments who typically performed 40 + surgeries per week are now performing less than 20 per week

Fig. 4

Equipment and PPE shortages recorded by respondents. Most respondents (86%) indicated a shortage in PPE or equipment, while only 14% indicated no shortages

Fig. 5

Hospital mechanisms to address shortages in PPE. Many hospitals are relying on a reduction in PPE allotment, increased supply, and donations by community/local businesses in order to maintain adequate PPE levels

Fig. 6

Method of allotment of PPE by specific hospitals. Many hospitals are allotting PPE to intensivists/anesthesiologists first, while some are providing equal PPE to all providers

Fig. 7

Number of countries implementing telemedicine. Most countries are implementing telemedicine visits in the wake of the COVID-19 pandemic. Six out of 11 low- or middle-income countries (55%) have implemented telemedicine, while 14 out of 18 high-income countries (78%) have implemented telemedicine