St Andrew's COVID-19 surgery safety study: hand trauma

Abstract

Introduction: Adaptation is vital to ensure successful healthcare recovery during the COVID-19 pandemic. Hand trauma represents the most common acute emergency department presentation internationally. This study prospectively evaluates the COVID-19 related patient risk, when undergoing management within one of the largest specialist tertiary referral centres in Europe, which rapidly implemented national COVID-19 safety guidelines.

Materials and methods: A prospective cohort study was undertaken in all patients referred to the integrated hand trauma service, during the UK COVID-19 pandemic peak (April-May 2020); all were evaluated for 30-day COVID-19 related death. Random selection was undertaken for patients with hand trauma who either underwent non-operative (control group) or operative (surgery group) management; these groups were prospectively followed-up within a controlled cohort study design and telephoned at 30 days following first intervention (control group) or postoperatively (surgery group).

Results: Of 731 referred patients (566 operations), there were no COVID-19 related deaths. Both groups were matched for sex, age, ethnicity, body mass index, comorbidities, smoking, preoperative/first assessment COVID-19 symptoms, pre- and postoperative/first assessment isolation and positive COVID-19 contact (p > 0.050). There were no differences in high service satisfaction (10/10 compared with 10/10; p = 0.067) and treatment outcome (10/10 compared with 10/10; p = 0.961) scores, postoperative/first assessment symptoms (1%, 1/100 compared with 0.8%, 2/250; p = 1.000) or proportion of positive tests (7.1%, 1/14 compared with 2.2%, 2/92; p = 0.349), between the control (n = 100) and surgery (n = 250) groups.

Conclusion: These data support continued and safe service provision and no increased risk to patients who require surgical management. Such findings are vital for healthcare providers when considering service adaptations to reinstate patient treatment.

Keywords: Coronavirus; General surgery; Hand; Injuries; Plastic surgery; Trauma.

Figure 1

Prospective cohort study primary operative diagnosis for hand trauma cases performed during April/May 2019 (blue) and 2020 (red). There were 731 patients referred to the integrated hand trauma service during the prospective cohort study period, resulting in 566 operations of which 543 were for hand trauma; there were no 30-day COVID-19 related deaths (0%, 0/731). This represents a 34.3% decrease in referrals and 3.9% decrease in operations, compared with the 1,112 referrals received and 589 operations performed during the same period in the previous year; therefore, the proportion of referred patients who required operative management, was significantly greater compared with the previous year (77.4% compared with 53.0%; p < 0.001). Overall, when grouped by primary operative diagnosis, the numbers of operative cases performed during the study period were similar.