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Observational Study
. 2021 Oct;45(10):2473-2482.
doi: 10.1007/s00264-021-05064-8. Epub 2021 May 13.

A seven week observational analysis of clinical activities in a North Italian orthopaedic hospital during the second wave of SARS-CoV-2 pandemic: far from usual volumes, but different from the first wave

Luigi Zagra  1 , Martina Faraldi  2 , Mauro Andreata  3 , Immacolata Ottaiano  4 , Giuseppe Basile  5 , Giovanni Lombardi  2   6
Affiliations
Observational Study

A seven week observational analysis of clinical activities in a North Italian orthopaedic hospital during the second wave of SARS-CoV-2 pandemic: far from usual volumes, but different from the first wave

Luigi Zagra et al. Int Orthop. 2021 Oct.

Abstract

Purpose: We previously described the radical changes occurred in an orthopaedic hospital in Milan (Italy) during the first SARS-CoV-2 pandemic outbreak. Currently, during the second wave, the situation is still far from normality. Here we describe the changes that took place, and are still ongoing, in the clinical practice.

Methods: Number and type of admissions, outpatients activity, ER and urgent procedures in SARS-CoV-2 negative and positive patients have been analyzed over seven weeks (October 26th-December 13th, 2020) and compared with the correspondent period in 2019 and the same timeframe during the first wave (February 24th-April 10th).

Results: 2019 vs. 2020: Overall admissions decreased by 39.8%; however, while admissions for elective surgery dropped by 42.0%, urgent surgeries increased by 117.0%. Rehabilitation admissions declined by 85.2%. White and green priority ER consultations declined by 41.6% and 52.0%, respectively; yellow and red increased by 766.7% and 400.0%, respectively. Second vs. first wave: Overall admissions increased by 58.6% with a smoother decrement in weekly admissions than during the first wave. Disparity of acute admissions vs. rehabilitation expanded: Acute cases increased by 63.6% while rehabilitation cases decreased by 8.7%. Admissions to triage procedures increased by 72.3%.

Conclusions: Activity levels are far from normality during the second COVID-19 wave. Elective surgery and outpatients-related activities are still strongly limited compared to 2019 while the number of urgent cases treated increased consistently. SARS-CoV-2 positive emergencies are slightly higher than during the first wave. These important changes are expected to impact on health service and hospital budget for long.

Keywords: COVID-19; Coronavirus; Healthcare systems; Orthopaedic surgery; Orthopaedic trauma.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Admissions from October 26th to December 13th, 2020, compared to the corresponding period in 2019. A Weekly admission trends during the considered 7-week timeframe in 2020 and 2019. B Mean number of weekly admissions in 2020 compared to 2019. Data are reported as minimum to maximum, and were compared trough the Mann–Whitney U test. Comparison is significant when p < 0.05
Fig. 2
Fig. 2
Planned and urgent surgery from October 26th to December 13th, 2020, compared to the corresponding period in 2019. A Weekly trends of planned surgery in 2020 and 2019. B Weekly trends of urgent surgery in 2020 and 2019. C Percentage of weekly planned and urgent surgery in 2019. D Percentage of weekly planned and urgent surgery in 2020
Fig. 3
Fig. 3
Outpatients from October 26th to December 13th, 2020, compared to the corresponding period in 2019. A Weekly outpatient trends during the considered 7-week timeframe in 2020 and 2019. B Outpatients weekly mean number in 2020 compared to 2019. Data are reported as minimum to maximum, and were compared trough the Mann–Whitney U test. Comparison is significant when p < 0.05
Fig. 4
Fig. 4
Admissions from February 24th to April 10th, 2020 (first wave) compared to admissions from October 26th to December 13th, 2020 (second wave). A Weekly admission trends during the first wave and the second wave. B Mean number of weekly admissions in the first wave compared to the second wave. Data are reported as minimum to maximum, and were compared trough the Mann–Whitney U test. Comparison is significant when p < 0.05
Fig. 5
Fig. 5
Outpatients from February 24th to April 10th, 2020 (first wave) compared to outpatients from October 26th to December 13th, 2020 (second wave). A Weekly outpatient trends during the first wave and the second wave. B Mean number of weekly outpatients in the first wave compared to the second wave. Data are reported as minimum to maximum, and were compared trough the Mann–Whitney U test. Comparison is significant when p < 0.05
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