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. 2021 Oct 29;2(10):e213460.
doi: 10.1001/jamahealthforum.2021.3460. eCollection 2021 Oct.

Association of COVID-19 With Achieving Time-to-Surgery Benchmarks in Patients With Musculoskeletal Trauma

Ida Leah Gitajn  1 , Paul M Werth  1 , Sheila Sprague  2 , Nathan O'Hara  3 , Gregory Della Rocca  4 , Robert Zura  5 , Meir Marmor  6 , Christopher M Domes  7 , Lauren C Hill  8 , Christine Churchill  9 , Christine Townsend  10 , Chi Van  11 , Natalie Hogan  12 , Cara Girardi  9 , Gerard P Slobogean  3 ; PREP-IT Investigators
Collaborators, Affiliations

Association of COVID-19 With Achieving Time-to-Surgery Benchmarks in Patients With Musculoskeletal Trauma

Ida Leah Gitajn et al. JAMA Health Forum. .

Abstract

Importance: In response to the COVID-19 pandemic, many hospital systems were forced to reduce operating room capacity and reallocate resources. The outcomes of these policies on the care of injured patients and the maintenance of emergency services have not been adequately reported.

Objective: To evaluate whether the COVID-19 pandemic was associated with delays in urgent fracture surgery beyond national time-to-surgery benchmarks.

Design setting and participants: This retrospective cohort study used data collected in the Program of Randomized Trials to Evaluate Preoperative Antiseptic Skin Solutions in Orthopaedic Trauma among at 20 sites throughout the US and Canada and included patients who sustained open fractures or closed femur or hip fractures.

Exposure: COVID-19-era operating room restrictions were compared with pre-COVID-19 data.

Main outcomes and measures: Surgery within 24 hours after injury.

Results: A total of 3589 patients (mean [SD] age, 55 [25.4] years; 1913 [53.3%] male) were included in this study, 2175 pre-COVID-19 and 1414 during COVID-19. A total of 54 patients (3.1%) in the open fracture cohort and 407 patients (21.8%) in the closed hip/femur fracture cohort did not meet 24-hour time-to-surgery benchmarks. We were unable to detect any association between time to operating room and COVID-19 era in either open fracture (odds ratio [OR], 1.40; 95% CI, 0.77-2.55; P = .28) or closed femur/hip fracture (OR, 1.01; 95% CI, 0.74-1.37; P = .97) cohorts. In the closed femur/hip fracture cohort, there was no association between time to operating room and regional COVID-19 prevalence (OR, 1.07; 95% CI, 0.70-1.64; P = .76).

Conclusions and relevance: In this cohort study, there was no association between meeting time-to-surgery benchmarks in either open fracture or closed femur/hip fracture during the COVID-19 pandemic compared with before the pandemic. This is counter to concerns that the unprecedented challenges associated with managing the COVID-19 pandemic would be associated with clinically significant delays in acute management of urgent surgical cases and suggests that many hospital systems within the US were able to effectively implement policies consistent with time-to-surgery standards for orthopedic trauma in the context of COVID-19-related resource constraints.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Gitajn reported personal fees for consulting/teaching from Stryker outside the submitted work. Dr Sprague reported grants from Patient-Centered Outcomes Research Institute, Canadian Institute of Health Research, US Department of Defense, McMaster University Surgical Associates, and Physicians’ Services Incorporated during the conduct of the study; and personal fees from Global Research Solutions outside the submitted work. Mr O’Hara reported grants from US Department of Defense and Patient-Centered Outcomes Research Institute during the conduct of the study; and grants from Agency for Healthcare Research and Quality and Osteosynthesis and Trauma Care Foundation and stock options from Arbutus Medical Inc outside the submitted work. Dr Della Rocca reported being a shareholder of The Orthopaedic Implant Company and Mergenet Medical outside the submitted work. Dr Zura reported personal fees from Stryker and Bioventus and serving as a consultant for OsteoCentric outside the submitted work. Dr Domes reported a Patient-Centered Outcomes Research Institute grant from University of Maryland during the conduct of the study; and personal fees for consulting from Synthes outside the submitted work. Dr Slobogean reported grants from Patient-Centered Outcomes Research Institute, US Department of Defense, and National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24AR076445) during the conduct of the study; and personal fees from Zimmer Biomet and Smith & Nephew outside the submitted work. No other disclosures were reported.

References

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