Perspectives and consensus among international orthopaedic surgeons during initial and mid-lockdown phases of coronavirus disease

Jerome, J. Terrence Jose and Mercier, Francisco and Mudgal, Chaitanya S. and Arenas-Prat, Joan and Vinagre, Gustavo and Goorens, Chul Ki and Rivera-Chavarría, Ignacio J. and Sechachalam, Sreedharan and Mofikoya, Bolaji and Thoma, Achilleas and Medina, Claudia and Ilavarasu, Tamilmani and Rivera-Chavarría, Ignasio J. and Henry, Mark and Afshar, Ahmadreza and Dailiana, Zoe H. and Prasetyono, Theddeus O.H. and Artiaco, Stefano and Madhusudhan, Thayur R. and Ukaj, Skender and Reigstad, Ole and Hamada, Yoshitaka and Bedi, Rajesh and Poggetti, Andrea and Al-Qattan, Mohammad Manna and Siala, Mahdi and Viswanathan, Anand and Romero-Reveron, Rafael and Hong, Joon Pio and Khalid, Kamarul Ariffin and Bhaskaran, Shivashankar and Venkatadass, Krishnamoorthy and Leechavengvongs, Somsak and Goorens, Chul Ki and Nazim, Sifi and Georgescu, Alexandru Valentin and Tremp, Mathias and Nakarmi, Kiran K and Ellabban, Mohamed A. and Chan, Pingtak and Aristov, Andrey and Patel, Sandeep and Moreno-Serrano, Constanza L. and Rai, Shwetabh and Kanna, Rishi Mugesh and Malshikare, Vijay A, and Tanabe, Katsuhisa and Thomas, Simon and Gokkus, Kema and Baek, Seung-Hoon and Brandt, Jerker and Rith, Yin and Olazabal, Alfredo and Saaiq, Muhammad and Patil, Vijay and Jithendran, N. and Parekh, Harshil and Minamikawa, Yoshitaka and Atagawi, Abdulljawad Almabrouk and Hadi, Jalal Ahmed and Berezowsky, Claudia Arroyo and Moya-Angeler, Joaquin and Altamirano-Cruz, Marco Antonio and Galvis R, Luz Adriana and Antezana, Alex and Paczesny, Lukasz and Fernandes, Carlos Henrique and Asadullah, Md. and Yuan-Shun, Lo and Makelov, Biser and Dodakundi, Chaitanya and Regmi, Rabindra and Pereira, Ganarlo Urquizo and Zhang, Shuwei and Sayoojianadhan, Binoy and Callupe, Ivan and Rakha, Mohamed I. and Papes, Dino and Ganesan, Ramesh Prabu and Mohan, Mukesh and Jeyaraman, Arun and Prabhakar, Ponnaian and Rajniashokan, Arungeethayan and Geethan, I. and Chandrasekar, Sugavanam and Löw, Steffen and Thangavelu, Kannan and Giudici, Luca Dei and Palanisamy, Yuvarajan and Vaidyanathan, Singaravadivelu and Boretto, Jorge and Ramirez, Monica Alexandra and Goundar, Thirumalaisamy Subbiah and Kuppusamy, Thirumavalavan and Kanniyan, Kalaivanan and Srivastava, Atul and Chiu, Yung-Cheng and Bhat, Anil K and Gopinath, Nalli R and Vasudevan, Vijayaraghavan P. and Abraham, Vineet (2020) Perspectives and consensus among international orthopaedic surgeons during initial and mid-lockdown phases of coronavirus disease. Journal of Hand and Microsurgery, 12 (3). pp. 135-162. ISSN 0974-3227

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Abstract

With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.

Item Type:	Article (Review)
Additional Information:	2295/88148
Uncontrolled Keywords:	COVID-19 - consensus - recommendations - orthopaedics surgery - initial and mid-lockdown phases - rationale treatment
Subjects:	R Medicine > R Medicine (General) R Medicine > RD Surgery > RD701 Orthopedics
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Department of Orthopaedics, Traumatology & Rehabilitation
Depositing User:	Assoc. Prof. Dr. Kamarul Ariffin Khalid
Date Deposited:	03 Feb 2021 14:44
Last Modified:	03 Feb 2021 14:44
URI:	http://irep.iium.edu.my/id/eprint/88148

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