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Effects of the COVID-19 Pandemic on the Orthopedic Trauma Practice: Experiences From A University Hospital in Turkey

Yıl 2022, , 629 - 637, 29.09.2022
https://doi.org/10.20515/otd.1049883

Öz

After a new type of coronavirus in Wuhan, China was found to cause deadly pneumonia, the World Health Organization declared the disease caused by the virus a pandemic on March 11, 2020. This situation led to the effectuation of some social restrictions that radically changed our daily lives in our country and across the world. This comprehensive change in social life also affected the daily practices in all branches of medicine as well as orthopedic trauma practice. The aim of this study was to evaluate the incidence, location, and treatment methods of the fractures seen in the pediatric and adult population during the pandemic period, and to investigate their differences with the pre-pandemic period. Our study was designed as a retrospective cohort study comparing the acute fractures admitted to our center during the pandemic period and the fractures that occurred before the pandemic. Patients who presented with a new fracture to our emergency ward or outpatient clinic between March 16, 2020, and December 30, 2020, when social restrictions were in effect in our country, were identified. Patients who applied to our center with a new fracture within the same date range in 2019 and 2018 were also identified. The patient group was determined by scanning the International Classification of Diseases code and orthopedic consultation charts on the database. After removing the duplicate records, the radiological examinations of all patients were evaluated by the researchers. The data regarding patients’ age, gender, fracture location, treatment types, length of hospital stay, and in-hospital mortality were recorded. The patients were divided into two groups: the pediatric group (16 years and younger) and the adult group (over 16 years). The total number of fractures in the pandemic period was significantly less than in the non-pandemic period (p<0.001). Although the number of fractures decreased significantly in both groups (p<0.001), there was no significant difference between the pandemic and non-pandemic period data regarding the age groups (p=0.771). The most common fracture sites were the distal radius (20% and 19.4%) and the ankle (8, 45% and 8.54%) in the non-pandemic period, while the distal radius (21.5%) and the proximal femur (10.8%) were the most involved sites in the pandemic period. The percentage of surgically treated fractures among all fractures was 49.6%, 46.6%, and 39.4% for 2018, 2019, and 2020, respectively. Although the prevalence of surgical treatments was lower in the pandemic period, the difference was not statistically significant (p=0.089). The mean length of hospital stay for the surgically treated fractures for all groups was 5.36±2.79, 5.78±2.41, and 4.10±1.62 days for the years 2018, 2019, and 2020, respectively. The decline in the length of stay during the pandemic period was found to be significant (p<0.001). We experienced some difficulties and confusion due to our lack of previous experience in orthopedic daily practices under the extraordinary conditions brought by the pandemic. We have seen how necessary and important previous experience can be in such extraordinary situations. The main motivation for us to carry out this study was to contribute to the knowledge in the literature. We observed a 26% decrease in the prevalence of fractures during the pandemic period. Although the indications for surgical treatment have not changed, we observed that the changes in the patient population and trauma mechanism also changed the treatment type.

Kaynakça

  • 1. Özdin S, Bayrak Özdin Ş. Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. Int J Soc Psychiatry. 2020;66(5):504-11.
  • 2. Neher RA, Dyrdak R, Druelle V, et al. Potential impact of seasonal forcing on a SARS-CoV-2 pandemic. Swiss Med Wkly. 2020;150:w20224.
  • 3. Landin LA. Epidemiology of children's fractures. J Pediatr Orthop B. 1997;6(2):79-83.
  • 4. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7.
  • 5. Turgut A, Arlı H, Altundağ Ü, et al. Effect of COVID-19 pandemic on the fracture demographics: Data from a tertiary care hospital in Turkey. Acta Orthop Traumatol Turc. 2020;54(4):355-63.
  • 6. Bram JT, Johnson MA, Magee LC, et al. Where Have All the Fractures Gone? The Epidemiology of Pediatric Fractures During the COVID-19 Pandemic. J Pediatr Orthop. 2020;40(8):373-9.
  • 7. Kalem M, Kocaoğlu H, Merter A, et al. Effects of COVID-19 pandemic curfew on orthopedic trauma in a tertiary care hospital in Turkey. Acta Orthop Traumatol Turc. 2021;55(3):191-5.
  • 8. Hernigou J, Morel X, Callewier A, et al. Staying home during "COVID-19" decreased fractures, but trauma did not quarantine in one hundred and twelve adults and twenty eight children and the "tsunami of recommendations" could not lockdown twelve elective operations. Int Orthop. 2020;44(8):1473-80.
  • 9. Pichard R, Kopel L, Lejeune Q, et al. Impact of the COronaVIrus Disease 2019 lockdown on hand and upper limb emergencies: experience of a referred university trauma hand centre in Paris, France. Int Orthop. 2020;44(8):1497-501.
  • 10. Nuñez JH, Sallent A, Lakhani K, et al. Impact of the COVID-19 Pandemic on an Emergency Traumatology Service: Experience at a Tertiary Trauma Centre in Spain. Injury. 2020;51(7):1414-8.
  • 11. Muñoz Vives JM, Jornet-Gibert M, Cámara-Cabrera J, et al. Mortality Rates of Patients with Proximal Femoral Fracture in a Worldwide Pandemic: Preliminary Results of the Spanish HIP-COVID Observational Study. J Bone Joint Surg Am. 2020;102(13):e69.
  • 12. Kumar Jain V, Lal H, Kumar Patralekh M, Vaishya R. Fracture management during COVID-19 pandemic: A systematic review. J Clin Orthop Trauma. 2020;11(Suppl 4):S431-S441.
  • 13. Segarra B, Ballesteros Heras N, Viadel Ortiz M, et al. Are Hospitals Safe? A Prospective Study on SARS-CoV-2 Prevalence and Outcome on Surgical Fracture Patients: A Closer Look at Hip Fracture Patients. J Orthop Trauma. 2020;34(10):e371-e376.
  • 14. Ishii K, Kurozumi T, Suzuki T, et al. Impact of the COVID-19 pandemic on a trauma center of a university hospital in Japan [published online ahead of print, 2020 Dec 29]. J Orthop Sci. 2020;S0949-2658(20)30360-2.

COVID-19 Pandemisinin Ortopedik Travma Pratiğine Etkileri: Türkiye'de Bir Üniversite Hastanesinin Deneyimi

Yıl 2022, , 629 - 637, 29.09.2022
https://doi.org/10.20515/otd.1049883

Öz

Wuhan-Çin'deki yeni bir tür corono virüsün ölümcül pnömoniye neden olduğu tespit edildikten sonra Dünya Sağlı Örgütü 11 Mart 2020'de pandemi ilan etti. Bu durum tüm dünyada olduğu gibi ülkemizde de günlük hayatı kökten değiştiren bir takım sosyal kısıtlamalar uygulanmasına neden oldu.(1) Sosyal hayattaki bu kapsamlı değişiklik tüm tıp dallarındaki günlük pratikleri etkilediği gibi ortopedik travma pratiğini de etkiledi. Bu çalışmanın amacı, pandemi döneminde pediatrik ve erişkin popülasyonda görülen kırık insidansını, lokalizasyon dağılımlarını ve tedavilerini değerlendirmek ayrıca pandemi olmayan dönem ile farklılıklarını araştırmaktır. Çalışmamız, COVID-19 pandemisi nedeniyle yaygın sosyal kısıtlamaların uygulandığı dönemde merkezimize başvuran akut kırıklar ile pandemi öncesi döneme ait kırıkları karşılaştıran, retrospektif bir kohort çalışması olarak tasarlanmıştır. Ülkemizde sosyal kısıtlamaların uygulandığı 16 Mart 2020 ile 30 Aralık 2020 tarihleri arasında yeni kırık ile merkezimize acil servis ve ya poliklinik aracılığı ile başvuran hastalar hastane veri tabanı sistemi aracılığı ile belirlendi. Ayrıca 2019 ve 2018 yılında aynı tarih aralığında merkezimize yeni kırık ile başvuran hastalar belirlendi. Veri tabanı üzerinden ICD 10 kod ile ve ortopedik konsültasyon chartları taranarak hasta grubu belirlendi. Dublikasyonlar ve tekrar eden kayıtlar çıkartıldı. Ardından araştırmacılar tarafından tüm hastaların radyolojik tetkikleri incelendi. Ardından hastaların başvuru sırasındaki yaşları, cinsiyetleri, kırık lokalizasyonları, tedavi tipleri, hastanede yatış süreleri ve hastane içi mortalite verileri kayıt altına alındı. Hastalar pediatric grup (16 yaş ve altı) ile yetişkin grup (16 yaş üstü) olarak iki gruba ayrıldı. 2018,2019 ve 2020 yılına ait veriler karşılaştırıldı. Pandemic perioddaki toplam kırık sayısının nonpandemic döneme göre anlamlı derecede az olduğu görüldü. (p<0.001) Her ne kadar her iki grupta kırık sayısı anlamlı derecede (p<0.001) azalsa da oransal olarak yaş dağılımına göre pandemic period ile non pandemic arasından anlamlı fark bulunmadı. (p=0.771) En sık görülen kırık lokalizasyonları pandemik dönemde distal radius (21,5%) ve proksimal femur (10,8%) iken non-pandemik dönemde 2018 ve 2019 yıllarında distal radius (20% ve 19,4%) ve ayak bileği (8,45% ve 8,54%) olduğu görüldü. Cerrahi tedavi edilen kırıkların toplam kırıklara oranı 2018,2019 ve 2020 yılları için sırasıyla 49,6%, 46,6% ve 39,4% olduğu görüldü. Pandemik denemde cerrahi tedavi oranları düşük bulunsa da istatisliksel olarak anlamlı değildi. (p=0.089) Tüm gruplar için cerrahi olarak tedavi edilen kırıklarda hastanede yatış süreleri 2018,2019 ve 2020 yılları için sırasıyla ortalama 5.36 ± 2.79, 5.78± 2.41 ve 4.10 ± 1.62 gündür. Pandemic periodda yatış sürelerindeki azalma anlamlı bulunmuştur. (p<0.001) Pandeminin getirdiği olağanüstü şartlarda ortopedi günlük uygulamaları konusunda daha önce tecrübemiz olmaması nedeniyle bazı zorluklar ve kafa karışıklıkları yaşadık. Fakat dünya genelinde ortopedik cerrahların konu ile ilgili deneyimlerini hızla paylaşması sonucunda günlük uygulamalarımız kanıta dayalı olarak netleşti. Bu gibi olağan dışı durumlarda önceki tecrübelerin ne kadar gerekli ve önemli olabileceğini gördük. Bu çalışmayı yapmamızdaki temel motivasyon literatürdeki bu bilgi birikimine katkı sağlamaktı. Pandemi döneminde kırık sayısında 26% oranında azalma gözlemledik. Her ne kadar cerrahi tedavi endikasyonları değişmese de hasta popülasyonu ve travma mekanizmasındaki değişikliklerin tedavi tiplerini değiştirdiğini gözlemledik.

Kaynakça

  • 1. Özdin S, Bayrak Özdin Ş. Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. Int J Soc Psychiatry. 2020;66(5):504-11.
  • 2. Neher RA, Dyrdak R, Druelle V, et al. Potential impact of seasonal forcing on a SARS-CoV-2 pandemic. Swiss Med Wkly. 2020;150:w20224.
  • 3. Landin LA. Epidemiology of children's fractures. J Pediatr Orthop B. 1997;6(2):79-83.
  • 4. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7.
  • 5. Turgut A, Arlı H, Altundağ Ü, et al. Effect of COVID-19 pandemic on the fracture demographics: Data from a tertiary care hospital in Turkey. Acta Orthop Traumatol Turc. 2020;54(4):355-63.
  • 6. Bram JT, Johnson MA, Magee LC, et al. Where Have All the Fractures Gone? The Epidemiology of Pediatric Fractures During the COVID-19 Pandemic. J Pediatr Orthop. 2020;40(8):373-9.
  • 7. Kalem M, Kocaoğlu H, Merter A, et al. Effects of COVID-19 pandemic curfew on orthopedic trauma in a tertiary care hospital in Turkey. Acta Orthop Traumatol Turc. 2021;55(3):191-5.
  • 8. Hernigou J, Morel X, Callewier A, et al. Staying home during "COVID-19" decreased fractures, but trauma did not quarantine in one hundred and twelve adults and twenty eight children and the "tsunami of recommendations" could not lockdown twelve elective operations. Int Orthop. 2020;44(8):1473-80.
  • 9. Pichard R, Kopel L, Lejeune Q, et al. Impact of the COronaVIrus Disease 2019 lockdown on hand and upper limb emergencies: experience of a referred university trauma hand centre in Paris, France. Int Orthop. 2020;44(8):1497-501.
  • 10. Nuñez JH, Sallent A, Lakhani K, et al. Impact of the COVID-19 Pandemic on an Emergency Traumatology Service: Experience at a Tertiary Trauma Centre in Spain. Injury. 2020;51(7):1414-8.
  • 11. Muñoz Vives JM, Jornet-Gibert M, Cámara-Cabrera J, et al. Mortality Rates of Patients with Proximal Femoral Fracture in a Worldwide Pandemic: Preliminary Results of the Spanish HIP-COVID Observational Study. J Bone Joint Surg Am. 2020;102(13):e69.
  • 12. Kumar Jain V, Lal H, Kumar Patralekh M, Vaishya R. Fracture management during COVID-19 pandemic: A systematic review. J Clin Orthop Trauma. 2020;11(Suppl 4):S431-S441.
  • 13. Segarra B, Ballesteros Heras N, Viadel Ortiz M, et al. Are Hospitals Safe? A Prospective Study on SARS-CoV-2 Prevalence and Outcome on Surgical Fracture Patients: A Closer Look at Hip Fracture Patients. J Orthop Trauma. 2020;34(10):e371-e376.
  • 14. Ishii K, Kurozumi T, Suzuki T, et al. Impact of the COVID-19 pandemic on a trauma center of a university hospital in Japan [published online ahead of print, 2020 Dec 29]. J Orthop Sci. 2020;S0949-2658(20)30360-2.
Toplam 14 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Mustafa Kavak 0000-0002-0280-2088

Muzaffer Bilgin 0000-0002-6072-6466

Ulukan İnan 0000-0002-1903-5516

Yayımlanma Tarihi 29 Eylül 2022
Yayımlandığı Sayı Yıl 2022

Kaynak Göster

Vancouver Kavak M, Bilgin M, İnan U. Effects of the COVID-19 Pandemic on the Orthopedic Trauma Practice: Experiences From A University Hospital in Turkey. Osmangazi Tıp Dergisi. 2022;44(5):629-37.


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