Luigi Zagra1, Rocco D'Apolito2, Nicola Guindani3, Giovanni Zatti4, Fabrizio Rivera5, Flavio Ravasi6, Mario Mosconi7, Alberto Momoli8, Alessandro Massè9, Massimo Franceschini10, Fabio D'Angelo11, Dante Dallari12, Fabio Catani13, Alessandro Casiraghi14, Federico Bove15, Claudio Carlo Castelli3. 1. IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy. luigi.zagra@fastwebnet.it. 2. IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy. 3. Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy. 4. Department of Orthopaedic Surgery ASST Di Monza, Università Milano Bicocca, Via Pergolesi 33, 20900, Monza, Italy. 5. Department of Orthopaedic Surgery, Ospedale SS Annunziata, Via Ospedali 14, 12038, Savigliano, Italy. 6. Department of Orthopaedic Surgery, ASST Melegnano Martesana- Ospedale Di Vizzolo Predabissi, Via Pandina 1, 20077, Vizzolo Predabissi, Italy. 7. Department of Orthopaedic Surgery, IRCCS Policlinico San Matteo Di Pavia, Viale C. Golgi 19, 27100, Pavia, Italy. 8. Department of Orthopaedic Surgery, Ospedale San Bortolo, Viale F. Rodolfi 37, 36100, Vicenza, Italy. 9. Department of Orthopaedic Surgery, Ospedale Città Della Salute E Della Scienza Università Di Torino, Via G. Zuretti 29, 10126, Turin, Italy. 10. ASST Gaetano Pini- CTO, Piazza A. Ferrari 1, 20122, Milan, Italy. 11. Division of Orthopaedics and Traumatology, ASST Dei Sette Laghi, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Viale L. Borri 57, 21100, Varese, Italy. 12. Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy. 13. Department of Orthopaedic Surgery, Policlinico Universitario Di Modena, Via del Pozzo 71, 41124, Modena, Italy. 14. Department of Orthopaedic Surgery, ASST Degli Spedali Civili Di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy. 15. Department of Orthopaedic Surgery, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Abstract
BACKGROUND: Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. MATERIALS AND METHODS: Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien-Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. RESULTS: Median age was 81 years (range 70-96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1-4), median VAS score on admission was 3 (range, 0-6), median CFS was 4 (range, 1-8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1-5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1-5). The median LOS was 12.8 days (range 2-36 days), and 21 patients (55.3%) were discharged home. CONCLUSIONS: The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. LEVEL OF EVIDENCE: IV.
BACKGROUND: Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. MATERIALS AND METHODS: Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien-Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. RESULTS: Median age was 81 years (range 70-96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1-4), median VAS score on admission was 3 (range, 0-6), median CFS was 4 (range, 1-8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1-5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1-5). The median LOS was 12.8 days (range 2-36 days), and 21 patients (55.3%) were discharged home. CONCLUSIONS: The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. LEVEL OF EVIDENCE: IV.
Authors: Peter T Katzmarzyk; Corby K Martin; Robert L Newton; John W Apolzan; Connie L Arnold; Terry C Davis; Eboni G Price-Haywood; Kara D Denstel; Emily F Mire; Tina K Thethi; Phillip J Brantley; William D Johnson; Vivian Fonseca; Jonathan Gugel; Kathleen B Kennedy; Carl J Lavie; Daniel F Sarpong; Benjamin Springgate Journal: N Engl J Med Date: 2020-09-03 Impact factor: 91.245
Authors: Humaid Al Farii; Salim Al Rawahi; Elena Samaila; Franco Lavini; Bruno Magnan; Sultan Al Maskari Journal: Geriatr Orthop Surg Rehabil Date: 2020-11-19