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  • Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative

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Surgery
Original research
Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative
  1. Kapil Sugand1,2,
  2. Arash Aframian1,2,
  3. Chang Park2,
  4. Khaled M Sarraf2
  5. COVERT Collaborative
    1. 1MSk Lab, Imperial College London, London, UK
    2. 2Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
    1. Correspondence to Dr Kapil Sugand; ks704{at}ic.ac.uk

    Abstract

    Objective This is the first British multicentre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak.

    Design A longitudinal, multicentre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from 17 March 2020 compared with the same period in 2019.

    Setting Hospitals from six major urban cities were recruited around the UK, including London.

    Participants A total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion.

    Primary and secondary outcome measures Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia used.

    Results During the COVID-19 period, there was a 34% reduction in acute orthopaedic trauma referrals compared with 2019 (1792 down to 1183 referrals), and a 29.5% reduction in surgical interventions (993 down to 700 operations). The mortality rate was more than doubled for both risk and odds ratios during the COVID-19 period for all referrals (1.3% vs 3.8%, p=0.0005) and for those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-19-related complications (vs non-COVID-19 causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID-19, there was an increase in odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters, as well as doubled odds of a consultant acting as the primary surgeon.

    Conclusion Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared with the same time interval 1 year ago.

    • COVID-19
    • trauma management
    • orthopaedic & trauma surgery
    • epidemiology

    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Underlying data, code and supporting documentation may be made available as a redacted version to interested parties, subject to the completion of a protocol and signing of a Data Transfer Agreement.

    https://creativecommons.org/licenses/by/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

    https://doi.org/10.1136/bmjopen-2021-054919

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      Data availability statement

      Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Underlying data, code and supporting documentation may be made available as a redacted version to interested parties, subject to the completion of a protocol and signing of a Data Transfer Agreement.

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      Supplementary materials

      Footnotes

      • Twitter @KapilSugand, @MrAframian

      • Collaborators COVERT Collaborative (Individual names have been added after references as per your request including their extent of contribution and contact details) Thomas Ashdown; Ramla Ali; William Harland; Charles Hallett; Chinmay Gupte; Dominic Spicer; Robin Strachan; Dinesh Nathwani; Rajarshi Bhattacharya; Catrin Morgan; Katharine Bennett-Brown; Henry Simon; Rupen Dattani; Adham Mousa; Karen Vejsbjerg; Michael Zhang; Vikas Kumar; Hannah Emerson; Andrew Oliver; Callum Smith; Andreas Hinsche; Markus L Sagmeister; Gihan Jayasinghe; Marissa Lewis; Michael Avery; Tariq Aboelmagd; Shireen Ibish; Ruben Thumbadoo; Asanka Wijendra; Joseph Dixon; Vatsal Gupta; Laura Clifton; Suhib Taher; Nicholas Jia Jie Wei; Emma Reay; Ashish Khurana; Kathryn Rooney; Nakanda Kakaire; Oluwawyemisi Adesina.

      • Contributors KS is the guarantor and has overall responsbility of the content. We have read the ICJME guidelines attentively and have outlined the collaborative contributors below who have all satisfied the criteria to be recognised as a collaborative co-author if this study is published. The core committee of the collaborative consists of KS, AA, CP and KMS who all conceptualised the study, led the planning/investigation/methodology/design, supervised the collaborative contributors’ roles, as well as the initial and final version of the manuscript. Additionally, KS (primary author) was also leading data curation, project administration and resource allocation with KMS. KS was also leading on validation. KS, CP and AA led the data analysis and the reporting of the results. All other collaborative members, from the seven centres and outside the core committee, were involved in data curation, formal analysis and in resource allocation internally under consultant supervision (ie, those with FRCS). Individual contributions from the core committee and every collaborative member has been outlined below.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.