Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the “golden month”: The COVid Emergency Related Trauma and orthopaedics (COVERT) Collaborative

Background and purpose — The COVID-19 pandemic has been recognized as an unprecedented global health crisis. This is the first observational study to evaluate its impact on the orthopedic workload in a London level 1 trauma center (i.e., a major trauma center [MTC]) before (2019) and during (2020) the “golden month” post-COVID-19 lockdown.Patients and methods — We performed a longitudinal observational prevalence study of both acute orthopedic trauma referrals, operative and anesthetic casemix for the first “golden” month from March 17, 2020. We compared the data with the same period in 2019. Statistical analyses included median (median absolute deviation), risk and odds ratios, as well as Fisher’s exact test to calculate the statistical significance, set at p ≤ 0.05.Results — Acute trauma referrals in the post-COVID period were almost halved compared with 2019, with similar distribution between pediatric and adult patients, requiring a significant 19% more admissions (RR 1.3, OR 2.6, p = 0.003). Hip fractures and polytrauma cases accounted for an additional 11% of the modal number of injuries in 2020, but with 19% reduction in isolated limb injuries that were modal in 2019. Total operative cases fell by a third during the COVID-19 outbreak. There was a decrease of 14% (RR 0.85, OR 0.20, p = 0.006) in aerosol-generating anesthetic techniques used.Interpretation — The impact of the COVID-19 pandemic has led to a decline in the number of acute trauma referrals, admissions (but increased risk and odds ratio), operations, and aerosolizing anesthetic procedures since implementing social distancing and lockdown measures during the “golden month.”

The global impact of COVID-19The novel coronavirus SARS-COV-2 (COVID-19) was first reported in December 2019 with the first patient hospitalized in the city of Wuhan, China (Wu et al. 2020). By mid-March 2020 the outbreak affected over 190 countries with over 450,000 cases and over 20,000 deaths, thus being declared a pandemic and a global public health emergency by the World Health Organization (2020). On January 24, 2020 Europe reported its first case followed by a case in the United Kingdom (UK) 5 days later (Spiteri et al. 2020). Such a pandemic is an unprecedented event, and governments have had to enact firm social distancing and lockdown measures in an attempt to mitigate further viral transmission (Anderson et al. 2020) in order to reduce morbidity and mortality.British response to the pandemicThe English government responded by implementing social distancing measures on the March 16, 2020 in an attempt to reduce the rate of transmission and therefore the demands on the National Health Service (UK Government 2020a). This was followed a week later by more stringent measures, commonly referred to as a societal “lockdown” (UK Government 2020b). As of March 23, 2020, all members of the public were required to stay at home except for limited purposes and this ruling received Royal Assent by March 26 within the rest of the UK. Furthermore, all public gatherings of more than 2 people and non-essential businesses were suspended. In response to the NHS emergency declaration (National Health Service England 2020), the Royal College of Surgeons (2020) and the British Orthopaedic Association (2020) both issued statements and guidelines for delivering emergency trauma and orthopedic care during the COVID-19 outbreak. The phenomenon of a reduction in trauma burden due to such social distancing measures has been described by Stinner et al. (2020), as well as the potential impact of COVID-19 on operative capacity and pathways. There has been little to explore on how COVID-19 affects the etiology of trauma referral workloads and the operative casemix.We evaluated the impact of the COVID-19 pandemic at a central London level 1 trauma center, also known as a Major Trauma Centre (MTC), evaluating the trends of acute orthopedic trauma referral caseload and operative casemix before (2019) and during (2020) the COVID-19 lockdown (i.e., the “golden” month period starting from March 17).