Research Articles

Unlocking of the Orthopedic Department in the Largest Tertiary Referral Hospital of Iran: Our Experience during Coronavirus Disease 2019 Pandemic

Abstract

Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the largest global healthcare crisis of the last century since its emergence in December 2019. As more of the condition’s chronicity became evident and the government policies changed, the unlocking of the orthopedic wards seemed necessary. In this study, we decided to share our experience regarding the unlocking of our orthopedic ward in the largest tertiary referral hospital of Iran and to explain its negative and positive consequences.

 

Methods: This observational study was done in Imam Khomeini Hospital Complex, Tehran, Iran, from April to August 2020. We extracted the data regarding the number of elective/trauma operations, emergency patients, and morning report sessions attendance from our registry database. The data were analyzed and plotted using Microsoft Excel 365.

 

Results: The mean weekly number of orthopedic operations decreased from 50 for elective and 30 for trauma operations in January 2020 to almost zero for both in late March and early April 2020 [the first coronavirus disease 2019 (COVID-19) peak]. Following the department unlocking, the mean weekly elective and trauma operations returned to 50 and 20 by mid-June, respectively. The mean weekly orthopedic emergency visits followed the same order with decrease from 50 to almost zero in late March and increase to 70 in mid-June. However, by the beginning of the second wave, it decreased to almost 38 in early July and further to 28 in late July by the end of the second wave.

 

Conclusion: The unlocking of the orthopedic department in a tertiary referral hospital during the COVID-19 pandemic is possible, provided that there is a set of protocols for patient care in the ward, emergency room (ER), operating room (OR), and clinic during the pandemic.

1. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199-207.doi: 10.1056/NEJMoa2001316. [PubMed: 31995857]. [PubMed Central: PMC7121484].

2. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.doi: 10.1056/NEJMoa2001017. [PubMed: 31978945]. [PubMed Central: PMC7092803].

3. Ashford RU, Nichols JS, Mangwani J. Annotation: The COVID-19 pandemic and clinical orthopaedic and trauma surgery. J Clin Orthop Trauma. 2020;11(3):504-5. doi: 10.1016/j.jcot.2020.04.002. [PubMed: 32292257]. [PubMed Central: PMC7132434].

4. Sohrabi C, Alsafi Z, O'Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-6. doi: 10.1016/j.ijsu.2020.02.034

5. Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, et al. Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: A systematic review and meta-analysis.

Am J Sports Med. 2014;42(9):2242-52. doi: 10.1177/0363546513508376. [PubMed: 24214929].

6. Tuite AR, Bogoch II, Sherbo R, Watts A, Fisman D, Khan K. Estimation of coronavirus disease 2019 (COVID-19) burden and potential for international dissemination of infection from Iran. Ann Intern Med. 2020;172(10):699-701. doi: 10.7326/M20-0696. [PubMed: 32176272]. [PubMed Central: PMC7081176].

7. Abdelnasser MK, Morsy M, Osman AE, AbdelKawi AF, Ibrahim MF, Eisa A, et al. COVID-19. An update for orthopedic surgeons. SICOT J. 2020;6:24. doi: 10.1051/sicotj/2020022. [PubMed: 32609085]. [PubMed Central: PMC7328530].

8. Askari A, Arasteh P, Jabalameli M, Bagherifard A, Razi M. COVID-19 and Orthopaedic Surgery: Experiences from Iran. J Bone Joint Surg Am. 2020;102(13):1126-8. doi: 10.2106/JBJS.20.00631. [PubMed: 32618911].

9. Sadighi M, Mortazavi SMJ, Ebrahimpour A, Manafi-Rasi A, Ebrahimzadeh MH, Jafari KM, et al. Fracture surgery in known COVID-19 infected patients: What are the challenges? Arch Bone Jt Surg. 2020;8(3):378-82. doi: 10.22038/abjs.2020.47899.2372. [PubMed: 32766396]. [PubMed Central: PMC7358239].

10. Abolghasemian M, Ebrahimzadeh MH, Enayatollahi M, Honarmand K, Kachooei AR, Mehdipoor S, et al. Iranian Orthopedic Association (IOA) Response Guidance to COVID-19 Pandemic April 2020. Arch Bone Jt Surg. 2020;8(Suppl 1):209-17. doi: 10.22038/ABJS.2020.47678.2370. [PubMed: 32733977]. [PubMed Central: PMC7296590].

11. Kalantar S, Farhoud A, Mortazavi J. Lockdown of an orthopedic department during COVID-19 epidemics, our experience in a general hospital. Arch Bone Jt Surg. 2020;8(Suppl1):235-41. doi: 10.22038/abjs.2020.47834.2362. [PubMed: 32607394]. [PubMedCentral: PMC7296600].

12. Khak M, Shakiba S, Rabie H, Naseramini R, Nabian MH. Descriptive epidemiology of traumatic injuries during the first lockdown period of COVID-19 crisis in Iran: A multicenter study. Asian J Sports Med. 2020;11(2):e103842. doi: 10.5812/asjsm.103842.
13. Anoushiravani AA, Barnes CL, Bosco JA 3rd, Bozic KJ, Huddleston JI, Kang JD, et al. Reemergence of multispecialty inpatient elective orthopaedic surgery during the COVID-19 Pandemic: Guidelines for a New Normal. J Bone Joint Surg Am. 2020;102(14):e79. doi: 10.2106/JBJS.20.00829. [PubMed: 32675667].

14. Graichen H. Reopening phase in Covid19 pandemic and it's changes for Orthopaedic Surgeons G-A German perspective. J Orthop. 2020;20:A1-A3. doi: 10.1016/j.jor.2020.08.004.

15. de Caro F., Hirschmann TM, Verdonk P. Returning to orthopaedic business as usual after COVID-19: strategies and options. Knee Surg Sports Traumatol Arthrosc. 2020;28(6):1699-704. doi: 10.1007/s00167-020-06031-3. [PubMed: 32342140]. [PubMed Central: PMC7185264].

16. Faridi S, Niazi S, Sadeghi K, Naddafi K, Yavarian J, Shamsipour M, et al. A field indoor air measurement of SARS-CoV-2 in the patient rooms of the largest hospital in Iran. Sci Total Environ. 2020;725:138401. doi: 10.1016/j.scitotenv.2020.138401. [PubMed: 32283308]. [PubMed Central: PMC7194859].

17. World Health Organization. Cleaning and disinfection of environmental surfaces in the context of COVID-19 [Online].

[cited 2020]; Available from: URL: https://www.who.int/publications/i/item/cleaning-and-disinfection-of-environmental-surfaces-inthe-context-of-covid-19

18. Parvizi J, Gehrke T, Krueger CA, Chisari E, Citak M, Van Onsem S, et al. Resuming Elective Orthopaedic Surgery During the COVID-19 Pandemic: Guidelines Developed by the International Consensus Group (ICM). J Bone Joint Surg Am. 2020;102(14):1205-12. doi: 10.2106/JBJS.20.00844. [PubMed: 32675662]. [PubMed Central: PMC7431146].

19. Dabas V, Bhatia N, Goel A, Yadav V, Bajaj V, Kumar V. Management of orthopaedic accidental emergencies amidst COVID-19 Pandemic: Our experience in preparing to live with Corona. Indian J Orthop. 2020;1-6. doi: 10.1007/s43465-020-00252-x. [PubMed: 32934420]. [PubMed Central: PMC7483059].
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IssueVol 6, No 2 (2020) QRcode
SectionResearch Articles
DOI https://doi.org/10.18502/jost.v6i2.4785
Keywords
COVID-19; Pandemic; Orthopedics
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Kalantar SH, Mortazavi SJ, Razzaghof M, Moharrami A, Bagheri N, Zarei M. Unlocking of the Orthopedic Department in the Largest Tertiary Referral Hospital of Iran: Our Experience during Coronavirus Disease 2019 Pandemic. J Orthop Spine Trauma. 2021;6(2):33-8.