Orthopedic Surgery

The impact of the novel coronavirus will be felt for years to come, in ways expected and unexpected, but its transformation of the health care system is already in motion. From the earliest days of the pandemic, the U.S. healthcare system was stressed in ways it’s never been tested before—with immediate consequences for orthopedic units all over the country.

Within 8 weeks of the first cases being detected in the United States, elective surgeries including joint replacement surgeries were suspended throughout the country. Between March and April, thirty-five states put moratoriums on elective surgeries, including joint replacements. As noted in the Journal of Arthroplasty, this had a devastating effect on the profitability of many hospitals, which was compounded by the increased expenses associated with infection control procedures and, in some places, crushes of COVID-19 patients.[1]

The issue of when and how to reopen these shuttered units has been an area of intense interest, and patients who had their procedures cancelled or postponed should be prepared for a different experience when they do finally have their surgery scheduled. The keys to successfully resuming will rely on several factors:

  • Patient safety—This can be accomplished by careful patient selection at first, focusing on patients who are likely to have a short in-patient stay and a shorter surgery. This means carefully looking at potential COVID exposure, patient age, comorbidities, and surgical indication.
  • Infection control—In addition to full PPE on all staff, elective surgeries should be performed in COVID-free facilities. Additional staff measures like having most team members wait outside the operating theater during intubation and other high-risk procedures can help keep both staff and patient safe.
  • Procedural safety—Surgical teams in many units are looking at ways to reduce use of equipment and tools that create aerosolized spray, including saws and other tools, among other changes.[2] Additionally, units are spacing patients apart to allow time for completely sanitizing the OR between patients.
  • Patient Preparation and Education—As infection prevention reduces in-person contact, including surgical prep classes, orthopedic units will need to rapidly develop alternative ways to provide patients crucial pre- and post-procedure education to ensure they are empowered to practice good self-care and reduce the risk of readmission.

While orthopedic units create local plans to reopen and move toward resuming full-time procedures, our comprehensive patient education platform, which supports remote patient education and engagement, can help patients better understand how their procedures will have changed and what they can expect, as well as receive reassuring information about safety protocols. This can include:

  1. Pre-surgical preparation, including specific education on reducing the risk of infection with coronavirus.
  2. In-patient education, including grounding in the specific ways the surgical team and facility are working to deliver superior patient care while keeping them safe.
  3. Discharge instructions, once again including messaging on how patients can safely obtain medications.
  4. Recovery education, because especially during a pandemic, taking any steps to reduce readmissions will improve outcomes and reduce the risk to patients.

Ultimately, with cases rising across the country once again, no one really knows what the “post-COVID” era will look like whether that’s in the operating room, the supermarket, the classroom, or anywhere else. With this in mind, it’s essential to communicate with patients and ensure they are equipped with the knowledge they need to feel confident and safe moving ahead with their surgery.

References

[1] O’Connor CM, Anoushiravani AA, DiCaprio MR, Healy WL, Iorio R. Economic Recovery After the COVID-19 Pandemic: Resuming Elective Orthopedic Surgery and Total Joint Arthroplasty. J Arthroplasty. 2020;35(7S):S32-S36.

[2] Sadigale O et al., Resuming arthroplasty: A well aligned and a balanced approach in the COVID-19 era, Journal of Clinical Orthopaedics and Trauma, https://doi.org/10.1016/j.jcot.2020.06.024