COVID-19-related hospital policies not associated with delays in urgent open and closed fracture surgeries compared to pre-pandemic

1. This retrospective cohort study demonstrated no association between the time-to-surgery benchmark of 24 hours for open fractures or closed pelvis/femur fractures requiring surgery during the COVID-19 pandemic compared to pre-pandemic.

Evidence Rating Level: 2 (Good)

Study Rundown: The COVID-19 pandemic has forced hospitals to reallocate resources, reduce operating room capacity, and shift protocols regarding clinical management strategies. These changes have raised concerns regarding delaying acute treatment for patients with a traumatic injury. This retrospective cohort study (secondary analysis of the PREP-IT trial) investigated whether COVID-19-related policies were associated with increased delays in urgent fracture surgery beyond national time-to-surgery benchmarks. The time-to-surgery benchmark for open fractures, hip fractures, and femoral shaft fractures is 24-hour from injury. This study enrolled 3598 patients from 20 sites across the U.S. and Canada, who presented with an open extremity fracture needing surgery or a closed lower extremity or pelvis fracture requiring surgery. The primary outcome was the proportion of these patients who had surgery within 24 hours of injury. March 13, 2020 was chosen as the threshold for when COVID-19-related hospital policies materialized. In the open fracture group, 30/1126 (2.7%) pre-COVID-19 patients compared to 24/609 (3.9%) patients during COVID-19 did not meet the 24-hour time-to-surgery benchmark; no association was found between admission during the pandemic and operating room delay (Odds ratio [OR]: 1.40 [95%: 0.77-2.55]; p= 0.28). In the closed fracture group, 244/1058 (23.1%) pre-COVID-19 patients compared to 163/805 (20.2%) COVID-19-era patients did not meet the 24-hour benchmark; no association was detected between admission during the pandemic and time-to-surgery beyond 24 hours (OR: 1.01 [95% CI: 0.74-1.37]; p= 0.97). Even in areas where the COVID-19 case rate was increased, there was no association detected between regional case rate and time-to-surgery delay for closed fractures (OR: 1.07 [95% CI: 0.70-1.64]; p= 0.76). Open fracture surgery delays were not evaluated on a regional basis. This study was limited by the low rate of cases who failed to meet open fracture surgery benchmarks; this restricted the ability to evaluate the association between regional COVID-19 cases and time-to-surgery for this cohort. Overall, this retrospective cohort study demonstrated that 24-hour time-to-surgery benchmarks for open and closed fractures were unaffected by COVID-19 hospital policies compared to pre-pandemic.

Click to read the study in JAMA Health Forum

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