[Satisfaction and feasibility of videoconsultation (VC) in orthopaedic and trauma surgery in the context of the COVID-19 pandemic: Prospective study of 783 patients].
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SUBMITTER: Perrin A
PROVIDER: S-EPMC9174351 | biostudies-literature | 2023 Feb
REPOSITORIES: biostudies-literature
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[Satisfaction and feasibility of videoconsultation (VC) in orthopaedic and trauma surgery in the context of the COVID-19 pandemic: Prospective study of 783 patients].
Perrin Alexis A Mainard Nicolas N Limousin Marc M Meyer Eric E Remy Franck F Strouk Guillaume G Norberciak Laurène L Ridon Pierre-Emmanuel PE
Revue de chirurgie orthopedique et traumatologique 20220608 1
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Project description:BackgroundThe COVID-19 pandemic has required that specialists use videoconsultation (VC) to maintain continuity of care. As in-person consultations (IPCs) and surgical procedures were cancelled, VC became the tool of choice. No recent French study has assessed VC as the main consultation modality. The objective of this prospective study was to evaluate: 1) patient satisfaction, 2) access to and the future of VC, 3) and the reasons for VC refusal in the setting of the pandemic.HypothesisPatients responded favourably to VC.Patients and methodWe conducted a prospective, single-centre, observational study of consecutive patients who were invited to switch from IPC to VC during the lockdown of March 16 to May 11, 2020, when IPCs were not available. All patients were included in the study, regardless of whether they accepted the VC. The reasons for refusal were recorded at the time of the invitation. The surgeons sent the patients who accepted an emailed satisfaction questionnaire after the VC.ResultsOf the 783 patients with scheduled IPCs, 291 (37.2%) accepted a VC instead, 408 (52.1%) refused the VC, and 84 (10.7%) could not be contacted by telephone and were therefore excluded. The VC acceptance rate was 37% (291/783). Of the 291 VC patients, 233 (80.1%) returned the satisfaction questionnaire, although 2 questionnaires had too many missing data to be included, leaving 231 patients for the analysis. The VC was the first consultation with the surgeon for 66 (28.6%) patients. Of the 165 (71.4%) other patients, 51.6% (85/165) were receiving post-operative follow-up. On a 0-5 scale, the global VC experience was scored 4.3±0.8. Of the 231 VC patients, 161 (69.7%) felt that the VC was equivalent to an IPC, 18 (7.8%) that it was poorer, and 7 (3%) that it was better than an IPC; 45 (19.5%) had no opinion on this point. If choosing between a VC or an IPC had been possible during this first lockdown, 168/231 (72.7%) patients would have chosen an IPC. In contrast, 198/231 (85.7%) patients said they would choose an IPC after the lockdown. The group that refused the VC had a significantly older mean age (57.8±16.4 years vs. 48.0±14.4 years, p<0.0001) and lived closer to the institution (p<0.0001), whereas the sex distribution was comparable, with 42.9% of males (175/408) refusing and 46.8% (108/231) accepting the VC (p=0.39). The main reason for refusal was a wish for an in-person encounter with the surgeon (268/408, 65.7%). Patients aged ≥65 years were more likely to refuse due to technical considerations (access to electronic equipment and to the Internet), whereas patients ≤35 years were more likely to wait for an IPC.ConclusionThe rate of satisfaction with the VC was high. Satisfaction was not significantly associated with the reason for the consultation (joint involved, degenerative or post-traumatic condition, first VC, first consultation, or follow-up before or after surgery). Although most patients who accepted the VC felt that this modality was equivalent to an IPC, many remained desirous of an in-person encounter with the surgeon, notably among the youngest individuals. Outside the setting of a pandemic, the IPC remains the consultation modality of choice for most of our patients.Level of evidenceV, prospective study without a control group.
| S-EPMC9167679 | biostudies-literature
Project description:PurposeThis study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery training in Europe by conducting an online survey among orthopaedic trainees.MethodsThe survey was conducted among members of the Federation of Orthopaedic and Trauma Trainees in Europe (FORTE). It consisted of 24 questions (single-answer, multiple-answer, Likert scales). Orthopaedic trainees' demographic data (six questions), clinical role changes (four questions), institutional changes due to the COVID-19 pandemic (nine questions), and personal considerations (five questions) were examined.ResultsThree hundred and twenty-seven trainees from 23 European countries completed the survey. Most trainees retained their customary clinical role (59.8%), but a significant number was redeployed to COVID-19 units (20.9%). A drastic workload decrease during the pandemic was reported at most institutions. Only essential activities were performed at 57.1% of institutions and drastic disruptions were reported at 36.0%. Of the respondents, 52.1% stated that faculty-led education was restricted and 46.3% pursued self-guided learning, while 58.6% stated that surgical training was significantly impaired. Concerns about the achievement of annual training goals were expressed by 58.2% of the participants, while 25.0% anticipated the need for an additional year of training.ConclusionsThe SARS-CoV-2 pandemic significantly affected orthopaedic and trauma training in Europe. Most trainees felt the decrease in clinical, surgical, and educational activities would have a detrimental effect on their training. Many of them consulted remote learning options to compensate training impairment, stating that after the COVID-19 pandemic electronic educational approaches may become more relevant in future.
| S-EPMC7372204 | biostudies-literature
Project description:AimTo systematically review and quantify the efficacy of tranexamic acid (TXA) use in reducing the risk of receiving a blood transfusion in patients undergoing orthopaedic trauma surgery, in reducing blood loss, and risk of thromboembolic events.MethodsA systematic literature search was performed using MEDLINE, Embase, ClinicalTrials.gov, and conference proceeding abstracts from 2014 to 2016. A minimum of 2 reviewers screened each study and graded quality. The primary outcome measure was the risk of receiving a blood transfusion in the TXA group versus control. A meta-analysis was performed to construct a combined odds ratio (OR) of receiving a blood transfusion, mean difference (MD) of blood loss, and OR of thromboembolic events.ResultsTwelve studies were included in the quantitative analysis (1,333 patients). The risk of blood transfusion was significantly less in patients who were administered TXA compared with controls [OR 0.407; 95% confidence interval (CI) 0.278-0.594, I = 34, Q = 17, P ≤ 0.001]. There was significantly less blood loss in the TXA group compared with controls, as the mean difference was 304 mL (95% CI, 142-467 mL) (I = 94, Q value = 103, P < 0.001). There was no significant difference in risk of symptomatic thromboembolic events (OR 0.968; 95% CI, 0.530-1.766, I = 0, Q value = 5, P = 0.684).ConclusionsIn patients with orthopaedic trauma, TXA reduces the risk of blood transfusion, reduces perioperative blood loss, and has no significant effect on the risk of symptomatic thromboembolic events. More high-quality studies are needed to ensure the safety of the drug in these patients.Level of evidenceTherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
| S-EPMC6827340 | biostudies-literature
Project description:BackgroundA good patient-surgeon relationship relies on adequate preoperative education and counseling. Several multimedia resources, such as web-based education tools, have become available to enhance aspects of perioperative care.Purpose/hypothesisThe purpose of this study was to evaluate the effect of an interactive web-based education tool on perioperative patient satisfaction scores after outpatient orthopaedic surgery. It was hypothesized that web-based education prior to outpatient orthopaedic surgery enhances patient satisfaction scores.Study designRandomized controlled trial; Level of evidence, 1.MethodsAll patients undergoing knee arthroscopy with meniscectomy, chondroplasty, or anterior cruciate ligament reconstruction or shoulder arthroscopy with rotator cuff repair were eligible for inclusion and were randomized to the study or control group. The control group received routine education by the surgeon, whereas the study group received additional web-based education. At the first postoperative visit, all patients completed the OAS CAHPS (Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems) survey. Differences in patient satisfaction scores between the study and control groups were determined with an independent t test.ResultsA total of 177 patients were included (104 [59%] males; mean age, 42 ± 14 years); 87 (49%) patients were randomized to receive additional web-based education. Total patient satisfaction score was significantly higher in the study group (97 ± 5) as compared with the control group (94 ± 8; P = .019), specifically for the OAS CAHPS core measure "recovery" (92 ± 13 vs 82 ± 23; P = .001). Age, sex, race, workers' compensation status, education level, overall health, emotional health, procedure type and complexity, and addition of a video did not influence patient satisfaction scores.ConclusionSupplemental web-based patient education prior to outpatient orthopaedic surgery enhances patient satisfaction scores.
| S-EPMC5788117 | biostudies-literature
Project description:Heterotopic Ossification (HO) is a potential long-term complication in orthopaedic surgery. It is commonly classified according to the Brooker classification, which is based on radiological findings. To our knowledge the correlation of histological features to the Brooker grade is unknown as is the association between HO and the indication for revision. The aim of this paper is to analyze the ossification grade of HO tissue in patients undergoing revision hip and knee arthroplasty and to propose a histologically based classification system for HO. We also assess the relationship between the grade of HO and the indication for revision (septic and aseptic revision). From January to May 2019 we collected 50 human HO samples from hip and knee revision arthroplasty cases. These tissue samples were double-blinded and sent for histopathological diagnostic. Based on these results, we developed a classification system for the progression of HO. The grade of ossification was based on three characteristics: Grade of heterotopic ossification (Grade 1-3), presence of necrosis (N0 or N1) and the presence of osteomyelitis (HOES-Score Type 1 to 5). Demographic data as well as surgical details and indication for surgery was prospectively collected from clinical records. Fifty tissue samples were harvested from 44 hips and 6 knee joints. Of these 33 exhibited Grade I ossifications (66%), followed by 11 Grade II (22%) and one Grade III (2%). Necrosis was noted in two tissue samples (4%) and 2 more had osteomyelitis findings according to HOES-Score. Six samples (12%) with radiologically suggestive of HO turned out to be wear-induced synovitis, SLIM Type 1. Of these cases 16 were septic (32%) and 34 aseptic (68%) revisions. Most of the HO tissue samples were classified as a low-grade. High-grade ossification-Score is rare. Higher grades of ossification seem to be associated with septic revision cases. Wear-induced synovitis potentially influences HO development. A histological scoring system for ossification grading can be derived from the data presented in this study.
| S-EPMC6895226 | biostudies-literature
Project description:PurposeTo evaluate the feasibility of day surgery anterior cruciate ligament reconstruction (ACLR) in children. Our hypothesis was that proper patient selection, adequate information and a streamlined clinical pathway would allow for a safe and satisfactory procedure.MethodsA total of 20 patients, seven girls and 13 boys, who underwent outpatient ACLR at mean age of 14 years (8 to 16) were included in this single institution prospective case series. Surgery took place under simple general anesthesia while analgesia protocol combined local anesthesia, oral analgesics for the postoperative period and compressive cryotherapy. The main failure criterion was the inability to return home the day of surgery or the need for rehospitalization during the first week after discharge. Secondary evaluation parameters were the rate of postoperative complications, postoperative pain, quality of life (QOL) and patients' satisfaction outcome questionnaire (PSOQ) at postoperative day 1, 7 and 31.ResultsOf the 20 patients included, only one failed the ambulatory mode. The mean PSOQ score was, respectively for children and parents, 91.4% and 90.7% at day 7 and 94.6% and 95.7% at one month. Postoperative QOL at day 7 was very satisfying for all patients. Two minor early complications were reported. Both of the late complications, which included one partial wound dehiscence and one persistent knee swelling, resolved spontaneously.ConclusionThis study indicates that, in a targeted and well-informed population, day surgery for children ACLR yields high level of patient and family satisfaction in a safely manner.Level of evidenceIV, prospective case series.
| S-EPMC6376444 | biostudies-literature
Project description:PURPOSE:The outbreak of the SARS-CoV-2 virus has been associated with reports of increased anxiety, depression and fear among the general population. People with underlying psychiatric disorders are more susceptible to stress than the general population. The purpose of this study was to determine the prevalence of concomitant psychiatric conditions in the orthopaedic trauma population during the COVID-19 pandemic. METHODS:This retrospective cohort study evaluated orthopaedic trauma patients who received care at our institution between February through April of 2019 and February through April of 2020. Patient sex, age, mechanism of injury, associated injuries, fracture location, tobacco use, employment status, mental health diagnosis and presence of interpersonal violence were documented. Mental health diagnoses were defined based on International Classification of Diseases-10 classification. RESULTS:The study included 553 orthopaedic patients evaluated at our institution during the defined time period. Patients in the 2020 cohort had a higher prevalence of mental health diagnoses (26% vs. 43%, p <?0.0001) compared with the 2019 group. The odds ratio for mental health disorder in the 2020 patients was 2.21 (95% CI 1.54, 3.18) compared with the 2019 cohort. The 2020 cohort had a higher percentage of patients who reported interpersonal violence (20% vs. 11%, p =?0.005). CONCLUSION:Our study showed a higher prevalence of psychiatric disease among orthopaedic trauma patients during the COVID-19 pandemic when compared with those seen during the same time of the year in 2019. Stress induced by the coronavirus pandemic can place patients with mental illness at a higher risk for perilous behaviours and subsequent fractures.
| S-EPMC7365601 | biostudies-literature
Project description:BackgroundThe Coronavirus disease-2019 (COVID-19) placed unprecedented pressure on the healthcare system. Many institutions implemented a government-mandated restructured set of safety and administrative protocols to treat urgent orthopaedic trauma patients. The objective of this study was to compare two cohorts of patients, a COVID group and non-COVID control group, and to evaluate the effectiveness of safety measures outlined in the Rutgers Orthopaedic Trauma Patient Safety Protocol (ROTPSP). Secondary outcomes were to elucidate risk factors for complications associated with fractures and COVID-19.MethodsPatients treated for orthopaedic traumatic injuries were retrospectively identified between March and May 2020, and compared to a series of patients from the same time period in 2018. Main outcome measures included surgical site infections (SSI), length of stay (LOS), post-operative LOS (poLOS), presentation to OR time (PORT), and length of surgery.ResultsAfter review, 349 patients (201 non-COVID, 148 COVID) undergoing 426 surgeries were included. Average LOS (11.91 days vs. 9.27 days, p = 0.04), poLOS (9.68 days vs. 7.39 days, p = 0.03), and PORT (30.56 vs. 25.59 h, p < 0.01) was significantly shorter in the COVID cohort. There were less SSI in the COVID group (5) compared to the non-COVID group (14) (p = 0.03). Overall complications were significantly lower in the COVID group. Patients receiving Cepheid tests had significantly shorter LOS and poLOS compared to patients receiving the RNA and DiaSorin tests (p < 0.01 and p < 0.01, respectively). The Cepheid test carried the best benefit-to-cost ratio, 0.10, p < 0.05.ConclusionThe restructuring of care protocols caused by COVID-19 did not negatively impact perioperative complication rates, PORT or LOS. Cepheid COVID test type administered upon admission plays an integral role in a patient's hospital course by reducing both length of stay and hospital costs. This information demonstrates we can continue to treat orthopaedic trauma patients safely during the COVID-19 pandemic by utilizing strict safety protocols.
| S-EPMC8088543 | biostudies-literature
Project description:BackgroundThe purpose of the present study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery departments in university hospitals in Germany in order to clarify current challenges.MethodsIn this cross-sectional study, an online-based anonymous survey was conducted within the Convention of University Professors of Orthopaedic and Trauma Surgery in Germany from April 3 to April 11, 2020. A bipolar 5-point Likert scale (with possible responses of "totally disagree," "rather disagree," "neutral," "rather agree," and "totally agree") was applied. Fifty-two (69.3%) of 75 clinic directors participated.ResultsCommunication and cooperation with the government, hospital administration, and other departments during the COVID-19 pandemic were mainly perceived as appropriate. However, only 7 respondents (13.7%) totally agreed or rather agreed with the statement that the authorities are supporters of orthopaedic and trauma surgery departments. Substantial financial and personnel changes in orthopaedic and trauma surgery departments of university hospitals were reported, resulting in an average reduction of 49.4% in operating room capacity and an expected 29.3% loss of revenue. In addition, 14.7% of physicians were reallocated from orthopaedic and trauma surgery to other care-delivery environments.ConclusionsOur study demonstrated that the COVID-19 pandemic has had a substantial impact on orthopaedic and trauma surgery departments in German university hospitals. Distinct structural and financial effects were noted. Nevertheless, the present study demonstrates the commitment of our specialty to overcome the pandemic by providing competent personnel as well as close cooperation with the hospital administration and other departments.Clinical relevanceTo our knowledge, this is the first Germany-wide survey among the heads of orthopaedic and trauma surgery departments in university hospitals on the impact of the COVID-19 pandemic. The survey results may help to inform system-wide decision-making in Germany, in Europe, and beyond.
| S-EPMC7431148 | biostudies-literature
Project description:PurposeTrauma and orthopaedic (T&O) surgery relies on medical implants and materials, often resulting in metalwork wastage (prosthesis, screws, nails, and plates). This places an economic strain on healthcare services and the environment. Our primary outcome is to quantify the implant wastage across the literature, and secondarily investigate the associated costs in this specialty.MethodsA literature search of three databases (Scopus, PubMed and Embase) was performed using MeSH terms relating to "implant waste" and "trauma and orthopaedic surgery", from January 1980 to November 2023. We included any observational studies that reported patients undergoing T&O surgery, where the wastage or associated costs was reported.ResultsOur search returned 2,145 articles, of which 15 met the final inclusion criteria, encompassing 26,832 procedures. Nine studies reported the extent and cost of waste, six reported the weight of waste and ten concurrently reported the cost. Implant waste events occurred in up to 30% of all T&O procedures, being the most likely to occur in fracture fixation, and cost hospitals between $4,130 and $189,628.41 annually. Screws were the most wasted material, followed by plates and nails. Up to 95% of waste events were caused by human factors.ConclusionDespite the limited number of studies, there is an economic burden and environmental footprint in T&O surgery services. The main factors contributing to the waste was human error, and contamination. Further research is required to determine methods of mitigating and limiting implant waste in T&O Surgery.
| S-EPMC11762414 | biostudies-literature