Outcomes of orthopaedic trauma surgery in COVID-19 positive patients.

OBJECTIVES

To investigate outcomes for operative orthopaedic trauma in patients who tested positive for coronavirus disease 2019 (COVID-19) during the height of the COVID-19 pandemic in New York.

DESIGN

Retrospective case series.

SETTING

Urban Level-1 academic trauma center.

PATIENTS/

PARTICIPANTS

Thirteen patients diagnosed with COVID-19 who underwent surgical management for orthopaedic trauma between January 21, 2020 and May 11, 2020.

INTERVENTION: Does not apply to this study.

MAIN OUTCOME MEASUREMENTS: Complications including death, coma lasting more than 24 hours, prolonged mechanical ventilation, unplanned intubation, blood transfusion, postoperative pneumonia, cerebrovascular event, thromboembolic event, myocardial infarction, urinary tract infection, acute renal failure, septic shock, return to the operating room, wound dehiscence, surgical site infection, graft/prosthesis/flap failure, and peripheral nerve injury.

RESULTS

Two (18%) patients had symptoms of COVID-19 (cough, shortness of breath, fevers, chills, nausea/vomiting, diarrhea, abdominal cramps/pains) on admission. Average length of stay (standard deviation) was 6.6 (4.31) days. Average time to follow up was 29 (10.77) days. Three (27%) patients developed pneumonia postoperatively and 1 (9%) underwent unplanned intubation. One (9%) patient was intubated for greater than 48 hours. Two (18%) patients developed postoperative deep venous thromboembolism. Three (27%) patients developed acute renal failure postoperatively. Six (55%) patients underwent blood transfusion intraoperatively or postoperatively. Two (18%) patients died postoperatively.

CONCLUSION

In this small series surgical management in Coronavirus-19 positive patients with skeletal injuries was successfully accomplished with patient anticoagulation, hematologic, and pulmonary status in mind. Therapeutic anticoagulation and patient hematologic status were optimized prior to the operating room to minimize development of venous thromboembolism and avoid blood transfusion.

LEVEL OF EVIDENCE: Level IV prognostic.