COVID-19 Not Associated With Ability to Meet 24-Hour Time-To-Surgery Benchmarks

Ida Leah Gitajn, MD

As a result of the COVID-19 pandemic, a large number of hospital systems were forced to reduce operating room capacity and reallocate resources, with unclear answers on the outcome of these policy decisions on the care of acutely injured patients.

Accordingly, new research evaluated if the COVID-19 was associated with delays in urgent fracture surgery beyond national time-to-surgery benchmarks.

Led by Ida Leah Gitajn, MD, Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, investigators observed no association between meeting time-to-surgery benchmarks in either open fracture or closed femur/hip fracture during the COVID-19 pandemic, in comparison to before the pandemic.

Methods

The cohort study was a secondary analysis of the Program of Randomized Trials to Evaluate Preoperative Antiseptic Skin Solutions in Orthopedic Trauma (PREP-IT) program.

It took place in 20 medical sites across the US and Canada, with adults aged ≥18 years presenting with an open fracture of an extremity requiring surgery or closed lower extremity or pelvis fracture requiring surgery.

The trials compared iodophor versus chlorhexidine-based antiseptic skin preparation solutions, with clinical sites randomized to determine which solution to begin using and crossed over to the alternative study solution every 2 months.

In the current retrospective cohort study, all patients included in the PREP-IT program sustained an open fracture, femur fracture, or hip fracture. Investigated outcomes included time to surgery bifurcated into surgery within 24 hours of hospital admittance or greater than 24 hours from hospital admittance.

It was noted that the primary focus of the study was to determine whether hospital policy changes related to COVID-19 were associated with time to surgery.

Findings

The study included a total of 3598 patients. In the open fracture cohort, the mean age was 45.4 years with 1100 (63.4%) men, while the closed fracture cohort had a mean age of 66.7 years with 813 (43.6%) men.

Data show a total of 54 patients (3.1%) in the open fracture cohort and 407 patients (21.8%) in the closed hip/femur fracture cohort did not meet 24-hour time-to-surgery benchmarks.

Investigators observed variability around odds ratios for meeting 24-hour time-to-surgery benchmarks across hospital sites (range, 73.9% to 100% in the open fracture cohort and 48.4% to 100% in the closed fracture cohort).

Following control for hypothesis-driven variables, there was no independent association between admission during COVID-19 and delay to the operating room beyond 24 hours in the open fracture cohort (OR, 1.40; 95% CI, 0.77 - 2.55, P = .28).

Additionally, no independent association between admission during COVID-19 and delay to the operating room beyond 24 hours in the femur/hip fracture cohort (OR, 1.01; 95% CI, 0.74 - 1.37, P = .97).

Among the closed femur/hip fracture cohort, when evaluating the association between meeting less-than-24-hour time-to-operating room benchmarks and regional COVID-19 case rate, they still found no association between regional COVID-19 rate and time-to-operating room benchmarks (OR, 1.07; 95% CI, 0.70 - 1.64, P = .76).

Takeaways

“Although the COVID-19 pandemic has created unprecedented challenge to health care systems far and wide, this cohort study suggests that hospital systems throughout the US and Canada were able to effectively mitigate these challenges such that 24-hour time-to-surgery benchmarks were unchanged from before the pandemic to after the pandemic,” investigators wrote.

The study, “Association of COVID-19 With Achieving Time-to-Surgery Benchmarks in Patients With Musculoskeletal Trauma,” was published in JAMA Health Forum.