Most elective surgical procedures in the US have been suspended because of the COVID-19 pandemic, but orthopaedic surgeons continue to provide acute care, and some are being recruited to the COVID-19 “front lines.” Available evidence suggests that older individuals are at higher risk for poor outcomes with COVID-19. In addition, >90% of US orthopaedic surgeons are male, which is thought to be another risk factor for COVID-19 severity.
In the latest fast-track JBJS article on COVID-19, Jella et al. considered those facts when making a geospatial map of US orthopaedic surgeons aged 60 years and older (see Figure above). It turns out that 4 states among those with the highest quintile of orthopaedic surgeons ≥60 years of age are also the 4 states most severely affected by COVID-19: New York, New Jersey, California, and Florida.
The authors did not account for comorbid conditions, nor does their data indicate any direct relationship between older orthopaedic providers and their risk of contracting COVID-19. Nevertheless, Jella et al. make the following observations:
- The high proportion of older surgeons in areas of high rates of disease prevalence may increase their susceptibility.
- The risk of fulminant, possibly fatal disease in older orthopaedic surgeons should be considered in the setting of front-line COVID-19 work.
- These findings could provide a rationale for matching of critically limited personal protective equipment to higher-risk providers.
- The 5-zone before-and-after-surgery protocols described by Rodrigues-Pinto et al. “should be heavily considered if older physicians continue to operate in the midst of this crisis.”
- Implementation of telemedicine services will help minimize contact between older providers and infected patients. Also, older orthopaedic surgeons may serve an important role in resident training during this time, with various digital platforms currently available for remote education.
The authors are quick to add that “the present study does not imply that COVID-19 infection among younger providers is in any way less severe or less important,” nor does it “imply that any particular ethical position should be taken.” The authors emphasize that it is up to individual healthcare systems to choose which surgeons are deployed and in what capacity.