Best COVID-19 Practices for Orthopaedic Surgeons

In response to the COVID-19 pandemic, an abundance of clinical orthopaedic information has been  disseminated in a short period of time. Some of that has been compiled and commented upon here in OrthoBuzz.

On April 12, 2020, the editors of OrthoEvidence, led by Mohit Bhandari, MD, published a report of global recommendations that puts forth evidence-based principles to guide musculoskeletal care in the face of the coronavirus pandemic. The carefully referenced, 65-page report identifies pandemic-related best practices in outpatient care, elective procedures, urgent/emergent procedures, and peri-/postoperative care.

Nearly three-quarters of the 72 publications analyzed for the report were based on expert opinion and/or clinical experience; just over one-quarter were developed using evidence-based methods alone or a combination of evidence-based methods plus expert opinion. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach, the report’s authors assign strength ratings for all the recommendations compiled in the review.

The detailed information is best digested from the report itself, but here is a summary of the report’s overarching recommendations for orthopaedic management at this time:

  • Ensure patient and staff safety.
  • Stay up-to-date about evolving clinical guidelines and your institution’s capacity issues.
  • Prevent unnecessary use of personal protective equipment and make contingency plans for supply shortages.
  • Schedule only urgent or emergent surgical cases.
  • Perform only operative interventions that can be expected to have superior outcomes relative to nonoperative management.
  • Convene teams to make decisions about definitive management in semi-urgent or controversial cases.
  • Prevent unnecessary follow-up visits.

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