OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Adam Bitterman, DO in response to 2 recent articles in the July 15, 2020 issue of The Journal of Bone & Joint Surgery.
The United States continues to struggle in the grip of the global COVID-19 pandemic. Certain regions within the US are experiencing a sharply increased COVID-19 case volume, while other locales have stabilized their disease burden. But overall, the country’s healthcare system and economy remain under stress.
Healthcare systems in regions that don’t have high COVID-19 burdens have begun to provide their full list of services, of which elective orthopaedic surgery is one. However, amid concern about a “second wave” of the pandemic, the reemergence of elective orthopedic surgery must be made–and monitored–in the context of public health. Now more than ever, surgeons and their patients must consider how individual patient-centered decisions might play out in the public domain.
As Anoushiravani and colleagues point out, the return of elective orthopedic surgery should be based in large part on the COVID-19 burden in any given geographic location. Local jurisdictions must regulate the return to “normalcy” according to measurements that gauge activity of the virus, such as the number of new diagnoses and hospitalizations and the percent occupancy of ICU beds. In another JBJS article on this topic, Parvizi et al. emphasize that local hospitals and health systems need to weigh resumption of elective orthopaedic procedures also against staffing capability and available supplies of PPE and ventilators. The sensible recommendations from both sets of authors emphasize the importance of ascertaining local disease patterns in order to provide appropriate and safe care for all patients.
The new “normal” in healthcare is a moving target that requires fluidity and flexibility to make frequent reassessments. The economic disruption caused by the pandemic may take years to resolve, and economics is another factor in these resuming-surgery equations. As members of the healthcare team, it is imperative that we focus on the well-being of our patients, surgical team and staff, and our local community. We all must be vigilant for signs of resurgence of the disease. And, please, wear a mask whenever you are out in public and social distancing is not feasible.
Adam Bitterman, DO is a foot and ankle specialist, an assistant professor of orthopaedic surgery at Zucker School of Medicine at Hofstra/Northwell, and a member of the JBJS Social Media Advisory Board.
OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Chad A. Krueger, MD, co-author of a recent fast-tracked review article in JBJS.
I’ll admit that when I first started hearing about COVID-19, I didn’t pay much attention. Life was busy, and I wasn’t going to worry about something that I figured would come and go without much fuss over the next few months. While that was obviously a faulty assumption, I think few of us could have predicted just how deadly, anxiety-provoking, and disruptive this virus would be. We are now 5 or so months into this pandemic and nothing is ”normal,” but some of the measures we have taken to help flatten the curve seem to be working. In the months ahead, figuring out how to safely regain some normalcy in our lives will require careful planning, nimble adjustments, and well-coordinated cross-functional execution.
Those three actions were also required to produce the fast-tracked Current Concepts Review article in JBJS about resuming elective orthopaedic surgery during the pandemic, which I had the privilege to co-author. Amazingly, that article progressed from an idea to a published manuscript, with input from 77 physicians, in the span of 2 weeks. This fast-paced project was driven by our knowledge that many facilities worldwide were getting ready to start performing elective surgeries again, and we wanted to ensure that practical, accurate, and relevant information was available as those plans were being made.
All the expert author-contributors offered unique insights as to how the pandemic was affecting healthcare delivery in their region of the globe, allowing us to keep the recommendations as balanced as possible. Although much of the research incorporated in this review came from outside the orthopaedic literature, it all touched on our ability to safely care for patients. The process of creating this article was a great example of how strong leadership, teamwork, and compromise can help us navigate through all aspects of these uncharted waters. Everyone who worked on this manuscript, including the peer-review and editorial teams at JBJS, had one goal in mind: to help orthopaedic surgeons safely return to caring for their patients.
The international consensus group that created this review is well aware that some of the recommendations will need to be updated, changed, or maybe even scrapped altogether as we learn more about the behavior of this virus. We drafted, discussed, and revised these guidelines while appreciating that some regions of the world have not been as adversely affected as others and that there are stark global differences in testing capabilities and supplies of personal protective equipment and other resources. We are painfully aware that some of our strongest recommendations might be impossible to implement in certain settings.
Developing a one-size-fits-all framework for restarting elective orthopaedic surgery was not possible; there are simply too many variables at play with this pandemic that are beyond any individual’s or health system’s control. However, this review provides as much evidence-based guidance as possible so that individual surgeons, practices, hospitals, and municipalities can make informed decisions about how elective surgery should reemerge. We are fully aware that some people may object to some of the recommendations in this article, even though 94% to 100% of the 77-member consensus group agreed on all of them. Nevertheless, we hope that this guidance—and updates to it as more evidence becomes available—will help us all continue to make highly informed decisions before, during, and after elective surgery to keep ourselves and our patients safe.
Chad A. Krueger, MD is an orthopaedic fellow in adult reconstructive surgery at the Rothman Institute and former Deputy Editor for Social Media at JBJS.