“Pandemic impacted all stakeholders of the healthcare ecosystem, with a substantial impact on timely delivery of optimal trauma care across hospitals globally”, opines Dr. Rahul Ghodke (MBBS, DNB – Orthopedics/Orthopedic Surgery) Orthopaedic and Joint Preservation Surgeon with 17 Years Experience.
It’s no secret that the last two years have been exceptionally difficult and especially tasking for the medical community. And, the rising pressure significantly disrupted the surgical healthcare system with an array of challenges. These ranged from cancellations, decision-making on optimal timing of surgery, vaccination model for safe surgery, risk prediction for mortality, pulmonary complications in elective surgery, and the financial implications on both hospitals and patients.
Additionally, the lack of standardised protocols for trauma patients in need of urgent medical help, forced the health systems to work under extreme stress to perform a complete re-organisation of the means and activities within the hospital.
To assess the situation, a study was conducted on an international, multi-center, prospective cohort that included patients undergoing elective or emergency surgery during the pandemic years 2020-2021 across the world. Its findings clearly indicated this impact of the pandemic on orthopaedic and trauma surgery.
Aiming to explore the impact of COVID-19 in surgical patients and services, the National Institute of Health Research and the University of Birmingham carried out a Herculine research project with a series of studies.
The studies were designed and delivered by an collaborating group of international surgeons and anaesthetists which reached over 122 countries, 1677 hospitals & collected data of 14,2,815 patients. This unique study, that I was lucky to be a part of, has also entered the Guinness World Records on March 24, 2021 for having the most number of authors on a single peer-reviewed academic paper.
COVID-19’s impact on Orthopaedic patient care & health of Orthopaedic surgeons:
The overwhelming global response to the COVID-19 pandemic has exposed inherent weaknesses in our preparedness and response. It highlighted the fact that the need for quality and operational health systems is continuous, and not time-dependent or of short duration. Any disruption in access to quality service delivery is not only detrimental to human health but can also be responsible for the loss of life and substantial economic losses.
Surgical interventions be it for saving lives or restoring essential senses such as vision and hearing and responding to acute emergencies including trauma are some of the services that are at the core of the health system. Any sudden man-made or natural disaster-induced disruption in the seamless delivery of health services has the potential to severely impact most of the essential services.
And that is what happened with the pandemic, as it also caused substantial disruption on the ongoing health programs in preventive orthopaedics and rehabilitation, including geriatrics. But it was not limited to patient care, impacting providers as well. From impacting mental health of patients and orthopaedic surgeons to the delivery of optimal trauma care across all hospitals globally, the detrimental effects of the pandemic were felt by all stakeholders in the healthcare ecosystem.
According to a survey conducted by 611 orthopaedic surgeons from 140 cities in India, 22.5% orthopaedic surgeons said that they were definitely stressed out, and 40.5% said they were mildly stressed out. With declining age, the percentage of orthopaedic surgeons feeling “a lot of stress” had increased. Disruption of work-life balance and uncertainties regarding return to work were other strongly associated factors closely related to the “absolutely stressed” group..
In clinical practice the workload impact included service volume impact on personal workload during the pandemic. A study on the workload in the UK revealed the average number of weekly referrals to the service decreased by 33% , The number of operations performed each week was reduced by 26%, the number of referrals for simple fractures, natural joint dislocations, wounds, and soft tissue injuries had been significantly reduced. Similarly, in the paediatric population, the reduction in referrals for simple fractures had also been demonstrated.
To summarise, the pandemic became a significant disruptive force not only for orthopaedics but for the entire health care system, but it was an eye opener. A wake-up call for the entire sector, it helped implement change in a very short period of time and prioritised the necessities of healthcare systems to regularly conduct audits, research and observational study for the betterment of both patient care and the health of doctors and hospitals.