Published September, 2022
Low Mortality of Orthopaedic Trauma Patients with Asymptomatic COVID-19: A level-1 Trauma Center Pandemic Experience
Orthopedics research in early 2020 indicated that patients who were COVID-19–positive had alarming mortality and morbidity rates in the perioperative and postoperative periods, including increased pulmonary complications, thromboembolic events, sepsis, cardiac events, and death. Mortality rates ranging from 21% to 56% were reported. Although many of these studies focused on elderly patients or patients with low-energy hip fractures, the statistics raised concerns and prompted calls for postponement or cancellation of elective cases and greater use of nonoperative fracture care.
At LSU-Shreveport, elective cases were postponed in accordance with state mandates, but the orthopedic trauma service continued to operate on urgent and emergent injuries. During this period, the surrounding community hospitals treated most of the elderly patients with hip fractures, but LSU-Shreveport is the only Level I trauma center within a 180-mile radius. Consequently, the majority of the COVID-19–positive patients presenting to the trauma center were younger asymptomatic patients who were diagnosed on routine preoperative screening.
Because the mortality rate for younger patients was underreported, Patrick Massey, MD and his colleagues in the Department of Orthopaedic Surgery compared the 30-day mortality of asymptomatic COVID-19–positive patients and COVID-19–negative patients that they surgically treated during a 3-month period early in the pandemic.
A total of 471 patients were included in the analysis. The researchers found that asymptomatic COVID-19–positive orthopedic trauma patients had a 0% mortality rate, and they found no differences between COVID-19–positive and COVID-19–negative patients with respect to mortality and hospital length of stay. However, ICU days were increased for the COVID-19–positive patients.
"Early in the pandemic, Louisiana hospitals were hit hard. In the initial 3 months of the pandemic, our Orthopaedic Trauma team did 631 surgeries on 471 patients. Our study shows evidence that younger asymptomatic patients with COVID may not be at increased risk of mortality after orthopaedic surgery," Dr. Massey said.
This evidence can assist orthopedic surgeons weigh the risks and benefits of operating on a COVID-19–positive patient with acute orthopedic trauma.
