A Call to Arms: Emergency Hand and Upper-Extremity Operations During the COVID-19 Pandemic

Shawn Diamond, MD; Jonathan B. Lundy, MD; Erin L. Weber, MD, PhD; Shadi Lalezari, MD; Gregory Rafijah, MD; Amber Leis, MD; Benjamin L. Gray, MD, MSCE; Ines C. Lin, MD, MSEd; Ranjan Gupta, MD

Journal of Hand Surgery Global Online (Jul 2020)

A Call to Arms: Emergency Hand and Upper-Extremity Operations During the COVID-19 Pandemic

Shawn Diamond, MD,
Jonathan B. Lundy, MD,
Erin L. Weber, MD, PhD,
Shadi Lalezari, MD,
Gregory Rafijah, MD,
Amber Leis, MD,
Benjamin L. Gray, MD, MSCE,
Ines C. Lin, MD, MSEd,
Ranjan Gupta, MD

Affiliations

Shawn Diamond, MD: Department of Plastic Surgery, University of California, Irvine, Orange, CA; Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA; Corresponding author: Shawn Diamond, MD, Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Drive, Pavilion III, 2nd Floor, Orange, CA 92868.
Jonathan B. Lundy, MD: Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
Erin L. Weber, MD, PhD: Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
Shadi Lalezari, MD: Department of Plastic Surgery, University of California, Irvine, Orange, CA; Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA
Gregory Rafijah, MD: Department of Plastic Surgery, University of California, Irvine, Orange, CA; Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA
Amber Leis, MD: Department of Plastic Surgery, University of California, Irvine, Orange, CA; Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA
Benjamin L. Gray, MD, MSCE: Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
Ines C. Lin, MD, MSEd: Division of Plastic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Ranjan Gupta, MD: Department of Plastic Surgery, University of California, Irvine, Orange, CA; Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA

Journal volume & issue: Vol. 2, no. 4
pp. 175 – 181

Abstract

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Purpose: Limited data exist regarding volumetric trends and management of upper-extremity emergencies during periods of social restriction and duress, such as the coronavirus disease 2019 pandemic. We sought to study the effect of shelter-in-place orders on emergent operative upper-extremity surgery. Methods: All patients undergoing emergent and time-sensitive operations to the finger(s), hand, wrist, and forearm were tracked over an equal number of days before and after shelter-in-place orders at 2 geographically distinct Level I trauma centers. Surgical volume and resources, patient demographics, and injury patterns were compared before and after official shelter-in-place orders. Results: A total of 58 patients underwent time-sensitive or emergent operations. Mean patient age was 42 years; mean injury severity score was 9 and median American Society of Anesthesiologist score was 2. There was a 40% increase in volume after shelter-in-place orders, averaging 1.4 cases/d. Indications for surgery included high-energy closed fracture (60%), traumatic nerve injury (19%), severe soft tissue infection (15%), and revascularization of the arm, hand, or digit(s) (15%). High-risk behavior, defined as lawlessness, assault, and high-speed auto accidents, was associated with a significantly greater proportion of operations after shelter-in-place orders (40% vs 12.5%; P < .05). Each institution dedicated an average of 3 inpatient beds and one intensive care unit–capable bed to upper-extremity care daily. Resources used included an average of 115 minutes of daily operating room time and 8 operating room staff or personnel per case. Conclusions: Hand and upper-extremity operative volume increased after shelter-in-place orders at 2 major Level I trauma centers across the country, demanding considerable hospital resources. The rise in volume was associated with an increase in high-risk behavior. Type of study/level of evidence: Therapeutic IV.

Published in Journal of Hand Surgery Global Online

ISSN: 2589-5141 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/journal-of-hand-surgery-global-online

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