Research

Low 30-day mortality in South African orthopaedic patients undergoing surgery at an academic hospital during the first wave of the COVID-19 pandemic: It was safe to perform orthopaedic procedures at our hospital during the first COVID-19 peak

R Waters, R Dey, M Laubscher, R Dunn, S Maqungo, G McCollum, M Nortje, S Roche, T Hilton, W Mugla, M Held

Abstract


Background. Initial local and global evidence suggests that SARS-CoV-2-infected patients who undergo surgery, and those who become infected perioperatively, have an increased mortality risk post surgery.

Objectives. To analyse and describe the 30-day mortality, presurgical COVID-19 status and hospital-acquired SARS-CoV-2 infection rates of patients, both SARS-CoV-2-positive and negative, undergoing orthopaedic surgery at a tertiary academic hospital in South Africa (SA) during the first COVID-19 peak.

Methods. This single-centre, observational, prospective study included patients who underwent orthopaedic procedures from 1 April 2020 (beginning of the COVID-19 case increase in SA) to 31 July 2020 (first COVID-19 peak in SA). All patients were screened for COVID-19 and were confirmed positive if they had a positive laboratory quantitative polymerase chain reaction test for SARS-CoV-2 RNA on a nasopharyngeal or oral swab. Thirty-day mortality, presurgical COVID-19 status and hospital-acquired SARS-CoV-2 infection were assessed.

Results. Overall, a total of 433 operations were performed on 346 patients during the timeframe. Of these patients, 65.9% (n=228) were male and 34.1% (n=118) were female. The mean (standard deviation) age was 42.5 (16.8) years (range 9 - 89). Of the patients, 5 (1.4%) were identified as COVID-19 patients under investigation (PUI) on admission and tested positive for SARS-CoV-2 before surgery, and 1 (0.3%) contracted SARS-CoV-2 perioperatively; all survived 30 days post surgery. Twenty-nine patients were lost to follow-up, and data were missing for 6 patients. The final analysis was performed excluding these 35 patients. Of the 311 patients included in the final 30-day mortality analysis, 303 (97%) had a follow-up observation ≥30 days after the operation. The overall 30-day mortality for these patients was 2.5% (n=8 deaths). None of the recorded deaths were of screened COVID-19 PUI.

Conclusions. We report a low 30-day mortality rate of 2.5% (n=8) for patients undergoing orthopaedic surgery at our hospital during the first COVID-19 peak. None of the deaths were COVID-19 related, and all patients who tested SARS-CoV-2-positive, before or after surgery, survived. Our overall 30-day mortality rate correlates with several other reports of orthopaedic centres analysing over similar timeframes during the first peak of the COVID-19 pandemic. Regarding mortality and SARS-CoV-2 infection risk, we can conclude that with the appropriate measures taken, it was safe to undergo orthopaedic procedures at our hospital during the first peak of the COVID-19 pandemic in SA.


Authors' affiliations

R Waters, Orthopaedic Research Unit, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

R Dey, Orthopaedic Research Unit, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa

M Laubscher, Orthopaedic Research Unit, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

R Dunn, Orthopaedic Research Unit, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

S Maqungo, Orthopaedic Research Unit, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

G McCollum, Orthopaedic Research Unit, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

M Nortje, Orthopaedic Research Unit, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

S Roche, Orthopaedic Research Unit, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

T Hilton, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

W Mugla, Orthopaedic Research Unit, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

M Held, Orthopaedic Research Unit, Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

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Keywords

COVID-19; 30-day mortality; Orthopaedic; Surgery; SARS-CoV-2; Diagnosis; Infection; Survival; Safety

Cite this article

South African Medical Journal 2021;111(8):747-752. DOI:10.7196/SAMJ.2021.v111i8.15766

Article History

Date submitted: 2021-08-02
Date published: 2021-08-02

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