Collateral effect of COVID-19 on orthopedic and trauma surgery

Abstract

Objectives: The purpose of this study was to assess the impact of the COVID-19 pandemic on orthopedic and trauma surgery in private practices and hospitals in Germany.

Design: In this cross-sectional study, an online-based anonymous survey was conducted from April 2th to April 16th 2020.

Setting: The survey was conducted among 15.0000 of 18.000 orthopedic and trauma surgeons in Germany, both in private practices and hospitals.

Participants: All members of the German Society of Orthopedic and Trauma Surgery (DGOU) and the Professional Association for Orthopedic and Trauma Surgery (BVOU). were invited by e-mail to participate in the survey.

Main outcome measures: Out of 50 questions 42 were designed to enquire a certain dimension of the pandemic impact and contribute to one of six indices, namely "Preparedness", "Resources", "Reduction", "Informedness", "Concern", and "Depletion". Data was analyzed in multiple stepwise regression, aiming to identify those factors that independently influenced the indices.

Results: 858 orthopedic and trauma surgeons participated in the survey throughout Germany. In the multiple regression analysis, being employed at a hospital was identified as an independent positive predictor in the indices for "Preparedness", "Resources", and "Informedness" and an independent negative predictor regarding "Depletion". Self-employment was found to be an independent positive predictor of the financial index "Depletion". Female surgeons were identified as an independent variable for a higher level of "Concern".

Conclusions: The study confirms a distinct impact of the COVID-19 pandemic on orthopedic and trauma surgery in Germany. The containment measures are largely considered appropriate despite severe financial constraints. A substantial lack of personal protective equipment (PPE) is reported. The multiple regression analysis shows that self-employed surgeons are more affected by this shortage as well as by the financial consequences than surgeons working in hospitals.

What are the new findings: The COVID-19 pandemic has a profound impact on orthopedic and trauma surgery as an unrelated specialty. Self-employed surgeons are affected especially by a shortage of PPE and financial consequences.

How might it impact on clinical practice in the near future: Political and financial support can now be applied more focused to subgroups in the field of orthopedics and trauma surgery with an increased demand for support. A special emphasis should be set on the support of self-employed surgeons which are a more affected by the shortage of PPE and financial consequences than surgeons working in hospitals.

Conflict of interest statement

Dr. Perka reports personal fees from Smith&Nephew, personal fees from Link, personal fees from DePuy/Synthes, personal fees from Aesculap, personal fees from Zimmer, outside the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Overview of the answers to the index questions 1–42 of the questionnaire.

The graph depicts the answers as given by the participants in the 858 fully completed surveys of the first 42 questions, designed to to query certain dimension of the pandemic impact, most of them contributing to one of six indices. For the full question texts, please refer to the questionnaire in the supplemental data. The first 14 questions (Fig 1A) allowed “does apply”, “does not apply” and “neutral/unsure” for an answer, 15–21 (Fig 1B) asked for the level of reduction in in-patient and out-patient care, for both elective and urgent cases, on a 5-degree scale in percent. In questions 22 to 42 (Fig 1C), the participants’ level of agreement towards statements regarding preparations, handling, medical and financial consequences of the pandemic and support by the orthopaedic associations and the insurances was asked on a five-point Likert scale. COVID-19: Coronavirus Disease 19; PPE: Personal protection equipment; PA: Professional association of orthopedics and trauma surgeons; ASHIP: Association of statutory health physicians.

Fig 2. Overview of the participants’ profile.

The graphs show the composition of the participants’ profile information of n = 858 fully completed surveys. Fig 2A show the distribution of participants primary work environment; Fig 2B summarizes the sub-specialization of the participants (multiple answers were allowed). Figs 2C, 2D and 2E show the distribution of the participants’ professional position, their age group and gender.

Fig 3. Correlation matrix of profile items and indices.

The figure shows a heat map of the Spearman correlation between the different profile items and the calculated indices (bold italics, right and bottom). Red boxes indicate a negative correlation (Spearman r 0), with darker color representing stronger correlation and white or light colored boxes no or weak correlation. Surgical specialties, for example, positively correlate with each other, as well as with “Treating COVID-19 patients” and with “Working in hospital”. All correlate with higher levels of “Preparedness” and “Resources” indices.

Fig 4. Bivariate analysis of the profile items per index.

The graph shows the mean +/- 95% confidence interval of the index score for each of the six indices (“Preparedness”: Fig 4A, “Resources”: Fig 4B, “Informedness”: Fig 4C, “Reduction”: Fig 4D, “Concern”: Fig 4E and “Depletion”: Fig 4F), comparing subgroups that answered “yes” (green) or “no” (red) on those profile items that were most relevant / most significant in the bivariate analysis. For P-Values and significance levels please see Table 2.