Impact of the National Lockdown Due to the COVID-۱۹ Pandemic On Upper Limb Trauma Workload in Central London: A Multi-Centre Longitudinal Observational Study During Implementation and Ease of National Lockdown

Background: This study assessed the impact of the COVID-۱۹ pandemic on acute upper limb referrals and operative case-mix at the beginning and ease of British lockdown. Methods: A longitudinal multicentre observational cohort study was conducted for both upper limb trauma referrals and operative case-mix over a ۱۲-week period (۶ weeks from the beginning and ۶ weeks from the ease of the national lockdown). Statistical analysis included median (± median absolute deviation), risk and odds ratios, and Fisher’s exact test to calculate the statistical significance, set at p ≤ ۰.۰۵. Results: There was a ۱۵۸% (n = ۴۵۶ vs. ۱۷۷) increase in upper limb referrals and ۱۳۳% (n = ۹۱ vs. ۳۹) increase in the operative trauma caseload at the ease of lockdown compared with its commencement. An increase in sporting injuries was demonstrated (p=۰.۰۲), specifically cycling (p=۰.۰۰۴, OR=۲.۵۸). A significant increase in COVID-۱۹ testing was demonstrated during the ease of lockdown (p=۰.۰۰۰۱) with more patients having their management changed during the early pandemic (۹.۶% vs. ۰.۷%, p=۰.۰۰۰۱). Of these patients, ۴۷% went on to have delayed surgery within ۶ months. No patients who underwent surgery tested positive for COVID-۱۹ infection within ۱۴ days post-operatively and no mortalities were recorded at ۳۰ days. Conclusion: The ease of lockdown has seen upper limb referrals and operations more than double compared to early lockdown. With no patients testing positive for COVID-۱۹ within ۱۴ days of the procedure, this demonstrates that having upper limb surgery during the current pandemic is safe. Level of evidence: III

Keywords:

Trauma , Coronavirus , COVID-۱۹ , Upper Limb , lockdown