Study design
Single-center cross-sectional study (observational, non-randomized at a specific point in time) was performed in two different periods of time: pre-epidemic (pre-SARS-COV-2), and intra-epidemic (during SARS-COV-2 time) to compare these two very different scenarios. The subjects that inform the study were consultant orthopedic surgeons and orthopedic and trauma patients treated at our hospital in our various areas: outpatients, inpatients, ER and operating room.
Inclusion/Exclusion Criteria
Inclusion criteria: Orthopedic and trauma patients evaluated and treated by our service staff during a period of two weeks in two different points in time, pre-epidemic and intra-epidemic.
Exclusion criteria: We excluded patients 18 years old and younger as pediatric health care was centralized in two centers in Madrid during the intra-epidemic period.
Study development and groups
Patients were divided into two groups. The first one includes patients evaluated and treated during the third and fourth week of March 2019 (pre-epidemic). The second group includes patients evaluated and treated during the third and fourth week of March 2020 (intra-epidemic).
Data Analyzed
Data used in this study was collected anonymously from our hospital database. We analyzed the following variables in both groups:
A) Outpatients data
Gathered data related to the number of patients evaluated in-person and telematically, either through phone call or real-time videoconferences, main reason for consulting, and subsequent appointments resulting from the visit were recorded regarding the following variables: overall number of patients evaluated due to orthopedic or trauma pathology, main reason for consulting, number of specific subspecialty appointments (ie, shoulder/elbow, hand/microsurgery, hip, knee, foot/ankle, spine and general trauma) drawn from these evaluations, and categorized as urgent or standard appointments, and number of discharged patients from clinics.
B) Emergency room
Overall ER department attendance, time elapsed from injury and specific complaint classified as hand, shoulder/elbow, hip and other lower extremity as well as specific injury was recorded.
C) Surgical procedures
Number, type of procedures, average inhospital stay, and inpatient/outpatient ratio was assessed. Surgical procedures were allocated into four categories: trauma, infection, tumors and non-trauma/elective surgery.
D) Inpatients and outpatients.
The surgical procedures performed were distributed into four categories: trauma, infection, tumors and non-trauma/elective surgery. We also looked at total and preoperative average stay for admitted patients.
Perceived Quality
Patient and surgeon´s perceived quality of medical care delivery was evaluated through this epidemic period using an anonymous survey carried out following a specifically designed questionnaire over the phone. Items were scored using a numerical rating scale (NRS) ranking 1 to 10. Patients and surgeons were also asked about their perception on the possibility that a similar system of telemedicine might be followed for future health care delivery in outpatient clinics (Table 1,2). Sixteen orthopedic surgeons and 300 patients were randomly selected for this purpose. A balanced number of subgroups including all anatomic areas were procured.
Quality appraisal
The quality of the study was assessed using STROBE system [15]. Out of 22 possible items we used 18 of the STROBE checklist for the methodological assessment (Table 3).
Statistical analysis
Relevant data was inserted into an electronic database (Microsoft® Excel for Windows® (Microsoft Corp, Redmond, WA)) for further analysis. Mean and standard deviation was used to describe quantitative variables, and frequency and percentage for qualitative variables. Data analysis was carried out using IBM SPSS version 24.0 (IBM SPSS, Armonk, NY, USA), and significance of pooled estimates was set at p < 0.05.
Institutional review board approval under act 07/20 was obtained prior to the commencement of the study and informed consent was obtained from all patients.