One-fifth of hip patients caught Covid in hospital
Thousands of hip and knee patients are in limbo. Now surgeons have warned of infection risks and operations that might never go ahead, reports Helen Mcardle
A FIFTH of patients admitted to hospital with hip fractures in March and April went on to develop Covid, according to a letter leaked to The Herald.
The figure emerged in a memo distributed to orthopaedic surgeons by the Scottish Committee for Orthopaedics and Trauma, which warns of “genuine concern at senior levels of the danger of Sars-cov-2 transmission occurring in hospital”.
The letter adds that PPE requirements for surgery have slashed theatre capacity by 33 per cent because operations take longer and deep cleaning is required.
It comes as a former NHS clinical director and orthopaedic surgeon warned that the backlog for elective hip and knee replacements will be so severe as a result of the pandemic that patients face waiting years.
“I can see some people basically never getting their operations at all,” said Gavin Tait. Meanwhile, research from Edinburgh found a huge drop in patients admitted to hospital with broken bones from assaults, road collisions and sports injuries since the first UK Covid death was reported.
However, the study said fractures in the elderly showed no significant reduction.
SURGEONS have warned that as many as one-fifth of patients treated for broken hips in March and April went on to contract Covid while in hospital.
In a letter to members of the Scottish Committee for Orthopaedics and Trauma, chairman Alastair Murray said there was “genuine concern at senior levels” about the danger of virus transmission in hospitals.
Mr Murray, a consultant paediatric orthopaedic surgeon in Lanarkshire, said: “Early evidence from the Scottish IMPACT data suggests that up to 20 per cent of our hip fracture patients may have contracted Covid19 after admission in March and April this year.”
It comes after The Herald revealed that 908 patients in Scotland had become infected on non-covid wards, with 218 dying.
Although elective surgery, such as hip and knee replacements, was put on hold to free up beds during the pandemic, emergency admissions for patients with broken bones continued.
In Edinburgh alone, there were 169 admissions for “fragility fractures” in the elderly between March 5 and April 13, including hip fractures, but there are no published figures for Scotland as a whole.
The letter, shared with The Herald and dated June 3, goes on to discuss how to reduce the infection risk from Covid as routine operations resume.
It states: “Clearly our elective ‘green’ pathways will be designed to minimise this and should see nowhere near this [20%] level of risk for screened and tested elective patients, but the consequences of contracting Covid-19 [around the time of operation] emphasise the importance of getting this right.”
The “green” pathways refer to segregating hospitals into Covid and non-covid zones, which will require regular virus testing of NHS staff and of patients prior to admission.
Mr Murray added that there was “a consensus” that patients should be asked to self-isolate for 14 days prior to surgery, but added that testing could be harder to implement.
“Most suggest testing patients at around 48 hours pre-surgery but the logistics of this can be challenging.
“When, and if, to test staff is more contentious and how we separate staff teams from acute, unscreened, activity needs to be considered.
Thousands of orthopaedic appointments and operations have been cancelled since mid-march, with waiting lists closed to new referrals, leading to fears that it could take years to clear the backlog.
Mr Murray warned that the “scale of the challenge is already huge and will only become worse the longer it takes for us to resume some degree of normal activity”.
Theatre capacity has been cut by around one- third, he said, as a result of requirements for more stringent infection control measures and for surgeons to wear enhanced protective gear which significantly slows their operating speed.
One retired orthopaedic surgeon said he fears some patients waiting for hip and knee replacements will never get their operations.
Gavin Tait, the former clinical director at NHS Ayrshire and Arran until his retirement in 2016, said some elective treatments “will be severely rationed, if not unavailable”.
He said the current backlog of patients, combined with reduced turnaround times in theatre, and the possibility of planned operations being axed again in winter to free up beds – as some health boards have done in previous years due to flu – would exacerbate the crisis.
“I can see some people basically never getting their operations at all,” said Mr Tait.
“Or being told ‘I’m terribly sorry but it’ll be three or four years’.
“They might try going private, but I don’t see how the private hospitals are going to be financially viable if their surgical throughout drops by 30%.
“If they’ve been doing 15 hip and knee operations a day before, and it drops to five in a day, they won’t be able to make money.”
Mr Tait added that orthopaedics colleagues were “bored out their skulls” due to the elective shutdown.
“Tumbleweed in the corridors is a phrase I hear quite a lot,” he said, adding that he believes Covid and non-covid patients should be treated in separate hospitals.
Jacqui Mcmillan, an orthopaedics surgeon and deputy chair of the BMA’S Scottish Consultants’ Committee, said: “There will need to be enhanced cleaning between procedures to reduce the risk of the virus being spread, and plenty of time will need to be given for PPE to be taken off and put on.
“On that basis, it is absolutely clear that capacity for patients will inevitably be substantially reduced – I have no doubt that the NHS will simply not be able to see people or operate anywhere near the same capacity as pre-covid-19 for a considerable period of time.”
A Scottish Government spokesperson said:“the response to Covid-19 has seen necessary changes to the way that health services are delivered and we recognise additional service changes will be required to address the full impact of the pandemic going forward.
“We are working with health boards and partnerships to ensure robust orthopaedic plans are in place to strengthen capacity and minimise the impact of Covid-19. Our elective centres will be central to this.
“As we move into future phases of our response we will continue to work with professional bodies, health boards, local authorities, unions and other key stakeholders to ensure the NHS operates as effectively as possible.”
Last week, Health Secretary Jeane Freeman said elective services would resume on a “cautious, phased” basis, including “some elective surgery that is urgent and has been postponed”.
She said the NHS would prioritise treatments whose unavailability was “clearly having a detrimental impact on people’s lives”, while maintaining “sufficient capacity to deal with any surge in Covid-19 cases”.