Abstract
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic was an unprecedented phenomenon that affected the functioning of healthcare systems globally. At our institution (Changi General Hospital), a specialised workflow was established for emergency spinal surgeries to take place safely during the COVID-19 pandemic. This study aims to determine if time from admission to surgery for thoracic and lumbar vertebrae fractures was affected by the COVID-19 pandemic. METHODS: This was a retrospective cohort study. All patients admitted via the emergency department with thoracic or lumbar Arbeitsgemeinschaft für Osteosynthesefragen (AO) type A fractures and underwent single stage instrumentation from August 2015 to August 2022 at our institution were included in this study. The COVID-19 period was defined as the months from February 2020 to August 2022. The variables of interest included age, gender, date of admission, date of surgery and time from admission to surgery. For categorical variables, analyses were conducted using Chi-squared tests or Fisher's exact tests. After conducting a normality test using the Kolmogorov-Smirnov test, we performed Mann-Whitney U tests to compare continuous variables. A negative binomial regression model was utilised to identify factors associated with time from admission to surgery. A post-hoc power analysis was performed. RESULTS: From February 2020 to August 2022, 38 patients were identified. From August 2015 to January 2020, 102 patients were identified. The median number of days from admission to surgery was 6 [interquartile range (IQR), 3, 8] for the pre-COVID-19 period and 6 (IQR, 3, 9) for the COVID-19 period (P=0.38). During the COVID-19 period, more surgeries took place over the weekend (42.1% vs. 12.8%, P<0.05). The strength of this study was that all patients were managed within a single tertiary hospital with a standardised workflow. This eliminates potential variations that could compromise the validity of the results. However, this was a retrospective study of administrative data. Patients' clinical records were not assessed for factors that may potentially influence the results. This study also had a small number of patients limited to a specific condition. This limits the power to detect small but clinically relevant differences. The results also cannot be generalised to other institutions. CONCLUSIONS: The median time from admission to surgery was not affected by the pandemic. However, there was a significant increase in the proportion of weekend surgeries being performed during the COVID-19 period.