The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

The Effect of the COVID-19 Pandemic on Theatre Efficiency, Lessons to be Learned for Subsequent Waves

Document Type : RESEARCH PAPER

Authors
Rustam Karanjia 1
Kashif Memon 1
Daniel Rossiter 1
Ali Narvani 1
Ruth Varney 1
Mohamed A. Imam 2
1 Ashford and St. Peter’s Hospitals NHS Foundation Trust
2 1Ashford and St. Peter’s Hospitals NHS Foundation Trust 2 Intelligent Health Research Group, University of East London, London, UK
10.22038/abjs.2021.56950.2825
Abstract
Background: This study aims to demonstrate the impact of the COVID-19 pandemic on providing trauma services at 
our district general hospital. We aim to identify the impact on specific areas of theatre delay to help optimize theatre 
efficiency and generate better protocols and improve patient flow for future pandemic waves.
Methods: Patients who underwent orthopaedic trauma surgery at our hospital between July-August 2019 (preCOVID-19) and 2020 (first UK wave of COVID-19) were identified retrospectively and grouped by year of operation. 
Type of operation was recorded, including time for sending, anaesthetic induction, surgical preparation, operating time, 
and time for transfer to recovery. The two groups were compared for analysis.
Results: Case numbers were similar in both 2019 and 2020 (215vs.213 operations), with a similar proportion being 
hip fractures (39.1% and 36.6%), respectively. Median sending time (40vs.23 minutes, P <0.00001) and induction 
time (13vs.8 minutes, P<0.00001) were increased in 2020, a 74% and 63% increase compared to 2019, respectively. 
Median surgical preparation time (35vs.37 minutes, P=0.06) and operating time (56vs.50 minutes, P=0.16) were not 
statistically significant. Transfer time in 2020 (16vs.13 minutes, P<0.00001) was significantly increased. Overall case 
time increased in 2020 (2:40vs.2:11, P<0.00001) by 29 minutes.
Conclusion: COVID-19 had a significant impact on theatre efficiency in our hospital, causing multiple points of delay. 
As hospitals across the UK restart crucial elective services, focus should be given to maximizing theatre efficiency 
by providing rapid access COVID-19 testing for patients undergoing emergency surgery. We have proposed and 
implemented several steps for better theatre utilization. 
Level of evidence: IIIBackground: This study aims to demonstrate the impact of the COVID-19 pandemic on providing trauma services at 
our district general hospital. We aim to identify the impact on specific areas of theatre delay to help optimize theatre 
efficiency and generate better protocols and improve patient flow for future pandemic waves.
Methods: Patients who underwent orthopaedic trauma surgery at our hospital between July-August 2019 (preCOVID-19) and 2020 (first UK wave of COVID-19) were identified retrospectively and grouped by year of operation. 
Type of operation was recorded, including time for sending, anaesthetic induction, surgical preparation, operating time, 
and time for transfer to recovery. The two groups were compared for analysis.
Results: Case numbers were similar in both 2019 and 2020 (215vs.213 operations), with a similar proportion being 
hip fractures (39.1% and 36.6%), respectively. Median sending time (40vs.23 minutes, P <0.00001) and induction 
time (13vs.8 minutes, P<0.00001) were increased in 2020, a 74% and 63% increase compared to 2019, respectively. 
Median surgical preparation time (35vs.37 minutes, P=0.06) and operating time (56vs.50 minutes, P=0.16) were not 
statistically significant. Transfer time in 2020 (16vs.13 minutes, P<0.00001) was significantly increased. Overall case 
time increased in 2020 (2:40vs.2:11, P<0.00001) by 29 minutes.
Conclusion: COVID-19 had a significant impact on theatre efficiency in our hospital, causing multiple points of delay. 
As hospitals across the UK restart crucial elective services, focus should be given to maximizing theatre efficiency 
by providing rapid access COVID-19 testing for patients undergoing emergency surgery. We have proposed and 
implemented several steps for better theatre utilization. 
Level of evidence: III
Keywords
COVID-19
Orthopaedics
Theatre efficiency
Theatre utilization
Trauma
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The Archives of Bone and Joint Surgery
Volume 10, Issue 4
April 2022
Pages 353-357

  • Receive Date 01 May 2021
  • Revise Date 04 June 2021
  • Accept Date 21 August 2021