A Call to Arms: Emergency Hand and Upper Extremity Operations During the COVID-19 Pandemic

ABSTRACT Purpose Limited data exist regarding volumetric trends and management of upper extremity emergencies during periods of social restriction and duress, such as the COVID-19 pandemic We sought to study the effect of shelter-in-place orders on emergent operative upper extremity surgery Methods All patients undergoing emergent and time-sensitive operations to the finger(s), hand, wrist and forearm were tracked over an equal number of days before and after shelter-in-place orders at two geographically distinct Level 1 trauma centers Surgical volume and resources, patient demographics, and injury patterns were compared before and after official shelter-in-place orders Results Fifty-eight patients underwent time-sensitive or emergent operations The mean patient age was 42 years with mean injury severity score (ISS) of 9 and median ASA score of 2 There was a 40% increase in volume after shelter-in-place orders, averaging 1 4 cases per day Indications for surgery included high-energy closed fracture (60%), traumatic nerve injury (19%), severe soft tissue infection (15%), and revascularization of the arm, hand or digit(s) (15%) High-risk behavior, defined as lawlessness, assault, and high-speed auto accidents, was associated with a significantly greater proportion of operations after shelter-in-place orders (40% vs 12 5%, pl0 05) Each institution dedicated an average of three inpatient beds and one ICU capable bed to upper extremity care daily Resources utilized included an average of 115 minutes of daily operating room time and 8 operating room staff/personnel per case Conclusions Hand and upper extremity operative volume increased after shelter-in-place orders at two major Level 1 trauma centers across the country, demanding considerable hospital resources The rise in volume was associated with an increase in high-risk behavior Type of Study/Level of Evidence Therapeutic, Level IV