PMID- 33528801
OWN - NLM
STAT- MEDLINE
DCOM- 20220822
LR  - 20220822
IS  - 2035-5114 (Electronic)
IS  - 2035-5106 (Print)
IS  - 2035-5114 (Linking)
VI  - 106
IP  - 3
DP  - 2022 Sep
TI  - Retrospective study in clinical governance and financing system impacts of the 
      COVID-19 pandemic in the hand surgery and microsurgery HUB center.
PG  - 291-296
LID - 10.1007/s12306-021-00700-3 [doi]
AB  - INTRODUCTION: The authors presented a retrospective study in the surgical 
      activity of the HUB center for Hand Surgery and Microsurgery in Emilia-Romagna 
      comparing the data between March and April 2020, in the peak of Covid pandemic, 
      with the same period in 2019. MATERIALS AND METHODS: During the two months period 
      of March-April 2020 versus 2019 the authors analyzed the surgical procedures 
      performed in elective and emergency surgery with hospitalization and Day or 
      Outpatient surgery regime. Surgical treatments with no hospitalization were 
      planned in the Day-Surgery Service. The financing system impacts were analyzed 
      according to the Diagnosis Related Groups (DRG), the costs accounting method 
      mostly used in European countries. RESULTS: An overall reduction of 68.5% was 
      recorded in surgical procedures, with a more relevant reduction of 92.3% in 
      elective surgery and a significantly less relevant reduction of 37.2% in urgent 
      one. Replantation did not present a reduction in number of cases, while cutting 
      lesions of tendons at the hand and fingers increased such as the bone and 
      ligament injuries during domestic accidents. The negative impact in the financial 
      system recorded a reduction of 32.5%. DISCUSSION: The epidemiology of hand trauma 
      looks not only at the artisanal and industrial injuries, but also mostly at the 
      accidents in daily life activities. The data of the study evidenced the 
      significantly increase in the injuries occurring in the domestic environment. 
      Elective surgery was canceled. The 86% of surgical procedures performed were 
      urgent ones and the 72.8% of these were possible in Day and Outpatient surgery 
      with significantly reduction in hospitalization. All procedures followed a rigid 
      process for patient and healthcare workers with regard for personal protection 
      and safety. Telemedicine was arranged in emergencies, and economic damage was 
      analyzed also in the following rebound effect during summer period. CONCLUSIONS: 
      The significantly less reduction recorded in urgent surgery vs the more relevant 
      reduction in elective one showed how the hand injuries remained a major issue 
      also during the lockdown. The data highlighted the relevant role of the 
      organizational aspects of the surgical procedures and planning in hand trauma. 
      Despite the financial impact of the elective surgery, the presence of a 
      functional and skill Emergency Service and Day-Surgery Service resulted 
      fundamental in the efficacy and efficiency of the patient management and in 
      containment of economic damage. The telemedicine was significantly limited by 
      liability and risk management issues.
CI  - (c) 2021. Istituto Ortopedico Rizzoli.
FAU - Leti Acciaro, A
AU  - Leti Acciaro A
AD  - Department of Hand Surgery and Microsurgery, Azienda Ospedaliero Universitaria 
      Modena, Largo del Pozzo, 71, 41125, Modena, Italy. andrealetiacciaro@libero.it.
FAU - Montanari, S
AU  - Montanari S
AD  - Department of Hand Surgery and Microsurgery, Azienda Ospedaliero Universitaria 
      Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
FAU - Venturelli, M
AU  - Venturelli M
AD  - Department of Hand Surgery and Microsurgery, Azienda Ospedaliero Universitaria 
      Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
FAU - Starnoni, M
AU  - Starnoni M
AD  - Department of Plastic Surgery, Azienda Ospedaliero Universitaria Modena, Largo 
      del Pozzo, 71, 41125, Modena, Italy.
FAU - Adani, R
AU  - Adani R
AD  - Department of Hand Surgery and Microsurgery, Azienda Ospedaliero Universitaria 
      Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
LA  - eng
PT  - Journal Article
DEP - 20210202
PL  - Italy
TA  - Musculoskelet Surg
JT  - Musculoskeletal surgery
JID - 101498346
SB  - IM
MH  - *COVID-19/epidemiology
MH  - Clinical Governance
MH  - Communicable Disease Control
MH  - Hand/surgery
MH  - *Hand Injuries/epidemiology/surgery
MH  - Humans
MH  - Microsurgery
MH  - Pandemics/prevention & control
MH  - Retrospective Studies
PMC - PMC7851813
OTO - NOTNLM
OT  - COVID-19
OT  - Coronavirus
OT  - Epidemiology
OT  - Hand surgery
OT  - Telemedicine
COIS- The authors declare that they have no competing financial interests or could have 
      appeared to influence the work reported in this paper.
EDAT- 2021/02/03 06:00
MHDA- 2022/08/23 06:00
PMCR- 2021/02/02
CRDT- 2021/02/02 12:15
PHST- 2020/08/14 00:00 [received]
PHST- 2021/01/22 00:00 [accepted]
PHST- 2021/02/03 06:00 [pubmed]
PHST- 2022/08/23 06:00 [medline]
PHST- 2021/02/02 12:15 [entrez]
PHST- 2021/02/02 00:00 [pmc-release]
AID - 10.1007/s12306-021-00700-3 [pii]
AID - 700 [pii]
AID - 10.1007/s12306-021-00700-3 [doi]
PST - ppublish
SO  - Musculoskelet Surg. 2022 Sep;106(3):291-296. doi: 10.1007/s12306-021-00700-3. 
      Epub 2021 Feb 2.