Impact of the Covid-19 pandemic on elective and trauma orthopaedic surgery in a tertiary referral hospital in Kenya: A retrospective cross-sectional study

The impact of the COVID-19 pandemic is still being felt in multiple spheres of life. In healthcare, COVID-19 noticeably affected surgical practice in sub-Saharan Africa indicated by a reduction in elective cases with prioritisation of cancer and emergency cases. This study sought to describe the impact of COVID-19 on orthopaedic surgery volumes in a private tertiary referral hospital. Ethical approval was obtained for this retrospective cross-sectional study carried out at the Aga Khan University Hospital, Nairobi. The orthopaedic data was collected using the Electronic Healthcare Record (EHR) system in the hospital. Elective and trauma caseloads recorded during COVID-19 were compared with similar quarters in the pre and post COVID-19 periods. In the third quarter before the COVID-19 pandemic, there were 15 arthroplasty, 53 arthroscopy and 31 implant removal cases. During the pandemic, there was an expected fall in the numbers of procedures by 33%, 30% and 13% respectively compared to the previous (pre pandemic) year. There was also the expected drop in the number of adult trauma cases, however, there was an increase in paediatric fracture fixation with k-wires. In spinal surgery, there was a 71% increase in the number of laminectomies and anterior cervical decompression and fusions (ACDF) from the pre pandemic 21 cases recorded. The COVID-19 pandemic had an impact on elective and emergency orthopaedic procedure volumes. There was a reduction in the number of elective arthroplasty, arthroscopy, nailing and orthopaedic implant removal procedures. On the other hand there was a significant increase in the number of paediatric fracture fixation and with K-wires and ACDF/laminectomy volumes.