Exploring the impact of COVID-19 on pediatric orthopaedic surgery practice

As the world continues to grapple with the Coronavirus (COVID-19) pandemic, UBC Orthopaedics Associate Professor, Dr. Kishore Mulpuri, is one step closer to understanding how this novel virus has impacted patient care. The project “Impact of COVID-19 on pediatric orthopaedic surgery practice”  will examine the impacts of COVID-19 on pediatric orthopaedic practice across the globe. His study will involve an international anonymous online survey of pediatric orthopaedic surgeons. We spoke with Dr. Mulpuri to learn more about his inspiration for the project and what he hopes to accomplish with this research.

What inspired you to do this work?

Populations around the world have been affected in various ways by the COVID-19 pandemic and patient care is one of many sectors that have been confronted with new challenges in light of the current situation. In this unprecedented time, I believe it is especially vital for effective communication and collaboration between healthcare providers to optimize patient care practices while mitigating the risk of infection. I have been interested in learning about how other physicians have adapted their practice to reflect new guidelines and believe others can also benefit from this knowledge.

I was inspired by advanced efforts seen in various nations around the world to implement adjustments in pediatric orthopaedic practice that adhere to physical distancing protocols. These nations have demonstrated the exceptional ability to adapt in the face of crisis and have valuable expertise that should be shared with others to benefit the practice as a whole. It is important that we take the time to learn from this pandemic and share the knowledge we gain with others worldwide, because it will help us prepare to face any health crisis that arises in the future.

What do you hope to achieve with this research?

I have taken the opportunity to collaborate with an interdisciplinary team at BC Children’s Hospital to investigate the impact of the pandemic on the pediatric orthopaedic practice.

Dr. Emily Schaeffer, Jeffrey Bone, and I have collaborated on the editorial entitled “Do No Harm: Considerations for pediatric orthopaedic practice during coronavirus”. In this publication, we have presented modelling scenarios in the Orthopaedic Clinic for patients with developmental dysplasia of the hip (DDH). DDH is the most common pediatric hip condition and contributes a substantial number of patients to our clinic flow. The scenarios examine potential viral transmission contacts between patients and healthcare providers at varying levels of clinic restrictions. We outlined considerations for adaptations to the practice, including delaying treatment for elective patients and reducing clinic loads to support physical distancing procedures. We hope that these considerations can help guide the adjustment of clinical procedures to ensure the safety of patients and healthcare providers alike, while ensuring necessary patient care can still be administered.

In collaboration with Stacey Miller and Jeffrey Bone, the risks of continuing hip surveillance for children with cerebral palsy during the pandemic were analyzed in “Suspension of Hip Surveillance for Children with Cerebral Palsy during the COVID-19 Outbreak”. Due to the challenge of maintaining physical distancing, we found that the benefits of hip surveillance do not outweigh the risk of infection and hope this will advise adjustments to patient care for children with cerebral palsy at other centres.

Dr. Sarah Farrell, Dr. Emily Schaeffer and I, with valuable input from Caitlyn Siu and Wendy Krishnaswamy, created guidelines for the treatment and follow-up of various pediatric orthopaedic conditions in “Recommendations for the Care of Pediatric Orthopaedic Patients During the COVID-19 Pandemic”. These guidelines focus on minimizing hospital visits and person-to-person contact through the use of virtual and phone call follow-ups, as well as casting that can be removed by the patient in the safety of their own home. We hope that these guidelines will help establish clinical procedures that minimize the risk of COVID-19 infection for pediatric orthopaedic patients being treated during this time.

To investigate the effects of COVID-19 on the pediatric orthopaedic practice across the globe, Dr. Anthony Cooper, Dr. Alaric Aroojis, and I have designed an international online survey that will be administered to pediatric orthopaedic surgeons. We hope that the data from this survey will provide an understanding of how COVID-19 has impacted patient care in the surgeons’ perspective, which may highlight additional considerations that should be made during the pandemic.

What excites and challenges you about this project?

I am most excited about the global relevancy of these projects and the opportunity to collaborate and communicate with pediatric orthopaedic healthcare providers worldwide.

A significant challenge amidst the pandemic has been following-up with patients enrolled in our clinical research studies, as many elective appointments have been delayed or cancelled to minimize the risk of infection. However, we are exploring options to shift towards virtual follow-ups that can ensure patient safety without sacrificing the quality of research.

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