impact of the national lockdown due to the covid-19 pandemic on upper limb trauma workload in central london: a multi-centre longitudinal observational study during implementation and ease of national lockdown

Background: this study assessed the impact of the covid-19 pandemic on acute upper limb referrals and operative case-mix at the beginning and ease of british lockdown. methods: a longitudinal multicentre observational cohort study was conducted for both upper limb trauma referrals and operative case-mix over a 12-week period (6 weeks from the beginning and 6 weeks from the ease of the national lockdown). statistical analysis included median (± median absolute deviation), risk and odds ratios, and fisher’s exact test to calculate the statistical significance, set at p ≤ 0.05. results: there was a 158% (n = 456 vs. 177) increase in upper limb referrals and 133% (n = 91 vs. 39) increase in the operative trauma caseload at the ease of lockdown compared with its commencement. an increase in sporting injuries was demonstrated (p=0.02), specifically cycling (p=0.004, or=2.58). a significant increase in covid-19 testing was demonstrated during the ease of lockdown (p=0.0001) with more patients having their management changed during the early pandemic (9.6% vs. 0.7%, p=0.0001). of these patients, 47% went on to have delayed surgery within 6 months. no patients who underwent surgery tested positive for covid-19 infection within 14 days post-operatively and no mortalities were recorded at 30 days. conclusion: the ease of lockdown has seen upper limb referrals and operations more than double compared to early lockdown. with no patients testing positive for covid-19 within 14 days of the procedure, this demonstrates that having upper limb surgery during the current pandemic is safe.