Objective: This is the first British multi-centre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak.
Design: A longitudinal, multi-centre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from March 17, 2020 compared to the same period in 2019.
Setting: Hospitals from six major urban cities were recruited around the UK, including London.
Participants: A total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion.
Primary and secondary outcome measures: Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates, and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia utilised.
Results: During the COVID-19 period there was a 34% reduction in acute orthopaedic trauma referrals compared to 2019 (1792 down to 1183 referrals), and 29.5% less surgical interventions (993 down to 700 operations). The mortality rate significantly (both statistically and substantially) more than doubled for both risk and odds ratios during the COVID period in all referrals (1.3% vs 3.8%, p=0.0005) and in those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-related complications (versus non-COVID causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID, there was a greater odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters as well as doubled odds of a Consultant acting as the primary surgeon.

Conclusion: Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared to the same time interval one year ago.