Unintended consequences of COVID-19 safety measures on patients with chronic knee pain forced to defer joint replacement surgery.
Unintended consequences of COVID-19 safety measures on patients with chronic knee pain forced to defer joint replacement surgery.
复制标题
DOI：
10.1097/pr9.0000000000000855
复制
发表时间：
2020-11
期刊：
影响因子：
4.8
通讯作者：
Nahama A
中科院分区：
文献类型：
--
作者：
Cisternas AF;Ramachandran R;Yaksh TL;Nahama A
COVID-19 危机推迟了选择性关节置换术，导致潜在的手术积压。手术等待时间延长可能会恶化慢性疼痛患者的身心健康。近几个月来，随着 COVID-19 大流行的出现，美国外科医生学会和美国疾病控制与预防中心正式建议推迟非紧急程序，直至公共卫生危机得到解决。将选择性关节置换手术推迟一段未知的时间可能会降低 SARS-CoV-2 感染的发生率，但可能对患有慢性膝关节疼痛的个体产生不利影响。这些有害影响不仅限于骨关节炎 (OA) 带来的不适和重新安排手术的不便。致残性疼痛是个人寻求医疗干预的一个驱动因素，包括药物姑息治疗和外科手术。由于慢性疼痛而需要进行手术干预的膝关节和髋关节置换术现在被无限期搁置，因为获得手术治疗的机会受到限制。虽然手术干预的适度延迟可能不会导致膝关节内骨关节炎的显着进展，但它可能会因不动而导致肌肉萎缩，并加剧合并症，使康复更具挑战性。重要的是，它将对 OA 严重程度引起的合并症产生影响，尤其是生活质量下降和抑郁症。这些持续疼痛的患者越来越容易受到药物滥用障碍的影响，包括阿片类药物、酒精以及处方药和非法药物。认识到延迟手术矫正造成的下游危机需要积极考虑非手术、非阿片类药物支持的干预措施，以减少与目前关节修复受限所带来的延迟相关的发病率。
COVID-19 crisis deferred elective arthroplasty leading to potential surgical backlog. Prolonged surgical waiting times may worsen physical and mental health of patients in chronic pain. In recent months, with the emergence of the COVID-19 pandemic, the American College of Surgeons and the U.S. Centers for Disease Control and Prevention officially recommended the delay of nonemergency procedures until the public health crisis is resolved. Deferring elective joint replacement surgeries for an unknown period is likely to decrease the incidence of infection with SARS-CoV-2 but is likely to have detrimental effects in individuals suffering from chronic knee pain. These detrimental effects extend beyond the discomfort of osteoarthritis (OA) and the inconvenience of rescheduling surgery. Disabling pain is a driving factor for individuals to seek medical intervention, including pharmacological palliative treatment and surgical procedures. The need for surgical intervention due to chronic pain as for knee and hip replacement is now put on hold indefinitely because access to surgical care has been limited. Although a moderate delay in surgical intervention may not produce a significant progression of OA within the knee, it could lead to muscle wasting due to immobility and exacerbate comorbidities, making rehabilitation more challenging. Importantly, it will have an impact on comorbidities driven by OA severity, notably decreased quality of life and depression. These patients with unremitting pain become increasingly susceptible to substance use disorders including opioids, alcohol, as well as prescription and illegal drugs. Appreciation of this downstream crisis created by delayed surgical correction requires aggressive consideration of nonsurgical, nonopiate supported interventions to reduce the morbidity associated with these delays brought upon by the currently restricted access to joint repair.