Name:
REJOIN Study. Is it Safe to Operate?
Description:
REJOIN Study. Is it Safe to Operate?
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Duration:
T00H07M24S
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https://cadmoreoriginalmedia.blob.core.windows.net/104c8992-edb5-46a0-b4bf-209b47fb93cc/BOA-2021-VID076-04.mp4?sv=2019-02-02&sr=c&sig=oDk1cItPdb0%2FhPl08ySfSxFFdArcBaDemAMouPlu%2Bxs%3D&st=2025-01-23T01%3A16%3A01Z&se=2025-01-23T03%3A21%3A01Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
TIM BOARD: So hopefully this might be a little bit of good news in amongst the doom and gloom of the pandemic. So I'm going to talk to you about the Rejoin study. And this is a collaboration between the British Society and the Knee Society supported by the BOA, and also supported by GIRFT. So obviously in a pre-pandemic situation, the risks of surgery were very well understood. We could communicate very well with our patients, undertake shared decision making.
TIM BOARD: But then in a post-COVID situation era, it was really unclear what the risks of surgery would be in terms of contracting COVID after surgery. And what influence that might have on patients' outcomes. So there were studies coming out all the time. It was difficult to keep up with the amount of papers coming out in the early phases of the pandemic. And we are faced with outcomes from the COVID surge showing a very high morbidity and mortality after surgery if a patient contracted COVID.
TIM BOARD: Now obviously, the background prevalence is much lower. But we do need to live with COVID. So we need to know what's the chance of contracting COVID if you're having an operation. What are the risks of complications and the mortality if you do contract it? And the problem is that current data capture mechanisms are too slow to respond; the NJR, Public Health England, and HES data takes a long time to extract.
TIM BOARD: So that's when the societies came together and decided that what we really need to do is to start a cohort study, observational study to try and answer this question, is elective hip and knee replacement surgery with the new pathways designed by the BOA, is it safe in terms of complications and mortality after surgery? So it's a multicenter study. All hip and knee replacements with six recruiting centers.
TIM BOARD: And these are the centers around the UK that recruited to this. And I'm very grateful for all of the people involved in those centers that put a lot of effort into collecting all the data. And the data was analyzed with the Oxford Surgical Trials Unit in combination with Warwick. So the study flow is essentially to measure and assess data on preoperative isolation, COVID testing, and then 30-day and 90-day outcomes.
TIM BOARD: So obviously, a large number of patients recruited, nearly 3,000. But there was a degree of incompleteness of data when this output was undertaken. Obviously 69% at 30 days, and then nearly 60% that had 90-day data. So to cut to the chase the current analysis. So this is the overall data. So this is a period from March 2020 to August '21, nearly 3,000 cases.
TIM BOARD: And the splits there between hip and knee. And you can see the Royal College of Surgeon's priority level was also measured. And you can see, there is a reasonable number of cases of the 1B and 2. And we'll come on to talk about emergency cases shortly. You can see in terms of preoperative testing, the vast majority of patients did have preoperative testing, and virtually all of those were negative.
TIM BOARD: So if we look at the actual outcomes, so obviously we can see here in terms of overall, the chance of developing a COVID positive test result within 30 days of surgery is about 1%, and the all cause mortality at 90 days for the whole group was about 2% and 1/2. And the COVID related mortality at 90 days was 0.28%. Now that's the whole group of hips and knees primaries and revisions and emergency surgery.
TIM BOARD: If we look at the current analysis of just the total hip replacement data, you can see here that actually there's a significant number of emergency and planned urgent surgery. So these are likely to be fractured neck of femur patients, and patients with complications requiring immediate interventions. And you can see that the rates of COVID positivity at 30 days were about just over 2%.
TIM BOARD: And the COVID related mortality at 90 days was 0.5%. But really the real question for the study was if you have a patient on a green pathway doing elective primary hip replacement, what is the risk of COVID? So this is the key slide, I suppose. So this is an elective total hip replacement, primary and revision. The rate of COVID positivity at 30 days was 0.2%, and the COVID related mortality was 0.
TIM BOARD: So there were no deaths from COVID after elective primary hip replacement. And in terms of the comparative data, obviously a 90-day mortality rate is approximately 1/2% from NJR and CPRD data. So if we look at the emergency situation. So you can see that the rates are somewhat higher, and that is what you would expect because a lot of these patients are clearly coming in as emergency.
TIM BOARD: They haven't been isolated prior to surgery. So when do these cases occur? So this is a timeline of the positive COVID results within 30 days. And you can see the orange line is the our cases, and the background blue is a background level of COVID in the UK. And you can see that most of the cases occurred in the spike around the Christmas period of last year.
TIM BOARD: If we look at the elective patients, you can see that only the two post-operative COVID positive results also occurred around that time frame. So in summary, I think what we conclude here is that in elective primary and revision surgery with screening, certainly this does appear to be safe. In terms of consenting patients and figures to give patients, obviously we can say that approximately a quarter of a percent rate of developing COVID within 30 days.
TIM BOARD: And at the moment, the chance of mortality obviously from these figures is zero. But emergency surgery does remain a higher risk. Now clearly, there is some limitations to this. This is purely an observational study. We don't have any data on whether patients are immunized or not immunized. And more detailed analysis of the data will follow with a comparison with much data from HES from prior to the pandemic.
TIM BOARD: So thank you for listening. If there are any questions, if you would like to get in touch with the unit at Oxford, they'll be happy to answer any questions. Thank you very much. [APPLAUSE]
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