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      The Impact of COVID-19 Surges in 2019–2021 on Patient-Reported Outcome Measures After Spine Surgery at an Academic Tertiary Referral Center in Taiwan: A Retrospective Observational Cohort Study

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          Abstract

          Aim

          Limited data are available on the impact of the coronavirus disease 2019 (COVID-19) pandemic on patient-reported outcome measures (PROMs) in patients who underwent spine surgery. In this study, we aimed to investigate the associations between the COVID-19 outbreak in Taiwan (May 2021) and PROMs in patients who underwent spine surgery.

          Method

          We retrospectively identified patients who underwent spine surgery during identical defined 6-week time-intervals (May 16 to June 30) in 2019, 2020, and 2021. PROMs, including visual analog scale (VAS) score for pain, Oswestry disability index (ODI), and EuroQol-5D (EQ-5D), were investigated before surgical intervention and at a 1-month follow-up. Relevant clinical information was collected from the electronic medical records of patients. Linear regression analysis was used to examine the association between the pandemic in 2021 (vs. 2019/2020) and the PROMs after adjusting for age, sex, and relevant clinical variables.

          Results

          The number of patients who underwent spine surgery at our hospital during the identical defined 6-week time-intervals in 2019, 2020, and 2021 was 77, 70, and 48, respectively. The surgical intervention significantly improved VAS, ODI, and EQ-5D of the patients (1 month after surgery vs. before surgery, all p < 0.001) in all three study periods. However, there was a significant between-group difference in change from baseline in VAS ( p = 0.002) and EQ-5D ( p = 0.010). The decrease in VAS and increase in EQ-5D after surgery in 2021 were not as much as those in 2019 and 2020. The associations between the pandemic in 2021 (vs. 2019/2020) and changes in VAS (β coefficient 1.239; 95% confidence interval [CI] 0.355 to 2.124; p = 0.006) and EQ-5D (β coefficient, −0.095; 95% CI, −0.155 to −0.035; p = 0.002) after spine surgery were independent of relevant clinical factors.

          Conclusion

          There was less improvement in short-term PROMs (VAS and EQ-5D) after spine surgery during the COVID-19 pandemic. Assessment of PROMs in surgical patients during a pandemic may be clinically relevant, and psychological support in this condition might help improve patients' outcomes.

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          Most cited references32

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          Psychosocial impact of COVID-19

          Background Along with its high infectivity and fatality rates, the 2019 Corona Virus Disease (COVID-19) has caused universal psychosocial impact by causing mass hysteria, economic burden and financial losses. Mass fear of COVID-19, termed as “coronaphobia”, has generated a plethora of psychiatric manifestations across the different strata of the society. So, this review has been undertaken to define psychosocial impact of COVID-19. Methods Pubmed and GoogleScholar are searched with the following key terms- “COVID-19”, “SARS-CoV2”, “Pandemic”, “Psychology”, “Psychosocial”, “Psychitry”, “marginalized”, “telemedicine”, “mental health”, “quarantine”, “infodemic”, “social media” and” “internet”. Few news paper reports related to COVID-19 and psychosocial impacts have also been added as per context. Results Disease itself multitude by forced quarantine to combat COVID-19 applied by nationwide lockdowns can produce acute panic, anxiety, obsessive behaviors, hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long run. These have been fueled by an “infodemic” spread via different platforms social media. Outbursts of racism, stigmatization, and xenophobia against particular communities are also being widely reported. Nevertheless, frontline healthcare workers are at higher-risk of contracting the disease as well as experiencing adverse psychological outcomes in form of burnout, anxiety, fear of transmitting infection, feeling of incompatibility, depression, increased substance-dependence, and PTSD. Community-based mitigation programs to combat COVID-19 will disrupt children's usual lifestyle and may cause florid mental distress. The psychosocial aspects of older people, their caregivers, psychiatric patients and marginalized communities are affected by this pandemic in different ways and need special attention. Conclusion For better dealing with these psychosocial issues of different strata of the society, psychosocial crisis prevention and intervention models should be urgently developed by the government, health care personnel and other stakeholders. Apt application of internet services, technology and social media to curb both pandemic and infodemic needs to be instigated. Psychosocial preparedness by setting up mental organizations specific for future pandemics is certainly necessary.
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            Covid-19 and Health Care’s Digital Revolution

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              The Oswestry low back pain disability questionnaire.

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                Author and article information

                Contributors
                Journal
                Front Surg
                Front Surg
                Front. Surg.
                Frontiers in Surgery
                Frontiers Media S.A.
                2296-875X
                17 March 2022
                2022
                17 March 2022
                : 9
                : 853441
                Affiliations
                [1] 1Department of Orthopedics, Taichung Veterans General Hospital , Taichung, Taiwan
                [2] 2Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University , Taipei, Taiwan
                [3] 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital , Taichung, Taiwan
                [4] 4Ph.D. Program in Translational Medicine, National Chung Hsing University , Taichung, Taiwan
                [5] 5College of Medicine, National Chung Hsing University , Taichung, Taiwan
                [6] 6Department of Computer Science and Information Engineering, Providence University , Taichung, Taiwan
                [7] 7Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management , Miaoli, Taiwan
                [8] 8Department of Physical Therapy, Hung Kuang University , Taichung, Taiwan
                [9] 9Department of Food Science and Technology, Hung Kuang University , Taichung, Taiwan
                Author notes

                Edited by: Sebastian Weckbach, Ulm University Medical Center, Germany

                Reviewed by: Philip Frank Stahel, Rocky Vista University, United States; Rizaldy Taslim Pinzon, Duta Wacana Christian University, Indonesia

                *Correspondence: Cheng-Hung Lee 298f@ 123456vghtc.gov.tw

                This article was submitted to Orthopedic Surgery, a section of the journal Frontiers in Surgery

                †These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fsurg.2022.853441
                8967975
                d8dbc84a-8ef0-4211-9ce9-65535cb90a9a
                Copyright © 2022 Lin, Wang, Wang, Lin, Wu, Chen, Pan, Chin, Shih and Lee.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 12 January 2022
                : 15 February 2022
                Page count
                Figures: 0, Tables: 5, Equations: 0, References: 32, Pages: 7, Words: 4879
                Categories
                Surgery
                Original Research

                coronavirus disease 2019,health care quality,pandemic,patient report outcome,spine surgery

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