30-day outcomes in hip fracture patients during the COVID-19 pandemic compared to the preceding year

Abstract

Aims To establish if COVID-19 has worsened outcomes in patients with AO 31 A or B type hip fractures. Methods Retrospective analysis of prospectively collected data was performed for a five-week period from 20 March 2020 and the same time period in 2019. The primary outcome was mortality at 30 days. Secondary outcomes were COVID-19 infection, perioperative pulmonary complications, time to theatre, type of anaesthesia, operation, grade of surgeon, fracture type, postoperative intensive care admission, venous thromboembolism, dislocation, infection rates, and length of stay. Results In all, 76 patients with hip fractures were identified in each group. All patients had 30-day follow-up. There was no difference in age, sex, American Society of Anesthesiologists (ASA) classification or residence at time of injury. However, three in each group were not fit for surgery. No significant difference was found in 30-day mortality; ten patients (13%) in 2019 and 11 patients (14%) in 2020 (p = 0.341). In the 2020 cohort, ten patients tested positive for COVID-19, two (20%) of whom died. There was no significant increase in postoperative pulmonary complications. Median time to theatre was 20 hours (interquartile range (IQR) 16 to 25) in 2019 versus 23 hours (IQR 18 to 30) in 2020 (p = 0.130). Regional anaesthesia increased from 24 (33%) cases in 2019 to 46 (63%) cases in 2020, but ten (14%) required conversion to general anaesthesia. In both groups, 53 (70%) operations were done by trainees. Hemiarthroplasty for 31 B type fractures was the most common operation. No significant difference was found for intensive care admission or 30-day venous thromboembolism, dislocation or infection, or length of stay. Conclusion Little information exists on mortality and complications after hip fracture during the COVID-19 pandemic. At the time of writing, no other study of outcomes in the UK has been published. Cite this article: Bone Joint Open 2020;1-7:415–419.

Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: A systematic review and meta-analysis

“…A total of 45 studies were retrieved after the search of electronic databases using the keywords; of which, eight studies were eligible for review after screening[ 9 , 19 , 20 , 27 - 29 , 38 , 39 ] (Figure 1 ). There were three prospective studies and five retrospective comparative studies.…”

“…The female patients had more incidences of hip fracture during both the time periods. The study by Macey et al [ 9 ] had age- and sex-matched hip fracture patient cohort from the pre-pandemic time. The body mass index and domicile status during both time periods have been provided in Table 2 .…”

“…The preoperative morbidity status of the patients in both pandemic and pre-pandemic periods were compared using the American Society of Anesthesiologists (ASA) classification. Pooled analysis of five studies ( n = 1159) revealed significantly increased number of severely morbid (ASA grade > 3) hip fracture patients who were treated during the pandemic period (OR, 1.43; 95%CI, 1.08, 1.89; P = 0.01)[ 9 , 27 , 29 , 38 , 39 ]. Egol et al [ 20 ] (2020) did not observe a significant difference in preoperative morbidity using the Charlson Co-morbidity index between 2020 hip fracture cohort and 2019 hip fracture cohort.…”

“…After pooling of the data from five studies[ 9 , 20 , 27 , 38 , 39 ], it was observed that there was no difference in time to surgery following the injury (MD, 6.57; 95%CI, −0.25, 13.39; P = 0.06). The high grade of heterogeneity ( I 2 = 88%) among the studies was addressed by the random effect model (Figure 2 ).…”

“…Only three studies ( n = 874) had provided details about the type anesthesia (regional vs general anesthesia) used during surgery[ 9 , 20 , 29 ]. There was significantly less use of general anesthesia during the pandemic period (37.17% vs 44.86%; OR, 0.57; 95%CI, 0.42, 0.77; P = 0.0003) (Figure 2 ).…”