COVID-19 Infection Increases Mortality and Complications in Patients With Neck of Femur Fracture

Jagadeesh, Nuthan; Kapadi, Sachindra; Deva, Venkatesh; Channabasappa, Deepak; Shaw, Debbie

doi:10.7759/cureus.22264

Cited by 3 publications

(3 citation statements)

References 26 publications

(28 reference statements)

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“…For these patients, 30-day mortality was three times higher than seen in those without the infection. The national 30-day mortality among neck of femur fractures with COVID-19 was 20-25%, according to the NHFD report 2020, but numerous studies from individual hospitals in the UK have published mortality rates varying between 30% and 40% [1,[6][7][8][9]. According to Hall et al, COVID-19-positive patients with hip fractures had a mortality rate of 35.5% after 30 days, and COVID-19 was three times more likely to result in mortality after adjusting for confounding factors, including age, sex, residence, Nottingham Hip Fracture Score (NHFS), and American Society of Anesthesiologists (ASA) grade [10].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of 120-Day Mortality Among Hip Fractures With Concomitant COVID-19 Infection

Jagadeesh¹,

Deva²,

Kapadi³

et al. 2022

Cureus

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Background Hip fractures cause substantial morbidity and mortality worldwide, and the coronavirus disease 2019 (COVID-19) pandemic has only worsened the global burden. Increased 120-day mortality is well established in the literature among hip fractures with COVID-19. However, the risk factors associated with mortality have been poorly understood. We aimed to determine the risk factors associated with increased 120-day mortality among hip fractures with COVID-19. Methods Seventy patients with hip fractures with confirmed COVID-19 infection between March 2020 and December 2021 were included. Thirty-three patients who died within 120 days of admission were allotted to the non-survivor group and the rest 37 patients were allotted to the survivor group. Various parameters such as demographic variables, Nottingham Hip Fracture Score (NHFS), Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA), Abbreviated Mental Score Test (AMTS), National Early Warning Score (NEWS), fracture type, operation type, and delay in surgery were compared between the groups to determine the risk factors for increased mortality. Multivariate regression analysis was performed to know the independent association with increased mortality. Results A total of 33 patients died within 120 days giving the 120-day mortality rate of 47.1%. Baseline parameters such as ASA, AMTS on admission, NEWS on admission, and type of residence did not significantly affect mortality. The mean NHFS was significantly high in non-survivors (5.38 ± 1.52) compared to survivors (4.40 ± 1.75) (p < 0.001). Similarly, mean CCI was also significantly high in non-survivors (5.58 ± 1.74) compared to survivors (4.76 ± 2.29) (p < 0.001). A total of 70% (seven out of 10) of patients with delayed surgery of more than 36 hours from the admission died within 120 days of admission (p < 0.001). Mortality was significantly higher in patients who underwent internal fixation of fractures like a dynamic hip screw (DHS) or intramedullary (IM) nailing than in those who underwent hemiarthroplasty or total hip arthroplasty (THA). Post-operative parameters such as early mobilization and the multidisciplinary approach to review these patients made no difference to the mortality. Multivariate regression analysis of the parameters that made a significant difference in the mortality showed that delay in surgery and type of surgery (internal fixation) independently increased the mortality among these patients (p < 0.001). However, NHFS and CCI were not independently affecting the mortality among hip fractures with concomitant COVID-19. Conclusion The 120-day mortality rate among patients with hip fractures with concomitant COVID-19 was 47.1%. Delay in surgery of more than 36 hours and patients who underwent internal fixation were independent risk factors associated with increased mortality among these patients.

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Section: Introductionmentioning

confidence: 99%

Risk Factors of 120-Day Mortality Among Hip Fractures With Concomitant COVID-19 Infection

Jagadeesh¹,

Deva²,

Kapadi³

et al. 2022

Cureus

Self Cite

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“…It is well known that suffering from a COVID-19 infection while attaining a fracture has a negative impact on patient recovery and increases mortality 11 . COVID-19 is already known to induce a high level of systemic inflammation which is only exacerbated by the inflammatory cascade induced by fracture.…”

Section: Discussionmentioning

confidence: 99%

Sex-Specific Systemic Inflammatory Responses in Mice Infected with a SARS-CoV-2-like Virus and Femur Fracture

Patrick,

Foster,

Aneja

et al. 2023

Preprint

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This study investigates the systemic inflammatory response in mice infected with a murine coronavirus (MHV), which shares a common genus with SARS-CoV-2, and sustaining a fracture. The study reveals that the combined inflammatory incidents of MHV infection and fracture disrupt the systemic immune response in both female and male mice, likely leading to immune dysregulation, altered cell recruitment, and disruption of the typical inflammatory cascade. Notably, the study uncovers sex-specific responses that modulate circulating immune factors. Females exhibit elevated levels of inflammatory factors, whereas males demonstrate a diminished response. This divergence is mirrored in cell populations, suggesting that the quantity of immune factors released may contribute to these discrepancies. The findings suggest that an overproduction of proinflammatory cytokines may induce a dysregulated immune response, contributing to the observed poorer prognosis in comorbid cases. These insights could pave the way for therapeutic advancements and treatment strategies aimed at reducing mortality rates in COVID-19 patients with fractures.

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“…In the early 2020s, countries around the world made a major commitment to developing a vaccine against SARS‑CoV‑2 resulting in public vaccination drives by December 2020 [ 10 ]. As part of the COVID-19 vaccination program, Pfizer-BioNTech's messenger RNA (mRNA) vaccine, BNT162b2, was approved for use in the UK in December 2020.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Vaccination: Does It Alter Postoperative Mortality and Morbidity in Hip Fractures?

Jagadeesh¹,

Gnany²,

Kapadi³

et al. 2022

Cureus

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Introduction The primary aim of our study was to evaluate the impact of coronavirus disease 2019 (COVID-19) vaccination on mortality in patients with hip fractures by comparing it to those who are unvaccinated. Our secondary objective was to compare the impact on postoperative morbidity parameters like length of hospital stay and complications. Methods A total of 619 hip fractures were divided into the 'Vaccinated group' consisting of 300 patients who had COVID-19 vaccination and the 'Unvaccinated group' consisting of 319 patients who were not vaccinated. Patient demographic variables, Nottingham hip fracture score, American Society of Anesthesiologists ( ASA ) grade, type of anaesthesia used, and Charlson Comorbidity Index were collected. Our primary outcome measures were 30- and 90-day mortality. Secondary outcome measures included postoperative complications like thromboembolic complications, cardiac, and respiratory complications, etc. Mortality among the COVID-positive patients was also compared between the groups. Results Thirty-day postoperative mortality was higher in the unvaccinated group at 13.2% than in the vaccinated group at 5.3%. A similar increase in 90-day mortality was also observed in the unvaccinated group at 24.8% when compared to 14.7% in the vaccinated group(p<0.001). Despite having a higher baseline prevalence of cardiac comorbidities, the Vaccinated group had fewer post-operative cardiac, thromboembolic, and neurological complications (p>0.05). Moreover, electrolyte imbalance and AKI were also seen in fewer patients in the vaccinated group compared to the control group (p<0.05). Furthermore, it was found that among the vaccinated patients who did have perioperative COVID-19 infection, the 30-day mortality was significantly lower (10%) compared to the control group (31.2%) (p<0.001). Similarly, 90-day mortality was significantly lower (25%) compared to the control group (43.75%) (p<0.001). Conclusion Vaccination against COVID-19 independently reduced mortality and morbidity among patients with hip fractures when compared to those who are not vaccinated. Furthermore, it decreased the risk of acquiring COVID-19, and subsequent postoperative complications. Among those who are infected with COVID-19 despite vaccination, the mortality was significantly lesser.

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COVID-19 Infection Increases Mortality and Complications in Patients With Neck of Femur Fracture

Cited by 3 publications

References 26 publications

Risk Factors of 120-Day Mortality Among Hip Fractures With Concomitant COVID-19 Infection

Risk Factors of 120-Day Mortality Among Hip Fractures With Concomitant COVID-19 Infection

Sex-Specific Systemic Inflammatory Responses in Mice Infected with a SARS-CoV-2-like Virus and Femur Fracture

COVID-19 Vaccination: Does It Alter Postoperative Mortality and Morbidity in Hip Fractures?

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