COVID-19 Is Associated With a 4 Fold Increase in 30-day Mortality Risk in Hip Fracture Patients in the United Kingdom: A Systematic Review and Meta-analysis

Abstract

Background Hip fracture in elderly patients is associated with a significant mortality which may be worsened by COVID-19 infection. Objective To undertake a systematic review and meta-analysis of studies assessing the effect of COVID-19 infection and mortality rates in hip fracture patients in the United Kingdom (UK) during the first surge of the pandemic. Design A systematic literature search of 9 online databases was undertaken independently by 2 reviewers using the Cochrane methodology for systematic reviews. Eligibility criteria were any study of an adult population with a hip fracture that assessed the relationship between COVID-19 infection and 30-day mortality in the UK. Meta-analysis was conducted using a random-effects model. Results Out of 309 identified articles, 10 studies reporting on 2448 hip fracture patients met the inclusion criteria. Meta-analysis showed that the estimated mortality rate in patients with laboratory confirmed COVID-19 infection was 32.5% (95% CI= 28.3 to 37.0) compared to 8.6% (95% CI= 6.3 to 11.6) in COVID-19 negative patients. Meta-analysis of 9 comparative studies showed a significantly higher mortality in patients with laboratory confirmed COVID-19 infection as compared to patients without (RR=3.937, 95% CI= 2.867 to 5.406, P<.001). Similar findings were obtained when comparing mortality in COVID-19 laboratory confirmed or clinically suspected infected vs non-infected patients (RR=4.576, 95% CI = 3.589 to 5.835, P <.001). Conclusions COVID-19 infection is associated with a 4-fold increase in mortality risk in hip fracture patients. Every effort should be made to avoid COVID-19 infection and nosocomial exposure in this highly vulnerable patient group.

COVID-19 Infection Was Associated with the Functional Outcomes of Hip Fracture among Older Adults during the COVID-19 Pandemic Apex

“…Another systematic review and meta-analysis discovered that patients with hip fractures who had concomitant COVID-19 infection had a 34% short-term mortality rate [ 13 ]. Mastan et al found that COVID-19 status was associated with a 4-fold increase in mortality among patients with hip fractures [ 14 ]. In a study conducted by Raheman, patients with hip fractures who had COVID-19 had a 4-fold risk of mortality (risk ratio: 4.59, p < 0.0001), and the 30-day mortality rate was 38% (hazard ratio: 4.73, p < 0.0001).…”

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

“…In the systematic review to determine the mortality of concomitant infection of COVID-19 with hip fractures, Mastan et al showed the 30-day mortality was 32.5% in COVID-positive patients compared to 8.3% in COVID-negative patients [ 20 ]. But the mortality rates among vaccinated patients are not available in the literature.…”

“…However, some studies have suggested that the vaccine is less effective in elderly frail patients [ 17 ]. Hip fractures are commonly seen in elderly frail patients and are associated with high mortality when infected with concomitant COVID-19 [ 18 - 20 ]. The effectiveness of the vaccine in hip fractures may be crucial in reducing the mortality among these patients but there is no evidence depicting the same at present.…”

COVID-19 hip fracture outcomes: The role of Ct values and D-dimer levels?

“…Expectedly, there was also a surge in hip fracture patients with concomitant COVID-19 infection. Although meta-analyses have illustrated a significantly higher mortality rate in COVID-19 patients with a hip fracture [ [4] , [5] , [6] ], most studies were of Caucasians. High quality cohort data regarding mortality and complications is still lacking amongst Asian populations [ [7] , [8] , [9] ].…”