COVID-19 pandemic and hip fractures: impact and lessons learned

Abstract

Aims The coronavirus disease (COVID)-19 pandemic forced an unprecedented period of challenge to the NHS in the UK where hip fractures in the elderly population are a major public health concern. There are approximately 76,000 hip fractures in the UK each year which make up a substantial proportion of the trauma workload of an average orthopaedic unit. This study aims to assess the impact of the COVID-19 pandemic on hip fracture care service and the emerging lessons to withstand any future outbreaks. Methods Data were collected retrospectively on 157 hip fractures admitted from March to May 2019 and 2020. The 2020 group was further subdivided into COVID-positive and COVID-negative. Data including the four-hour target, timing to imaging, hours to operation, anaesthetic and operative details, intraoperative complications, postoperative reviews, COVID status, Key Performance Indicators (KPIs), length of stay, postoperative complications, and the 30-day mortality were compiled from computer records and our local National Hip Fracture Database (NHFD) export data. Results Hip fractures and inpatient falls significantly increased by 61.7% and 7.2% respectively in the 2020 group. A significant difference was found among the three groups regarding anaesthetic preparation time, anaesthetic time, and recovery time. The mortality rate in the 2020 COVID-positive group (36.8%) was significantly higher than both the 2020 COVID-negative and 2019 groups (11.5% and 11.7% respectively). The hospital stay was significantly higher in the COVID-positive group (mean of 24.21 days (SD 19.29)). Conclusion COVID-19 has had notable effects on the hip fracture care service: hip fracture rates increased significantly. There were inefficiencies in theatre processes for which we have recommended the use of alternate theatres. COVID-19 infection increased the 30-day mortality and hospital stay in hip fractures. More research needs to be done to reduce this risk. Cite this article: Bone Joint Open 2020;1-9:530–540.

Decrease in incidence of proximal femur fractures in the elderly population during the Covid-19 pandemic: a case–control study

“…Arafa et al demonstrated a significant increase in the amount of PFFs during the pandemic period (61.7%). In contrast, Maniscalco et al examined the period of February to March 2019 in comparison to the corresponding months of 2020 and demonstrated a decrease of 28.4% (169 vs. 121) in PFF incidence; similar results were demonstrated by Slullitel et al [ 31 , 32 , 34 ] Compared to these studies, our present study encompassed the entire year of 2020 and included a larger patient cohort. Furthermore, our study included a sub-analysis based on the presence of lockdown measures.…”

“…Previous studies have demonstrated conflicting findings regarding the effect of Covid-19 on the incidence of PFFs [ 31 – 35 ]. Arafa et al demonstrated a significant increase in the amount of PFFs during the pandemic period (61.7%).…”

Postoperative mortality in the COVID-positive hip fracture patient, a systematic review and meta-analysis

“…Our search returned 253 articles on PubMed published from December 2019 to December 2020, one article on Cochrane published in October 2018, and 308 articles on EMBASE all published in 2020. After discarding duplicates, screening for inclusion criteria, and applying exclusion criteria, 19 articles were selected for qualitative analysis [7][8][9][10][11][19][20][21][22][23][24][25][26][27][28][29][30][31][32] and 17 for quantitative analysis (Fig. 1) [7-11, 19-29, 31].…”

“…Coronavirus disease 2019 (COVID- 19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an international public health emergency. As of December 11, 2020, over 69.6 million cases and approximately 1.58 million deaths have been reported worldwide [1].…”

Hip fracture mortality in patients co-infected with coronavirus disease 2019: a comparison of the first two waves of the United Kingdom pandemic during the pre-vaccine era

“…However, several studies have found that a patient sustaining a hip fracture with concomitant COVID-19 infection has a significantly increased mortality rate. Wright et al found a mortality rate of 11.7% (2/17) [ 5 ], Vives et al 30.4% (7/23) [ 6 ], Kayani et al 30.5% (25/82) [ 7 ], Hall et al 33.3% (9/27) [ 8 ], Egol et al 35.3% (6/17) [ 9 ], Arafa et al 36.8% (7/19) [ 10 ], Wignall et al 38.2% (13/24) [ 11 ] and Farii et al 40% (20/50) [ 12 ]. Similarly, meta-analyses conducted by Wang et al (16 studies) and Lim and Pranata (6 studies) found mortality rates of 32.6% [ 13 ] and 36% [ 14 ], respectively.…”