Do standards of care and early outcomes of periprosthetic fractures change during the COVID-19 pandemic? A multicentre study

Abstract

Background Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. Materials and methods Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien–Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. Results Median age was 81 years (range 70–96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1–4), median VAS score on admission was 3 (range, 0–6), median CFS was 4 (range, 1–8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1–5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1–5). The median LOS was 12.8 days (range 2–36 days), and 21 patients (55.3%) were discharged home. Conclusions The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. Level of evidence IV.

Changes in trends of orthopedic services due to the COVID-19 pandemic: A review

“…Hip replacements are generally the most common elective procedure, but elective procedures were halted and therefore most institutions did not perform them. Hip fractures have still been very common during this time[ 4 , 25 , 28 ]; however, the pandemic has increased the mortality and complication rate particularly amongst COVID-positive patients[ 5 , 8 , 11 , 16 , 38 ]. The importance of early treatment and proper rehabilitation was strongly emphasized in order to ensure prompt recovery[ 14 ].…”

“…Zagra et al [ 16 ] conducted a retrospective multicenter study in patients with periprosthetic fractures (PPF) during COVID-19 pandemic in northern Italy. Out of 1390 patients, 38 were found to suffer from PPF.…”

The comparison of Post-Operative Complications pre Covid era versus during Covid-Era based on Clavien-Dindo-classification: A Systematic Review and Meta-Analysis

“…(24,27,61,62). On the other hand, health care providers preferred close observation and conservative management to surgery in patients with younger age and better overall health condition (31,63,64) So the majority of operations were performed on elder adults with multiple comorbidities and more critical conditions with poorer prognosis (24,33,34,46,52,65).…”

Should we operate on all patients with COVID-19 and proximal femoral fractures? An analysis of thirty, sixty, and ninety day mortality rates based on patients’ clinical presentation and comorbidity: a multicentric study in Northern Italy

“…Dallari et al reported that few COVID-19-positive patients were surgically treated within 48 hours, and it seems that surgery performed within 48 hours does not associate with lower mortality in this subgroup of patients. However, according to the authors, these data could be influenced by the discrepancy of size between the COVID-19-positive and COVID-19-negative groups [ 23 ].…”