Early mortality after hip fracture surgery in COVID-19 patients: A systematic review and meta-analysis

Wang, Kevin C.; Xiao, Ryan; Cheung, Zoe B.; Barbera, Joseph; Forsh, David A.

doi:10.1016/j.jor.2020.11.012

Cited by 50 publications

(53 citation statements)

References 43 publications

(41 reference statements)

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“…The reported prevalence of 15.7% in the present study is similar to the 13% obtained from a recent meta-analysis [ 15 ], as well as the proportion of patients with COVID-19 at admission (36% present study vs. 35% meta-analysis [ 15 ]). These findings all suggest a similar behavior and similar effects of COVID-19 on patients with HF across different countries, or at least in those investigated up to now (mostly Europe and the New York City area [ 32 ]).…”

Section: Discussionmentioning

confidence: 58%

Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case–Control Study from a Single Center in Italy

Grassi

Andriolo

Golinelli

et al. 2021

IJERPH

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The mortality of hip fracture (HF) patients is increased by concomitant COVID-19; however, evidence is limited to only short follow-up. A retrospective matched case–control study was designed with the aim to report the 90-day mortality and determine the hazard ratio (HR) of concomitant HF and COVID-19 infection. Cases were patients hospitalized for HF and diagnosed with COVID-19. Controls were patients hospitalized for HF not meeting the criteria for COVID-19 diagnosis and were individually matched with each case through a case–control (1:3) matching algorithm. A total of 89 HF patients were treated during the study period, and 14 of them were diagnosed as COVID-19 positive (overall 15.7%). Patients’ demographic, clinical, and surgical characteristics were similar between case and control groups. At 90 days after surgery, 5 deaths were registered among the 14 COVID-19 cases (35.7%) and 4 among the 42 HF controls (9.5%). COVID-19-positive cases had a higher risk of mortality at 30 days (HR = 4.51; p = 0.0490) and 90 days (HR = 4.50; p = 0.025) with respect to controls. Patients with concomitant HF and COVID-19 exhibit high perioperative mortality, which reaches a plateau of nearly 30–35% after 30 to 45 days and is stable up to 90 days. The mortality risk is more than four-fold higher in patients with COVID-19.

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Section: Discussionmentioning

confidence: 58%

Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case–Control Study from a Single Center in Italy

Grassi

Andriolo

Golinelli

et al. 2021

IJERPH

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“…Whilst attempts have been made to evaluate the mortality of hip fracture patients during COVID-19, these studies are limited by their search strategy and oversight in addressing sources of heterogeneity that may directly or indirectly impact the outcomes of hip fracture patients 15 , 16 . The aim of our systematic review, meta-analysis and meta-regression is to quantitatively assess the independent impact of COVID-19 on the mortality of hip fracture patients and identify characteristics predictive of poor outcomes.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

Raheman

Rojoa

Parekh

et al. 2021

Sci Rep

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Incidence of hip fractures has remained unchanged during the pandemic with overlapping vulnerabilities observed in patients with hip fractures and those infected with COVID-19. We aimed to investigate the independent impact of COVID-19 infection on the mortality of these patients. Healthcare databases were systematically searched over 2-weeks from 1st–14th November 2020 to identify eligible studies assessing the impact of COVID-19 on hip fracture patients. Meta-analysis of proportion was performed to obtain pooled values of prevalence, incidence and case fatality rate of hip fracture patients with COVID-19 infection. 30-day mortality, excess mortality and all-cause mortality were analysed using a mixed-effects model. 22 studies reporting 4015 patients were identified out of which 2651 (66%) were assessed during the pandemic. An excess mortality of 10% was seen for hip fractures treated during the pandemic (OR 2.00, p = 0.007), in comparison to the pre-pandemic controls (5%). Estimated mortality of COVID-19 positive hip fracture patients was four-fold (RR 4.59, p < 0.0001) and 30-day mortality was 38.0% (HR 4.73, p < 0.0001). The case fatality rate for COVID-19 positive patients was 34.74%. Between-study heterogeneity for the pooled analysis was minimal (I2 = 0.00) whereas, random effects metaregression identified subgroup heterogeneity for male gender (p < 0.001), diabetes (p = 0.002), dementia (p = 0.001) and extracapsular fractures (p = 0.01) increased risk of mortality in COVID-19 positive patients.

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“…Five more papers were discovered on hand search. After screening duplicates and excluding unrelated articles based on the title, 65 papers8–72 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 5 with 35 having hip fracture data were finally considered for review after full-text assessment. ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…1 However, early limited evidence published so far suggests poor outcomes with high postoperative mortality in patients with a hip fracture and concomitant COVID-19 infection (available studies indicate a mortality rate greater than 30%). 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 We have undertaken a ...…”

Section: Introductionmentioning

confidence: 99%

Mortality escalates in patients of proximal femoral fractures with COVID-19: A systematic review and meta-analysis of 35 studies on 4255 patients

Patralekh

Jain

Iyengar

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background Concerns have been raised about the escalated mortality in patients of proximal femoral fractures (PPFs) with COVID-19. A meta-analysis to evaluate mortality in patients with PPFs managed during the current COVID-19 pandemic was conducted. Methods A systematic review and meta-analysis of all published studies were conducted with a search on PubMed, Scopus, Web of Science, and Cochrane Library databases using appropriate keywords from January 01, 2020 to January 29, 2021. Results 35 relevant studies reporting 3979 patients with hip fracture in the current ongoing pandemic, out of which 692 patients were COVID -19 positive. Twenty studies reported mortality and other relevant statistics on hip fracture patients with and without COVID 19 (4123 hip fracture patients in the year 2020–21, out of which 560 had or were suspected of having COVID -19). A meta-analysis of mortality statistics in patients with and without COVID revealed increased odds of mortality among COVID patients [odds ratio (OR) 6.31, 95% confidence interval (CI) [5.09, 7.83] and meta-analysis on the subgroup of surgically treated patients also showed markedly increased mortality risk among those with COVID-19 (OR) 5.99, 95% CI [3.88,9.24]. Conclusion The mortality risk is markedly increased in hip fracture with concomitant COVID -19 compared to those without it. This increased risk persisted in those managed surgically. It could be due to the inflammation induced by the fracture or surgery for fracture fixation, further exacerbating inflammation, leading to cytokine storm. It is imperative that such patients are informed regarding increased mortality risk during the consent and shared decision-making process.

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Early mortality after hip fracture surgery in COVID-19 patients: A systematic review and meta-analysis

Cited by 50 publications

References 43 publications

Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case–Control Study from a Single Center in Italy

Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case–Control Study from a Single Center in Italy

Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

Mortality escalates in patients of proximal femoral fractures with COVID-19: A systematic review and meta-analysis of 35 studies on 4255 patients

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