Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study

Abstract

Background Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. Materials and methods For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C− group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. Results Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C− group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. Conclusions Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. Level of evidence Therapeutic study, level 4.

Morbidity and mortality in hip surgery patients due to fracture during the COVID-19 pandemic

“…Hall et al 2020 [8] presented 315 patients with hip fractures of which 27 were diagnosed with COVID-19 and 9 (27%) of them died [8] , Biarnés-Suñé et al 2021 [15] presented a group of 63 patients with hip fracture of which 18 presented COVID-19 and 20% of them died [15] . Dallary et al 2021 [16] reported 477 patients with hip fractures, of which 53 presented COVID-19 during the first postoperative month, and 22.6% died [16] . Wignall et al 2021 [17] presented 276 patients operated for proximal femur fracture, of which 34 were positive for COVID-19, and 38.2% died 30 days after surgery [17] .…”

Determination of risk factors of postoperative pneumonia in elderly patients with hip fracture: What can we do?

“…This may be because elderly patients have more underlying diseases and the body's immune function is reduced, which is extremely easy under the invasion of pathogenic bacteria, combined with fracture trauma, surgical stress, and long-term bed rest caused a further decline in immunity, which induced pulmonary infection [25][26][27]. However, some studies [28][29][30] have pointed out that the occurrence of postoperative pulmonary infections should be attributed to the increase in the number of comorbidities that accompany age, rather than age itself. However, it is currently recognized that the incidence of hip fractures in elderly patients increases with age, and surgery is the current main treatment method.…”

Fájdalomtünetek és a fájdalomcsillapítás lehetőségei SARS-CoV-2-környezetben

“…A COVID-19-fertőzött betegek az izomgyengeség miatt gyakrabban esnek el, az idősebb populációban a csípőtáji és a végtagtörések valószínűsége és a következményes mortalitás magasabb [19]. A fokozott koaguláció miatt a vénás és artériás elzáródás kockázata magasabb.…”