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

Abstract

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.

Survivorship Analysis in Asymptomatic COVID-19+ Hip Fracture Patients: Is There an Increase in Mortality?

“…In addition, the COVID-19+ cohort is very small, limiting the power of our comparisons; however, for this we are limited by the number of patients with COVID-19+ tests who underwent procedures. However, results of our own post-hoc power analysis revealed power similar to that reported by other studies investigating mortality rates following hip fracture surgery 27 28 29) . There may also be some confounding factors, such as pre-existing pulmonary disease, which could contribute to increased length of stay, which has been shown to increase mortality following hip fracture surgery.…”

Analyzing Mid-to-Long Term Mortality Rates and Associated Factors of Geriatric Patients with Hip Fractures during the COVID-19 Pandemic: A Single Centre Prospective Study

“…Although few studies are stating the contrary, the prevailing opinion in the literature is that the mortality rate of geriatric patients with hip fractures during the COVID-19 pandemic is higher, especially in the short term (6)(7)(8)(9)(10). On the other hand, the number of studies examining the medium-and long-term outcomes and mortality rates of geriatric patients with hip fractures during the pandemic period is relatively lower (11,12). Furthermore, some reports have stated that the mortality rates and disease severity of COVID-19 may vary according to the geographical characteristics of the regions (14).…”

“…There is a prevailing opinion in the literature that the 30-day mortality rate of geriatric hip fractures increased significantly during the COVID-19 pandemic (6)(7)(8)(9)(10). Moreover, several studies have concluded that 90-days and 120-days mortality rates have also increased significantly (11)(12). On the other hand, some studies in the literature have stated that a significant increase in mortality rates of hip fractures can be prevented with the right precautions (3,13).…”

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

“…reported the increased mortality risk in COVID-19 hip fracture patients persisted despite treated surgically [ 33 ]. A few studies also reported on the 90-day mortality rate, which ranged from 14.7% to 67% [ [34] , [35] , [36] ]. Our study demonstrated 90-day mortality rate of 21.4% in COVID-19 hip fracture patients in the Chinese population, which is consistent with overseas studies.…”