Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review

Zhong, Haoyan; Poeran, Jashvant; Liu, Jiabin; Wilson, Laird; Memtsoudis, Stavros G.

doi:10.1016/j.bja.2021.04.003

Cited by 39 publications

(38 citation statements)

References 27 publications

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“…The impact of COVID-19 on the prognosis of patients with hip fractures has been evaluated in a few studies indicating that COVID-19 in hip fracture patients is associated with a seven- to 10-fold increased mortality risk [ 5 , 20 , 21 , 22 ]. The also markedly increased complication rate contributes to the low survival of these patients.…”

Section: Discussionmentioning

confidence: 99%

The Procoagulant Effect of COVID-19 on the Thrombotic Risk of Patients with Hip Fractures Due to Enhanced Clot Strength and Fibrinolysis Shutdown

Tsantes

Papadopoulos

Trikoupis

et al. 2021

JCM

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Introduction: Coronavirus disease 2019 (COVID-19) in patients with hip fractures is associated with increased incidence of venous thromboembolism (VTE). The purpose of this study was to evaluate the hemostatic alterations of COVID-19 that are associated with a higher thrombotic risk using rotational thromboelastometry (ROTEM). Methods: A retrospective observational study was performed including 20 COVID-19 patients with hip fractures. To compare the coagulopathy of patients with mild COVID-19 and hip fractures with the coagulopathy associated with each of these two conditions separately, we used two previously recruited groups of patients; 198 hip fracture patients without COVID-19 and 21 COVID-19 patients without hip fractures. The demographics, clinical parameters, conventional coagulation parameters and ROTEM findings of the three groups were analyzed and compared. Results: COVID-19 hip fracture patients had higher amplitude of clot firmness at 10 min (p < 0.001), higher alpha angle (p < 0.001), higher lysis index at 60 min (p < 0.001), and shorter clot formation time (p < 0.001) than non-COVID-19 hip fracture patients, indicating increased clot strength and impaired fibrinolysis due to COVID-19. The value of lysis index at 60 min (99%) in COVID-19 patients with hip fractures was consistent with fibrinolysis shut down. Multivariable linear regression analysis further confirmed that COVID-19 resulted in increased amplitude of clot firmness at 10 min (p < 0.001), increased maximum clot firmness (p < 0.001), increased lysis index at 60 min (p < 0.001) and increased alpha angle (p < 0.001), but significantly shortened clot formation time (p < 0.001). Discussion: The higher thrombotic risk in COVID-19 patients with hip fractures is characterized by increased clot strength and fibrinolysis shutdown, as shown by ROTEM findings. Further prospective studies are warranted to evaluate the need for modification of thromboprophylaxis to balance the hemostatic derangements of COVID-19 patients with hip fractures.

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Section: Discussionmentioning

confidence: 99%

The Procoagulant Effect of COVID-19 on the Thrombotic Risk of Patients with Hip Fractures Due to Enhanced Clot Strength and Fibrinolysis Shutdown

Tsantes

Papadopoulos

Trikoupis

et al. 2021

JCM

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“…Comparando os anos de 2019 e 2020, não houveram grandes diferenças em relação ao número de internações, sendo 12208 e 12031, respectivamente. Diferente do exposto em estudo recente americano, que registrou uma queda de 50% das internações de pacientes por fratura de quadril quando se compararam as internações antes do Covid-19 e durante a pandemia (Zhong et al, 2021). Segundo o estudo, a queda das internações pode ter ocorrido em virtude da redução das atividades devido à quarentena ou pelo redirecionamento desses pacientes a grandes centros de trauma diferentes dos analisados, uma vez que o número de fraturas registrados no país não reduziu (Zhong et al, 2021).…”

Section: Discussionunclassified

“…Diferente do exposto em estudo recente americano, que registrou uma queda de 50% das internações de pacientes por fratura de quadril quando se compararam as internações antes do Covid-19 e durante a pandemia (Zhong et al, 2021). Segundo o estudo, a queda das internações pode ter ocorrido em virtude da redução das atividades devido à quarentena ou pelo redirecionamento desses pacientes a grandes centros de trauma diferentes dos analisados, uma vez que o número de fraturas registrados no país não reduziu (Zhong et al, 2021). A quarentena, e a consequente diminuição das atividades externas, não influenciaria na diminuição desses resultados, posto que a maioria das fraturas nos idosos ocorre por queda da própria altura, que por sua vez, ocorre majoritariamente em ambiente domiciliar (Maia et al, 2011).…”

Section: Discussionunclassified

“…Contudo, essa proporção foi consideravelmente inferior às encontradas em estudos realizados em Fortaleza e em São Paulo (Silveira et al, 2005;Fortes et al, 2008;Daniachi et al, 2015). Recentes estudos, americano e chinês, também mostraram prevalência de fraturas em mulheres em uma proporção aproximadamente duas vezes maior que em homens (Zhong et al, 2021;Gong et al, 2021). O estudo atual discordou do estudo BRAZOS que encontrou uma tendência maior em homens da região Nordeste a apresentar fratura por baixo impacto, contudo, nas outras regiões as mulheres também foram a maioria nas amostras (Pinheiro et al, 2010).…”

Section: Discussionunclassified

“…Em Salvador (BA), também na região Nordeste do Brasil, foi verificada uma prevalência de indivíduos pardos (Santana et al, 2015). Nos EUA, houve predomínio de indivíduos brancos, representando por volta de 88% dos casos, nos dois anos avaliados (Zhong et al, 2021). As porcentagens dos estudos podem ser reflexo da prevalência das raças nas respectivas populações, uma vez que no Sul do País, por exemplo, a população caucasiana é mais prevalente, já no Nordeste há predomínio de pardos.…”

Section: Discussionunclassified

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Fraturas do fêmur em idosos do Nordeste do Brasil: dados epidemiológicos e gastos para o SUS

Júnior

Silva

2021

RSD

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Objetivos: avaliar dados epidemiológicos incluindo incidência, faixa etária, sexo, cor/raça, mortalidade, média de permanência em internação e os gastos para o Sistema Único de Saúde (SUS) relativos às fraturas de fêmur em idosos (≥60 anos) do Nordeste do Brasil. Métodos: estudo descritivo feito a partir de dados secundários provenientes do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Na plataforma DATASUS foram selecionados filtros representando as variáveis do estudo relacionadas ao período compreendido entre janeiro de 2019 a dezembro de 2020. Os cálculos de incidência foram feitos com base na população da região Nordeste definida pelo censo de 2010 do IBGE. Resultados: houveram 24239 internações por fratura de fêmur no intervalo de tempo estudado. A incidência anual média foi de 22,22 casos a cada 10000 idosos nordestinos. Esses números geraram um custo total ao SUS de R$ 62.713.218,03. Idosos com idade igual ou superior a 80 anos foram a maioria, protagonizando 48,17% das internações. As mulheres apresentaram 2,2 vezes mais internações que os homens. Os homens apresentaram uma taxa de mortalidade maior, 3,97%. Pardos totalizaram a maior parte das internações. Indígenas e brancos apresentaram maior mortalidade. Conclusão: as fraturas de fêmur apresentam elevada incidência em idosos do Nordeste do Brasil e geram gastos onerosos para o sistema de saúde.

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Surgical treatment for fragility hip fractures during the COVID-19 pandemic resulted in lower short-term postoperative functional outcome and a higher complication rate compared to the pre-pandemic period

et al. 2022

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The COVID-19 pandemic adversely affected the functional outcomes of fragility hip fracture patients. This study revealed a higher in-hospital complication rate and lower postoperative function at 3 months among patients treated during the pandemic. Therefore, modified in-hospital and post-discharge protocols should be developed for implementation during pandemic crisis periods. Introduction This study aims to investigate the in-hospital complication rate and short-term postoperative functional outcomes of fragility hip fracture (FHF) patients compared between during the COVID-19 pandemic and the same 14-month time period 1 year prior to the pandemic. Methods Using data from the Siriraj Fracture Liaison Service registry, FHF patients treated during the COVID-19 pandemic (1 March 2020 to 30 April 2021) were time-matched with FHF patients treated during the pre-pandemic period (1 March 2018 to 30 April 2019). We collected the rate of in-hospital postoperative complications and the postoperative functional outcomes at discharge and 3 months as measured by the Barthel Index (BI) and EuroQol visual analog scale (EQ-VAS). Functional outcome measures were compared between the pre-pandemic and pandemic periods. Results There were 197 and 287 patients in the pre-pandemic and pandemic groups, respectively. At the 3-month postoperative follow-up, the mean postoperative BI score and change in BI score were both significantly lower in the pandemic group indicating poorer postoperative function. Moreover, FHF patients treated during the pandemic had significantly more inhospital complications (36.6% vs. 22.8%, p = 0.002). There was no significant difference in the 3-month EQ-VAS or change in the EQ-VAS between groups. ConclusionThe results of this study revealed a higher in-hospital complication rate and lower postoperative function at 3 months among FHF patients treated during the COVID-19 pandemic compared to the pre-pandemic period. Therefore, modified in-hospital and post-discharge protocols should be developed for implementation during pandemic crisis periods.

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Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review

Cited by 39 publications

References 27 publications

The Procoagulant Effect of COVID-19 on the Thrombotic Risk of Patients with Hip Fractures Due to Enhanced Clot Strength and Fibrinolysis Shutdown

The Procoagulant Effect of COVID-19 on the Thrombotic Risk of Patients with Hip Fractures Due to Enhanced Clot Strength and Fibrinolysis Shutdown

Fraturas do fêmur em idosos do Nordeste do Brasil: dados epidemiológicos e gastos para o SUS

Surgical treatment for fragility hip fractures during the COVID-19 pandemic resulted in lower short-term postoperative functional outcome and a higher complication rate compared to the pre-pandemic period

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