Impact of COVID-19 on clinical outcomes for patients with fractured hip

Abstract

Aims There are reports of a marked increase in perioperative mortality in patients admitted to hospital with a fractured hip during the COVID-19 pandemic in the UK, USA, Spain, and Italy. Our study aims to describe the risk of mortality among patients with a fractured neck of femur in England during the early stages of the COVID-19 pandemic. Methods We completed a multicentre cohort study across ten hospitals in England. Data were collected from 1 March 2020 to 6 April 2020, during which period the World Health Organization (WHO) declared COVID-19 to be a pandemic. Patients ≥ 60 years of age admitted with hip fracture and a minimum follow-up of 30 days were included for analysis. Primary outcome of interest was mortality at 30 days post-surgery or postadmission in nonoperative patients. Secondary outcomes included length of hospital stay and discharge destination. Results In total, 404 patients were included for final analysis with a COVID-19 diagnosis being made in 114 (28.2%) patients. Overall, 30-day mortality stood at 14.4% (n = 58). The COVID-19 cohort experienced a mortality rate of 32.5% (37/114) compared to 7.2% (21/290) in the non-COVID cohort (p < 0.001). In adjusted analysis, 30-day mortality was greatest in patients who were confirmed to have COVID-19 (odds ratio (OR) 5.64, 95% confidence interval (CI) 2.95 to 10.80; p < 0.001) with an adjusted excess risk of 20%, male sex (OR 2.69, 95% CI 1.37 to 5.29; p = 0.004) and in patients with ≥ two comorbidities (OR 4.68, CI 1.5 to 14.61; p = 0.008). Length of stay was also extended in the COVID-19 cohort, on average spending 17.6 days as an inpatient versus 12.04 days in the non-COVID-19 group (p < 0.001). Conclusion This study demonstrates that patients who sustain a neck of femur fracture in combination with COVID-19 diagnosis have a significantly higher risk of mortality than would be normally expected. Cite this article: Bone Joint Open 2020;1-11:697–705.

The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients

“…A study conducted at a single NHS hospital trust comprising 157 hip fracture patients admitted in March to May 2020 showed similar findings; approximate length of hospital stay for COVID-19-negative patients was lower at 12 days vs 17 days, although not statistically significant [ 35 ]. Another multicentre UK study comprising 404 hip fracture patients admitted in March 2020 again showed similar findings; approximate length of hospital stay for COVID-19-negative patients was statistically significantly lower at 14 days vs 18 days [ 36 ].…”

30-Day Mortality Rate in Hip Fractures Among the Elderly with Coexistent COVID-19 Infection: A Systematic Review

“…Seventeen studies were excluded as per the exclusion criteria and a total of 20 studies [ 1 , 7 , 8 , 12 – 28 ] were included for qualitative analysis. Comparative meta-analysis was performed from 14 studies [ 1 , 8 , 15 , 16 , 19 – 28 ] for 30 days mortality, from 4 studies [ 8 , 16 , 17 , 22 ] for in-hospital mortality, and 6 each for the length of hospital stay [ 1 , 8 , 15 , 17 , 25 , 28 ] and number of complications. [ 1 , 8 , 14 , 18 , 22 , 26 ]…”

“…Of the 20 studies, 16 were retrospective [ 1 , 7 , 13 – 18 , 21 – 28 ] and 4 were prospective [ 8 , 12 , 19 , 20 ] studies. Nine studies were multicentric trials [ 1 , 7 , 15 , 17 , 19 , 21 , 23 , 25 , 28 ]. A total of 3211 patients were included in the review; of these, the pooled analysis was done for 3157 patients in 18 studies [ 1 , 7 , 8 , 14 – 28 ].…”

“…It was compared between the 2 groups in 6 studies [ 1 , 8 , 15 , 17 , 25 , 28 ] and showed that the length of hospital stay was significantly higher in COVID-19 positive patients as compared to COVID-19 negative patients, with a mean difference of 4.96 days (95% CI 2.86, 7.05; p < 0.00001) (Fig. 7 ).…”

Pushing the Envelope

“…Multiple studies examined the association of COVID-19 infections in patients and postoperative outcomes 52 , 53 , 54 , 55 . In the United Kingdom (UK), 340 COVID-19 negative patients were matched to 82 COVID-19 positive patients, who required hip surgery for fracture.…”