Impact of COVID-19 Pandemic on the Length of Hospital Stay in Hip Fracture Patients: A Single Centre Study

Yawar, Bakhat; Salmon, Jennifer; McSorley, Aoife; Meehan, Seanna; Auld, Callum; Abdulrahman, Hassan; Khan, Mohammad Noah; Qureshi, Ammal Imran; Flynn, Ryan; Neely, Ivan; Yawar, Ali; Asim, Ayeisha; Mustafa, Sami; McAdam, Andrew; Sapumohotti, Adriana; Duffy, Eimhear; Sandhu, Hushil; Hanratty, Brian

doi:10.7759/cureus.27328

Cited by 3 publications

(3 citation statements)

References 18 publications

(20 reference statements)

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“…Reduction in duration of hospitalization and duration of hospitalization until surgery were other findings raised in our research. Similar to our study, in Northern Ireland, the USA and the East Midlands region of England a shorter length of stay during the pandemic was reported compared to the pre-pandemic period [ 26 – 28 ]. Also, the shorter time to surgery during the pandemic was a finding that other studies have supported [ 29 , 30 ].…”

Section: Discussionsupporting

confidence: 90%

The process of hip fracture management before and during the COVID-19 pandemic in Iran

Yalamchi,

Khalagi,

Fahimfar

et al. 2024

BMC Geriatr

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Background The COVID-19 pandemic affected the control of many chronic conditions, including hip fractures, worldwide. This study was to examine the impact of the COVID-19 pandemic on the management of hip fractures in a referral orthopedic hospital in Iran. By understanding how the pandemic has influenced the care of hip fracture patients, we can gain valuable insights into the challenges, adaptations, and potential improvements in orthopedic healthcare during such public health crises. Methods Data was collected on hip fracture patients aged 50 and above who were admitted to the hospital before and during the pandemic. The number of admissions and operations, length of hospital stay, and time from admission to surgery were recorded from the hospital information system (HIS) and compared between the two periods. Results The median number of admitted hip fracture patients per month increased slightly during the pandemic (11%), although this increase was not statistically significant (p = 0.124). After adjusting for potential confounders, the mean length of hospital stay was significantly lower during the pandemic period, indicating that patients were discharged sooner (p = 0.019) and the time from admission to surgery was shorter during the pandemic (p = 0.004). Although the increase in the number of hip fracture surgeries per month during the pandemic was not statistically significant (P = 0.132), a higher percentage of patients underwent surgery during the pandemic compared to before (84.8% VS. 79.4%). Conclusion The study suggests that the COVID-19 pandemic did not have a negative impact on hip fracture management in the investigated orthopedic hospital in Iran. further research is needed to explore the effects of the pandemic on other aspects of healthcare services, particularly in general hospitals.

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Section: Discussionsupporting

confidence: 90%

The process of hip fracture management before and during the COVID-19 pandemic in Iran

Yalamchi,

Khalagi,

Fahimfar

et al. 2024

BMC Geriatr

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“…Our findings are consistent with another large population-based study on hip fracture patients, which demonstrated a two-fold increase in length of stay in COVID-19-positive patients. 17 , 48 Notably, multiple studies and a systematic review compared lengths of stay in hip fracture patients before and after the pandemic, and demonstrated reduced lengths of stay, likely due to an attempt to prevent nosocomial viral transmission to the patient or other hospitalized patients. 49 A previous study compared postoperative outcomes of hip fracture patients before and after the pandemic, and found no differences in rates of 30-day hospital readmission and a decrease in rates of patients placed in skilled nursing facilities.…”

Section: Discussionmentioning

confidence: 99%

The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery

Mercier,

Koucheki,

Lex

et al. 2023

Bone Jt Open

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AimsThis study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures.MethodsUsing the National Surgical Quality Improvement Programme (NSQIP) database, patients who underwent common orthopaedic surgery procedures from 1 January to 31 December 2021 were extracted. Patient preoperative COVID-19 status, demographics, comorbidities, type of surgery, and postoperative complications were analyzed. Propensity score matching was conducted between COVID-19-positive and -negative patients. Multivariable regression was then performed to identify both patient and provider risk factors independently associated with the occurrence of 30-day postoperative adverse events.ResultsOf 194,121 included patients, 740 (0.38%) were identified to be COVID-19-positive. Comparison of comorbidities demonstrated that COVID-19-positive patients had higher rates of diabetes, heart failure, and pulmonary disease. After propensity matching and controlling for all preoperative variables, multivariable analysis found that COVID-19-positive patients were at increased risk of several postoperative complications, including: any adverse event, major adverse event, minor adverse event, death, venous thromboembolism, and pneumonia. COVID-19-positive patients undergoing hip/knee arthroplasty and trauma surgery were at increased risk of 30-day adverse events.ConclusionCOVID-19-positive patients undergoing orthopaedic surgery had increased odds of many 30-day postoperative complications, with hip/knee arthroplasty and trauma surgery being the most high-risk procedures. These data reinforce prior literature demonstrating increased risk of venous thromboembolic events in the acute postoperative period. Clinicians caring for patients undergoing orthopaedic procedures should be mindful of these increased risks, and attempt to improve patient care during the ongoing global pandemic.Cite this article: Bone Jt Open 2023;4(9):704–712.

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“…In contrast, however, other studies have demonstrated that LOS was decreased during the pandemic. [26][27][28][29] So the question still remains: how exactly did COVID-19 affect our study, and why was LOS increased post-protocol? It is difficult to precisely measure the effects of COVID-19 on our study, but one possible explanation for the prolonged LOS in the post-protocol group is the difficulty in getting patients discharged to rehabilitation centers (ie SNFs).…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Multidisciplinary Preoperative Protocol for Geriatric Hip Fractures Improves Time to Surgery at a Level III Trauma Center

Meyer

Earnest

Johnson

et al. 2023

Geriatr Orthop Surg Rehabil

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Introduction Hip fractures are common among the elderly, and delays in time to surgery (TTS) and length of stay (LOS) are known to increase mortality risk in these patients. Preoperative multidisciplinary protocols for hip fracture management are effective at larger trauma hospitals. The purpose of this study is to evaluate the effect of a similar multidisciplinary preoperative protocol for geriatric hip fracture patients at our Level III trauma center. Materials and Methods In this single-center retrospective study, patients aged 65 and older who were admitted from March 2016 to December 2018 (pre-protocol group, Cohort #1, n = 247) and from August 2021 to September 2022 (post-protocol group, Cohort #2, n = 169) were included. Demographic information, TTS, and LOS were obtained and compared using Student’s t-test and Chi-square testing. Results There was a significant decrease in TTS in Cohort #2 compared to Cohort #1 ( P < .001). There was a significant increase in LOS in Cohort #2 compared to Cohort #1 ( P < .05), but when comparing a subset of Cohort #2 (Subgroup 2B, patients admitted from May to September 2022 when the effects of COVID-19 were likely dissipated) to Cohort #1, there was no significant difference in LOS ( P = .13). For patients admitted to skilled nursing facilities (SNF), LOS in Cohort #2 was significantly longer than in Cohort #1 ( P = .001). Discussion In general, Level III hospitals have fewer perioperative resources compared to larger Level I hospitals. Despite this fact, this multidisciplinary preoperative protocol effectively reduced TTS which improves mortality risk in elderly patients. LOS is a multifactorial variable, and we believe the COVID-19 pandemic was a significant confounder that reduced available SNF beds in our area which prolonged the average LOS in Cohort #2. Conclusion A multidisciplinary preoperative protocol for geriatric hip fracture management can improve efficiency of getting patients to surgery at Level III trauma centers.

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Impact of COVID-19 Pandemic on the Length of Hospital Stay in Hip Fracture Patients: A Single Centre Study

Cited by 3 publications

References 18 publications

The process of hip fracture management before and during the COVID-19 pandemic in Iran

The process of hip fracture management before and during the COVID-19 pandemic in Iran

The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery

Implementation of a Multidisciplinary Preoperative Protocol for Geriatric Hip Fractures Improves Time to Surgery at a Level III Trauma Center

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