Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

Raheman, Firas; Rojoa, Djamila; Parekh, Jvalant Nayan; Berber, Reshid; Ashford, Robert U.

doi:10.1038/s41598-021-89617-2

Cited by 10 publications

(10 citation statements)

References 50 publications

(99 reference statements)

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“…diabetes, dementia) were associated with higher mortality rates[ 45 ]. Extracapsular fractures are also an indicator of high mortality[ 46 ]. Smoking, alcohol consumption, and attitudes to COVID-19 may explain the higher prevalence in men than women[ 47 ].…”

Section: Management To Address the Issuementioning

confidence: 99%

Management of hip fracture in COVID-19 infected patients

Qin¹,

He²,

Luo³

et al. 2022

WJO

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Given that the global population of elderly individuals is expanding and the difficulty of recovery, hip fractures will be a huge challenge and a critical health issue for all of humanity. Although people have spent more time at home during the coronavirus disease 2019 (COVID-19) pandemic, hip fractures show no sign of abating. Extensive studies have shown that patients with hip fracture and COVID-19 have a multifold increase in mortality compared to those uninfected and a more complex clinical condition. At present, no detailed research has systematically analyzed the relationship between these two conditions and proposed a comprehensive solution. This article aims to systematically review the impact of COVID-19 on hip fracture and provide practical suggestions. We found that hip fracture patients with COVID-19 have higher mortality rates and more complicated clinical outcomes. Indirectly, COVID-19 prevents hip fracture patients from receiving regular medical treatment. With regard to the problems we encounter, we provide clinical recommendations based on existing research evidence and a clinical flowchart for the management of hip fracture patients who are COVID-19 positive. Our study will help clinicians adequately prepare in advance when dealing with such patients and optimize treatment decisions.

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Section: Management To Address the Issuementioning

confidence: 99%

Management of hip fracture in COVID-19 infected patients

Qin¹,

He²,

Luo³

et al. 2022

WJO

View full text Add to dashboard Cite

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“…Reportedly, the mortality rate in COVID-19 negative hip fractures patients varied from 7.1–53.6%. 21 26 27 In addition, comparative studies of mortality rates of hip fracture with COVID-19 negative before and after the COVID-19 pandemic reported no significant increase in the mortality rate. 8 13…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Effects of COVID-19 on Hip Fractures in Korea Without Lockdown: Interrupted Time Series Analysis Using a Nationwide Cohort

et al. 2023

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Background The purpose of this study was to investigate the change in the incidence rate, length of hospital stay (LOS), in-hospital mortality rate, and surgical method of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic in South Korea where lockdown restrictions were not implemented. Methods We calculated the expected values of the incidence of hip fractures, in-hospital mortality and LOS of hip fracture patients in 2020 (COVID period) based hip fracture database of the Korean National Health Insurance Review and Assessment (HIRA) during a 9-year period from 2011 to 2019 (pre-COVID period). A generalized estimating equation model with Poisson distribution and logarithmic link function was used to estimate adjusted annual percent change (PC) of incidence rate and 95% confidence intervals (CIs). Then, we compared the annual incidence, in-hospital mortality rate and LOS in 2020 with the expected values. Results The overall incidence rate of hip fracture in 2020 was not significantly different from the expected value (PC, −5%; 95% CI, −13 to 4; P = 0.280). In women, the incidence rate of hip fracture in age groups over 70 years was smaller than the predicted value ( P < 0.001). The in-hospital mortality rate was not significantly different from the expected value (PC, 5%; 95% CI, −8 to 19; P = 0.461). The mean LOS was larger than the expected value by 2% (PC, 2%; 95% CI, 1 to 3; P < 0.001). In intertrochanteric fracture, the proportion of internal fixation was smaller than the predicted value by 2% (PC, −2%; 95% CI, −3 to −1; P < 0.001), and that of hemiarthroplasty was larger than the predicted value by 8% (PC, 8%; 95% CI, 4 to 14; P < 0.001). Conclusions In 2020, the incidence rate of hip fracture did not significantly decrease, and in-hospital mortality rate did not significantly increase compared to the expected rates, which were projected based on the HIRA hip fracture data from 2011 to 2019. Only LOS increased slightly.

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“…Studies of patients regardless of COVID-19 status have yielded conflicting results when comparing the mortality of hip fracture patients treated during the COVID-19 pandemic to historical controls. Increased mortality was found in a cohort of 43 hip fracture patients in the United Kingdom compared to the same time period during the three years prior [ 41 ], and a meta-analysis of 2651 patients found an excess mortality of ~10% during the pandemic [ 21 ]. Another study in Spain, however, did not find a difference in 30-day mortality, similar to our study [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies across geographies have suggested that hip fracture patients who tested positive for COVID-19 had increased mortality [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Furthermore, meta-analyses have found a four- to seven-fold increase in mortality among patients with COVID-19 infection in comparison with those treated during the COVID-19 pandemic who did not have COVID-19 [ 18 , 19 , 20 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative Outcomes and Surgical Timing for Operative Fragility Hip Fracture Patients during the COVID-19 Pandemic: A Retrospective Cohort Study

et al. 2022

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The COVID-19 pandemic had wide-reaching effects on healthcare delivery, including care for hip fractures, a common injury among older adults. This study characterized factors related to surgical timing and outcomes, length-of-stay, and discharge disposition among patients treated for operative hip fractures during the first wave of the COVID-19 pandemic, compared to historical controls. A retrospective, observational cohort study was conducted from 16 March 2020-20 May 2020 with a consecutive series of 64 operative fragility hip fracture patients at three tertiary academic medical centers. Historical controls were matched based on sex, surgical procedure, age, and comorbidities. Primary outcomes included 30-day mortality and time-to-surgery. Secondary outcomes included 30-day postoperative complications, length-of-stay, discharge disposition, and time to obtain a COVID-19 test result. There was no difference in 30-day mortality, complication rates, length-of-stay, anesthesia type, or time-to-surgery, despite a mean time to obtain a final preoperative COVID-19 test result of 17.6 h in the study group. Notably, 23.8% of patients were discharged to home during the COVID-19 pandemic, compared to 4.8% among controls (p = 0.003). On average, patients received surgical care within 48 h of arrival during the COVID-19 pandemic. More patients were discharged to home rather than a facility with no change in complications, suggesting an opportunity for increased discharge to home.

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Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

Cited by 10 publications

References 50 publications

Management of hip fracture in COVID-19 infected patients

Management of hip fracture in COVID-19 infected patients

Analysis of the Effects of COVID-19 on Hip Fractures in Korea Without Lockdown: Interrupted Time Series Analysis Using a Nationwide Cohort

Comparative Outcomes and Surgical Timing for Operative Fragility Hip Fracture Patients during the COVID-19 Pandemic: A Retrospective Cohort Study

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