Mortality escalates in patients of proximal femoral fractures with COVID-19: A systematic review and meta-analysis of 35 studies on 4255 patients

Abstract

Background Concerns have been raised about the escalated mortality in patients of proximal femoral fractures (PPFs) with COVID-19. A meta-analysis to evaluate mortality in patients with PPFs managed during the current COVID-19 pandemic was conducted. Methods A systematic review and meta-analysis of all published studies were conducted with a search on PubMed, Scopus, Web of Science, and Cochrane Library databases using appropriate keywords from January 01, 2020 to January 29, 2021. Results 35 relevant studies reporting 3979 patients with hip fracture in the current ongoing pandemic, out of which 692 patients were COVID -19 positive. Twenty studies reported mortality and other relevant statistics on hip fracture patients with and without COVID 19 (4123 hip fracture patients in the year 2020–21, out of which 560 had or were suspected of having COVID -19). A meta-analysis of mortality statistics in patients with and without COVID revealed increased odds of mortality among COVID patients [odds ratio (OR) 6.31, 95% confidence interval (CI) [5.09, 7.83] and meta-analysis on the subgroup of surgically treated patients also showed markedly increased mortality risk among those with COVID-19 (OR) 5.99, 95% CI [3.88,9.24]. Conclusion The mortality risk is markedly increased in hip fracture with concomitant COVID -19 compared to those without it. This increased risk persisted in those managed surgically. It could be due to the inflammation induced by the fracture or surgery for fracture fixation, further exacerbating inflammation, leading to cytokine storm. It is imperative that such patients are informed regarding increased mortality risk during the consent and shared decision-making process.

Coronavirus Disease 2019 and the Injured Patient: A Multicenter Review

“…COVID 19+ patients had a lower overall survival probability than COVID 19-patients (Figure 3). Similarly, COVID 19+ patients had longer discharge probability with a longer time to discharge (Median [IQR] = 5 [4][5][6][7] vs. 3 [3][4] days) compared to COVID 19-patients (Figure 3).…”

“…Several studies have shown the deleterious effects of COVID-19 on patients with orthopedic trauma. [3][4][5] Other studies on the impact of the pandemic on trauma centers and outcomes of trauma patients revealed an increased risk of mortality, longer length of stay and pulmonary complications in COVID-19 positive (COVID 19+) patients, along with fewer traumatic blunt injury encounters. 6,7 Increased complications have also been seen in other surgical COVID 19+ patients as compared to COVID-19 negative (COVID 19-) patients; mainly pulmonary in nature, followed by multi-organ complications.…”

Effectiveness of patient triage at the orthopedic hospital and the hygiene concept in a professional handball team in the first year of the SARS-CoV-2 pandemic

“…The Robert Koch Institute informed weekly about the increasing number of SARS-CoV‑2 outbreaks in German hospitals [ 20 ]. Significant higher mortality rates were reported for patients undergoing emergency and elective surgery [ 6 , 7 , 13 , 17 ]. In the absence of vaccines and specific treatment for the COVID-19 disease, preventive strategies had to be implemented to protect our patients, especially the vulnerable groups.…”

Standard care of management in orthopaedic patient during COVID 19 pandemic: An institution based guideline

“…However there was increased in number mortality in proximal femoral fractures in elderly age group. Patralekh et all have done a systematic review in 4355 patients with proximal femoral fractures and reported increased mortality in COVID 19 positive patients and the reason was shown to cytokine storm post operatively [13] The recent COVID 19 pandemic is expected to continue for coming years. However high patient load compare to healthcare infrastructure is always challenging in India.…”