Peri-operative Outcomes and Predictors of Mortality in COVID-19 Positive Patients with Hip Fractures: A Multicentre Study in the UK

Abstract

Aim This UK based multi-centre study reports clinical characteristics, early outcomes and predictors of mortality in 34 consecutive COVID-19-positive hip fractures so that the lessons learnt could be utilised in other parts of World who are at a different phase of the pandemic. Methods This study analysed patient admitted with hip fractures with COVID positive swabs, between March and May’2020 in three large hospitals covering a population of nearly two million. Data was collected on demographic profile, peri-operative variables, post-operative complications and mortality. The specific aim was to identify any variables, which could predict high 30-day mortality. Results Overall, 12% of hip fractures were COVID positive with the mortality rate of 41.2%. The higher age ( p = 0.036) and male gender ( p = 0.025) was significantly associated with mortality and most of the deaths were between American Society of Anaesthesiologists (ASA) grade 3 and 4 patients. The patients having intramedullary (IM) nailing were more likely to die ( p = 0.02). There was no difference in laboratory parameters but there was significant difference in findings on chest radiographs ( p < 0.001), post-operative oxygen requirements ( p = 0.006) and early respiratory complications ( p = 0.006). Conclusion This study suggests that the mortality following surgery for a hip fracture in COVID-positive patients is strikingly high and is associated with higher age and male gender. Higher mortality has been observed for extracapsular fracture operated with intramedullary nailing. In the immediate post-operative period, rapid deterioration of chest imaging, higher oxygen requirement and early pulmonary complications can serve as warning signs and predicting factors for higher mortality.

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

“…A total of 598 records were identified and full texts were retrieved for 37 studies. 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.…”

“…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 ].…”

“…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 ]. The mean age of patients was 81.79 years with a range from 71.9 to 86.5 years.…”

“…The mean age of patients was 81.79 years with a range from 71.9 to 86.5 years. The review included 925 males and 2028 females reported in 18 studies [ 1 , 7 , 8 , 12 – 15 , 17 – 26 , 28 ] and the mean length of hospital stay ranged from 5 ± 2.6 to 24.21 days.…”

“…With numbers of hip fractures in the elderly increasing and COVID-19 infections multiplying, chances of their co-existence in the same patient is likely, wherein the patient’s age and co-morbidities could increase the morbidity and mortality by manifolds when compared to COVID-19 negative patients presenting with such fractures [ 7 , 8 ].…”