Perioperative management of elderly patients presenting with hip fracture during COVID-19 pandemic surge

Abstract

Highlights Patients with hip fracture and COVID-19 infection may have higher combined morbidity and mortality Universal testing with high level of clinical judgment should be used Appropriate timing of surgery vs non-surgical approach should be decided based on risk and severity of COVID-19 and underlying medical condition Universal contact and droplet as well as aerosol precautions, when needed, should be utilized Optimal surgery and anesthesia techniques should be chosen, with regional preferred over general anesthesia

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

“…Five more papers were discovered on hand search. After screening duplicates and excluding unrelated articles based on the title, 65 papers8–72 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 5 with 35 having hip fracture data were finally considered for review after full-text assessment. ( Fig.…”

“…Twenty papers reported data on both COVID-19 and non-COVID -19 patients with hip fractures and were considered for meta-analysis of 30-day mortality statistics. Rest articles were opinion pieces (4), general epidemiological studies (16), Specialist society guideline (1) 23 infographic analysis (1), errata (2), and reviews (7).These 35 studies in total 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 22 , 24 , 25 , 27 , 28 , 30 , 31 , 32 , 33 , 41 , 42 , 44 , 51 , 52 reported a total of 4225 patients with hip fracture in the current ongoing pandemic, out of which 692 patients were positive for COVID -19 ( Table 1 , Table 2A , Table 2B B).…”

“…Fifteen studies, reporting data separately for 158 patients (132 hip fracture patients) with COVID- 19 were summarized separately. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 22 , 24 , 25 , 32 , 33 , 41 , 42 , 52 ( Table 1 ). Apart from these, 20 studies reported mortality and other relevant statistics on hip fracture patients with and without COVID -19 {reporting 4123 hip fracture patients in the year 2020–21, out of which 560 had or were suspected to be having COVID- 19}, but individual patient data was not reported.…”

“… 8 , 9 A combination of comorbidities and elderly age could make these patients who sustain PFFs more vulnerable to respiratory illness due to their limited pre-injury ambulatory status. 24 …”

“…1 However, early limited evidence published so far suggests poor outcomes with high postoperative mortality in patients with a hip fracture and concomitant COVID-19 infection (available studies indicate a mortality rate greater than 30%). 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 We have undertaken a ...…”