The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients

Abstract

Background On the 11th March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. Multiple new guidelines were proposed and existing models of social, domestic and hospital care altered. Most healthcare systems were largely unprepared for this, and the pandemic has tested their adaptability. This study aimed to assess the impact of COVID-19 on the demographics, presentation, clinical management and outcomes of patients with proximal femoral (hip) fractures comparing them to a similar cohort of patients admitted a year earlier. Methods This retrospective multi-centre cohort study compared all patients admitted with hip fractures between 1st March and 30th May 2019 (group PC: pre-COVID-19) with hip fracture patients admitted over the same time period during the pandemic in 2020 (group C: COVID-19). The data was obtained from the hospitals’ local and National Hip Fracture Databases. Mortality data was checked with the Office for National Statistics (ONS). Primary outcomes were time to theatre, in-patient length of stay and 30-day mortality. Results A total of 580 patients were included (304 group PC, 276 group C). Patient demographics including Charlson Comorbidity Index and Nottingham Hip Fracture Scores were broadly similar across the two cohorts. There was a significant reduction in the percentage of total hip replacements (11 to 5%, p = 0.006) in group C. There was an increase in conservative management (1 to 5%, p = 0.002) in group C. Time to theatre was significantly delayed in group C (43.7 h) vs group PC (34.6 h) (p ≤ 0.001). The overall length of hospital stay was significantly longer in group PC (16.6 days) vs group C (15 days) (p = 0.025). The 30-day mortality rate in group C was 9.8% compared to 8.2% in group PC (p = 0.746), but for COVID-19 (+) patients, it was significantly higher at 38.2% vs 5.8% in COVID-19 (−) patients (p < 0.001). Conclusion This is one of the largest multi-centre comparative cohort study in the literature to date examining the impact of the COVID-19 pandemic on the management of hip fracture patients. Whilst mortality rates were similar in both groups, COVID-19-positive patients were almost seven times more likely to die, reflecting the seriousness of the COVID-19 infection and its sequelae in such elderly, vulnerable patients.

COVID-19 among patients with orthopedic surgery: our experience from the Middle East

“…Majority of patients (70.8%) were Iranian. Median (IQR) hospital stay was 4 [ 3 , 5 ] days (range from 1 to 31 days). Fever (45.8%) and cough (37.5%) were the most common symptoms among patients.…”

“…COVID-19 has affected orthopedics in different aspects [ 5 – 8 ]. On the other hand, reports on orthopedic surgery during the COVID-19 outbreak have been scarce.…”

The effect of COVID-19 positivity on inflammatory parameters and thirty day mortality rates in patients over sixty five years of age with surgically treated intertrochanteric fractures

“…The literature shows that COVID-19 positive patients have longer surgical and hospital stays compared to COVID-19 negative patients [ 18 ]. Management of COVID-19 positive patients and their need for additional treatments such as respiratory support in the postoperative period extend the hospitalization period [ 19 , 20 ].…”

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

“…Fifteen studies, reporting data separately for 158 patients (132 hip fracture patients) with COVID-19 were summarized separately. 8e14, 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 2020e21, out of which 560 had or were suspected to be having COVID-19}, but individual patient data was not reported.…”

“…Summary of studies reporting mortality and other relevant statistics on hip fracture patients with and without COVID 19. ,41,42,52 Among the rest 19 studies, Egol et al and LeBrun et al have reported data on fracture and surgery types in different groups. 16,17 Vives et al reported 52 FNF and 84 intertrochanteric fractures.…”