The impact of COVID-19 on morbidity and mortality in neck of femur fracture patients

Abstract

Aims Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients. Methods All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality. Results Overall, 132 patients were included. Of these, 34.8% (n = 46) were diagnosed with COVID-19. Bacterial pneumonia was observed at a significantly higher rate in those patients with COVID-19 (56.5% vs 15.1%; p =< 0.000). Non respiratory complications such as acute kidney injury (30.4% vs 9.3%; p =0.002) and urinary tract infection (10.9% vs 3.5%; p =0.126) were also more common in those patients with COVID-19. Length of stay was increased by a median of 21.5 days in patients diagnosed with COVID-19 (p < 0.000). 30-day mortality was significantly higher in patients with COVID-19 (37.0%) when compared to those without (10.5%; p <0.000). Conclusion This study has shown that patients with a neck of femur fracture have a high rate of mortality and complications such as bacterial pneumonia and acute kidney injury when diagnosed with COVID-19 within the perioperative period. We have demonstrated the high risk of in hospital transmission of COVID-19 and the association between the infection and an increased length of stay for the patients affected. Cite this article: Bone Joint Open 2020;1-11:669–675.

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

“…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. [ 1 , 8 , 14 , 18 , 22 , 26 ]…”

“…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.…”

“…The rate of complications like infections, acute renal failure, deep vein thrombosis, myocardial infarction and acute respiratory failure, was compared between the 2 groups in 6 studies [ 1 , 8 , 14 , 18 , 22 , 26 ] and the number of complications was found to be significantly high in COVID-19 positive/suspected patients with an Odds ratio of 9.28 (95% CI 4.46, 19.30; p < 0.00001) (Fig. 6 ).…”

Delayed Hospital Admission for Traumatic Hip Fracture During the COVID-19 Pandemic&nbsp;

“…Several studies have reported an increased mortality rate among patients with hip fractures who were diagnosed with COVID-19 [3,11,16,24,[27][28][29][30][31]. In this study none of the con rmed or suspected COVID-19 patients died in-hospital so the COVID-19 diagnosis may not be driving this increased risk for mortality.…”

Hip and distal femur fracture outcomes over three successive UK lockdown periods during the COVID-19 pandemic: what have we learnt?

“… 30 Given the pathophysiology of COVID-19 as a viral respiratory illness, the percentage of patients experiencing pneumonia during the pandemic was higher as compared to pre-pandemic years. 31 The higher rates of AKI and pneumonia for COVID-positive hip and distal femur fracture patients, resulting in higher rates of mortality, is also supported by a study by Ward et al 32 who demonstrated similar findings. Our results therefore demonstrate the importance of early recognition and management for AKI and pneumonia, especially for COVID-positive patients.…”