30-day mortality for fractured neck of femur patients with concurrent COVID-19 infection

Abstract

Introduction Risk factors for mortality associated with COVID-19 have been reported to include increased age, male sex and certain comorbidities. Fracture neck of femur (NOF) patients is high-risk surgical patients, often with multiple comorbidities and advanced age. We quantify the 30-day mortality rate in fractured NOF patients with a positive peri-operative COVID-19 antigen test and identify risk factors for increased mortality. Methods This is a retrospective multi-centre review of all patients admitted with a fractured NOF and a confirmed laboratory diagnosis of COVID-19 between 1 March and 26 April 2020. Demographic data, comorbidities, ASA grade and date of death (if applicable) were collected. Results There were 64 patients in the cohort with an overall 30-day mortality rate of 32.8% (n = 21). Thirty-five (55%) were female, and mean age was 83 (SD 9, range 46-100) years. There was significantly increased mortality for those with a history of myocardial infarction (p = 0.03). Sixty-four percent of patients underwent surgery within the 36-h target, which is comparable to previous data for the same time of year. Overall mortality increased to 50% (n = 32) at 45 days post-operatively. Conclusion This is a large review of 30-day mortality in NOF patients with concurrent COVID-19 infection. We report a substantial increase from the pre-COVID-19 mean 30-day mortality rate (6.5% in 2019). We highlight the need for counselling patients when presenting with a NOF in relation to peri-operative COVID-19 infection and the associated increased risks. Keywords COVID-19 • SARS-CoV-2 • Fractured neck of femur • Mortality • Hip fracture All collaborators assisted with data collection, drafting of the paper and reviewing the final article. North West COVID NOF Study Group authors listed in Acknowledgements section.

Falls as One of the Atypical Presentations of COVID-19 in Older Population

“…A study conducted by Spanish researchers indicates, respectively, that the total mortality rate was 30.4% for COVID-19 positive patients and 10.3% for patients without coronavirus. 20 Similar results were obtained by Kumar et al, Maniscalco et al and Hadfield et al 15 , 16 , 21 , 22 They indicate an increase in mortality rate of people tested positive for the presence of COVID-19 virus, with proximal femur fracture or hip fracture.…”

Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis

“…In all, 68 studies [ 4 , 17 – 83 ] were published in English and 1 study [ 84 ] published in Chinese. Out of which 54 studies [ 4 , 18 – 24 , 29 – 31 , 34 – 39 , 45 – 53 , 55 , 56 , 59 – 84 ] were from China, 3 studies [ 17 , 32 , 54 ] were from the USA, 3 studies [ 25 , 40 , 44 ] were from Korea, 2 studies [ 26 , 27 ] were from Italy and the remaining 7 studies [ 28 , 33 , 41 – 43 , 57 , 58 ] were from Austria, Iran, Israel, Saudi Arabia, Spain, Turkey, and UK. The sample size per study ranged from 27 to 1590 (total 17 879; 9686 males).…”

Hip fracture care and mortality among patients treated in dedicated COVID-19 and non-COVID-19 circuits

“…Narang [ 25 ] had a lower surgical delay for COVID-19( +) patients compared to those without infection (59.2% in < 36 h vs. 77.9%, respectively); Egol [ 26 ] reported a longer surgical delay among cases confirmed or suspected to have COVID-19, as in our series. Other authors had surgical delays comparable to or lower than previous years [ 7 , 27 ]. Many of our cases presented with viral pneumonia, fever and hypoxia; guidelines consider chest infections with systemic involvement an acceptable reason for surgical delay [ 28 ], and we considered it prudent to avoid the additional inflammatory insult of surgery on patients with systemic involvement.…”

“…Many have described high mortality with approximately one-third of patients dying in the first month after the fracture (Supplementary Table 1) [6]. However, several included preoperatively as well as postoperatively diagnosed infections, and the proportion of total infections diagnosed on admission varied between 7.7 and 70% [3,[6][7][8][9][10][11]24]. We report the results of patients diagnosed preoperatively and treated in a separate circuit; among those treated before the creation of separate pathways, four patients (23.5%) suffered coronavirus infectious disease-19 in the following 30 days and half of them died.…”

“…Recent studies have described a sevenfold increase in mortality in patients with hip fractures concomitantly affected by COVID-19, with approximately one-third of patients dying by the first month [5]. Many of these studies are not adjusted for age, sex or comorbidities and do not take other factors into account such as surgical delay, or are limited to data collected during 2020 without comparison with results from previous years [1,[6][7][8][9][10][11].…”