Effects of SARS-CoV‑2 infections on inpatient mortality of geriatric patients after proximal femoral fracture surgery

Abstract

Background The medical challenges caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) pose a tremendous burden on the healthcare system. This study aimed to analyze the effects of a SARS-CoV‑2 infections or disease progression on inpatient mortality of geriatric patients after proximal femoral fracture surgery. Methods A retrospective analysis was conducted in all patients with a proximal femoral fracture surgically treated in an urban regional trauma center from 01/01/2020 to 01/31/2021. According to PCR test results detecting SARS-CoV‑2, the patients were divided into two groups (SARS-CoV‑2 positive vs. SARS-CoV‑2 negative). Patient data, disease progression data, and treatment-related information were evaluated for all patients. Statistical data analysis was performed using unpaired Student’s t test or non-parametric Mann-Whitney U test. Results A total of 311 patients (women: 70.4%, age: 82.0 ± 11.0 years) were included in this study. Of these 3.9% (12/311) had a positive test result for SARS-CoV‑2. Significantly more deceased patients were found in the group tested positive for SARS-CoV‑2 (SARS-CoV‑2 positive: 41.7%, SARS-CoV‑2 negative: 5.4%, p < 0.001). In addition, the number of proximal femoral fracture associated deaths correlated with the number of positive test results performed in the Clinic. The length of stay of SARS-CoV‑2 COVID-19 survivors tended to be greater than in those who were tested negative (SARS-CoV‑2 COVID-19 positive: 15.6 ± 13.1 days, SARS-CoV‑2 COVID-19 negative: 11.5 ± 6.5 days, p = 0.683). Furthermore, a significant difference in age was found in SARS-CoV‑2 survivors and SARS-CoV‑2 decedents (deceased: 95.5 ± 7.5 years, alive: 83.5 ± 7.3 years, p = 0.020). Conclusion The study was conducted before the introduction of SARS-CoV‑2 vaccination. The results therefore refer to immune naive (unvaccinated) patients. In our study, more than 40% of all patients with proximal femoral fractures who tested positive for SARS-CoV‑2 died during hospitalization. An additional, critical factor in this respect was the age of the infected patients. Nonetheless, a positive correlation was demonstrated between the mortality rate and the number of positive SARS-CoV‑2 detections. Regarding the greater length of stay of patients tested positive for SARS-CoV‑2, the limited transfer options (further rehabilitation, skilled nursing facility) of the infected ones can be considered as causal. Particularly the vulnerable older patients are increasingly endangered by a combination of proximal femoral fracture and SARS-CoV‑2.

The impact of COVID-19 on mortality in trauma patients undergoing orthopedic surgery: a systematic review and meta-analysis

“…The majority of patients in these investigations were > 60 years old. The study characteristics and postoperative mortality findings are shown in Table 2 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. The most common injury sites were the hip and femur, followed by other lowerlimb sites such as the patella, tibia, ankle, foot, and upper limb.…”

“…Surgery within 48 hours of hospital admission does not correlate with a lower mortality rate in COVID-19-positive patients [13]. As shown in Table 3 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], the mean hospital stay length among COVID-19-positive patients undergoing hip and femur surgery was longer than that among COVID-19-negative patients. This result is in line with the study by Kayani et al [37], which stated that hip surgery in COVID-19-positive patients was associated with a longer hospital stay, longer immobilization, more hospitalizations in the intensive care unit, an increased chance of peri-operative complications, and greater mortality rates.…”

“…We included observational studies like cohort, cross-sectional, and case-control studies but excluded review articles. The validity of the papers included in this study was evaluated using a series of inquiries based on a checklist in line with the kind of study created by the Joanna Briggs Institute [7,8], as shown in Supplementary Table 1 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] and Supplementary Table 2 [24]. Articles that did not fit the requirements for inclusion were rejected.…”

“…According to Table 2 Complications due to COVID-19 were most commonly reported as the primary cause of postoperative death among COVID-19positive patients. The reported primary causes of postoperative death, complications, underlying disease, and mean hospital stay in both groups are shown in Table 3 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Eight studies [11][12][13][14][15]19,20,22] did not report the cause of death in their research.…”

“…A total of 1,616 reported surgeries from seven studies [13,[16][17][18][20][21][22] are shown in Supplementary Table 4. In contrast, nine studies [9][10][11][12]14,15,19,23,24] did not specify the surgeries performed in their studies. Only Lim et al [18] reported the type of anesthesia used in both groups.…”