Effects of the COVID-19 Pandemic on COVID-19 Negative Geriatric Patients with Hip Fractures

Lim, S.; Tan, Min; Sze, Yuen Lei; Au, Lydia Shu Yi

doi:10.14283/jfa.2020.54

Cited by 4 publications

(5 citation statements)

References 3 publications

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“…[13][14][15] In some reports, the hip fracture management changes during the COVID-19 pandemic impacted mortality and morbidity even in COVID-19-negative patients. [16] However, the evidence is conflicting, and research analyzing the COVID-19 pandemic impact on hip fracture patient care in the US is still lacking.…”

Section: Introductionmentioning

confidence: 99%

“…Operating room capacity and staffing decreased significantly in many hospitals in response to COVID-19 patient care needs and staff infections [13–15] . In some reports, the hip fracture management changes during the COVID-19 pandemic impacted mortality and morbidity even in COVID-19-negative patients [16] . However, the evidence is conflicting, and research analyzing the COVID-19 pandemic impact on hip fracture patient care in the US is still lacking.…”

Section: Introductionmentioning

confidence: 99%

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Hip fracture care during the COVID-19 pandemic: retrospective cohort and literature review

Topor

Wood

Switzer

et al. 2021

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objectives: The goal of this study was to investigate whether the COVID-19 pandemic has affected hip fracture care at a Level I Trauma hospital. The secondary goal was to summarize the published hip fracture reports during the pandemic. Design: A retrospective cohort study. Setting: Level I Trauma Center. Patients/Participants: Eighty-six operatively treated hip fracture patients age ≥65 years, occurring from January 17 to July 2, 2020. Intervention (if any): N/A. Main Outcome Measurements: We defined 3 phases of healthcare system response: pre-COVID-19 (period A), acute phase (period B), and subacute phase (period C). The primary outcome was 30-day mortality. Clinical outcomes including time to surgery (TTS) and length of stay (LOS) were extracted from the electronic medical record. Results: Twenty-seven patients from Period A, 27 patients from Period B, and 32 patients from Period C were included. The 30-day mortality was not statistically different. The mean TTS was 20.0 +/− 14.3 hours and was the longest in Period C (22.1 +/− 9.8 hours), but the difference was not statistically significant. The mean LOS was 113.0 +/− 66.2 hours and was longest in Period B (120.9 +/− 100.6 hours). However, the difference was not statistically significant. Conclusions: The 30-day mortality, TTS, and LOS were not statistically different across multiple phases of pandemic at a level 1 trauma center. Our results suggest that we successfully adapted new protocol changes and continued to provide evidence-based care for hip fracture patients. Our results were comparable with that of other authors around the world.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hip fracture care during the COVID-19 pandemic: retrospective cohort and literature review

Topor

Wood

Switzer

et al. 2021

OTA International: The Open Access Journal of Orthopaedic Trauma

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“…As public health policymakers tried to control the pandemic by focusing resources on COVID-19, the general population was afraid of contracting coronavirus from hospitals, resulting in changes in their healthcare seeking behaviour. 2 This was more pronounced in the geriatric age group patients as well as in their attendants. The adjustment of hospital policies also contributed to the need for innovation in the management of these fractures.…”

Section: Introductionmentioning

confidence: 93%

Early mobilisation after pain relief for conservative management for intertrochanteric fractures: a pandemic enforced innovation and its results

Prakash¹,

Dhar

2022

HIP International

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Background: The COVID pandemic challenged the orthopaedic mind on several fronts. 1 of them was in the management of intertrochanteric fractures. A subset of these patients refused surgical intervention during the pandemic for related reasons. Faced with the goal of early verticalisation, the senior author used pain relief as a method to facilitate early mobilisation in 23 patients with peritrochanteric fractures. Methods: 23 patients with stable intertrochanteric fractures received a β 6 distal sodium channel block (DSCB) and were allowed to walk from day 1 without surgery, traction or spica. The goal was to prevent complications of recumbency in this subset of patients. The basic idea of immediate mobilisation from the time of fracture was based on Sarmiento’s sausage theory. Results: All the fractures united. There were no major complications. No shortening was seen in more than 50% cases and the shortening did not exceed 2 cm in any case. All patients were satisfied with the outcome and had good to excellent Harris Hip Scores. Conclusions: The block and walk method is a surprisingly satisfactory method of treatment for stable intertrochanteric fractures. It circumvents the risks of surgery whilst allowing immediate mobilisation preventing complications associated with the other modalities of fracture management.

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“…Moreover, COVID-19 impacted key healthcare standards for high-quality hip fractures care, specifically time to surgery, which reflects the difficulty of maintaining normal workflow during the pandemic due to a significant decrease in the availability of operating rooms and healthcare staff. Several studies have also reported an increase in the rate of severe complications and mortality rate during the pandemic, even in COVID-19-negative patients 14 .…”

Section: Introductionmentioning

confidence: 97%

The Effects of COVID‐19 on Geriatric Hip Fracture Management and 1‐Year Mortality in Beijing

Liu

Yang

et al. 2022

Orthopaedic Surgery

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Objectives Concerns about the coronavirus disease 2019 (COVID‐19) pandemic resulted in unprecedented challenges to the management of geriatric hip fractures. We aimed to evaluate the effects of the COVID‐19 surge on the time to surgery and 1 year mortality in geriatric patients with hip fracture at a large, urban Level 1 trauma center in Beijing, and to guide the management of geriatric hip fracture patients throughout the COVID‐19 pandemic. Methods This single‐center retrospective study included consecutive patients aged ≥65 years and injured 3 weeks prior to admission. Demographic and surgical data were collected between January 20 and May 31, 2020, and from the same period in 2019. Mortality data and functional status were collected at follow‐up of 1‐year after surgery. The primary outcomes were time to surgery and 1 year mortality. Results There were no significant differences in sex, fracture type, and surgical pattern between the 2020 (n = 261) and 2019 time‐matched (n = 307) cohorts. The time from admission to surgery was significantly delayed in the 2020 cohort compared with that in the 2019 cohort (48.9 h vs 20.5 h, p < 0.001). Fewer patients underwent surgery within 48 h in the 2020 cohort (65.5% vs 87.6%, p < 0.001). Surgical delay was also associated with an increased risk of inpatient complications (30.2% vs 20.8%, p = 0.010), however there was no significant difference in the 1‐year mortality rate, nor between pre‐injury and 1 year follow‐up mobility as assessed by Parker score. Only approximately half of the patients in both groups completely returned to their pre‐injury mobility levels. Conclusions The COVID‐19 pandemic has significantly increased the surgery waiting time for geriatric patients with hip fractures, which resulted in increased inpatient complications without a higher mortality rate within 1 year. This reinforces the importance of maintaining timely and protocolized care for geriatric hip fractures throughout any subsequent waves of the pandemic.

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Effects of the COVID-19 Pandemic on COVID-19 Negative Geriatric Patients with Hip Fractures

Cited by 4 publications

References 3 publications

Hip fracture care during the COVID-19 pandemic: retrospective cohort and literature review

Hip fracture care during the COVID-19 pandemic: retrospective cohort and literature review

Early mobilisation after pain relief for conservative management for intertrochanteric fractures: a pandemic enforced innovation and its results

The Effects of COVID‐19 on Geriatric Hip Fracture Management and 1‐Year Mortality in Beijing

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