Evolving Effects of the COVID-19 Pandemic on Hip Fracture Outcomes: A Retrospective Comparison of Pre, Early, and Late Pandemic Timepoints

Abstract

Introduction: Hospital systems were strained during the COVID-19 pandemic, and although previous studies have shown that surgical outcomes in healthy hip fracture patients were unaffected in the initial months of the pandemic, subsequent data are limited. This study examined the evolution of hip fracture care throughout the COVID-19 pandemic. Methods: A retrospective review (level III evidence) was done of surgically treated adult hip fractures at a Level 1 academic trauma center from January 2019 to September 2022, stratified into three groups: pre, early, and late pandemic. Continuous variables were evaluated with the Student t-test and one-way analysis of variance, categorical variables were evaluated with chi-squared, P < 0.05 considered significant. Results: Late pandemic patients remained in the hospital 30.1 hours longer than early pandemic patients and 35.7 hours longer than prepandemic patients (P = 0.03). High-energy fractures decreased in the early pandemic, then increased in late pandemic (P < 0.01). Early pandemic patients experienced more myocardial infarctions (P < 0.01). No significant differences in time to surgery, revision surgery, 90-day mortality, or other adverse events were noted. Conclusion: To our knowledge, this is the longest study evaluating hip fracture outcomes throughout the COVID-19 pandemic. These results are indicative of an overburdened regional health system less capable of facilitating patient disposition.