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

Abstract

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.

Evaluation of Geriatric Falls in Emergency Department During the Early Coronavirus-2019 Pandemic and Pre-Pandemic Periods

“…Length of hospital stay was reported to be similar during the pandemic period in a retrospective study on senior citizens for hip fractures due to a fall [40]. Likewise, the LOS in the hospital, and hospitalization/mortality rates in the ED were similar in the pandemic (25.8%) and pre-pandemic periods (22.8%) in the present study whereas mortality rates in ED at both periods were quite low.…”

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

“…To our knowledge, this is the first study to evaluate standards of care and outcomes for hip fracture patients throughout the entire COVID-19 pandemic. This work builds on an earlier study conducted by Topor et al, 13 which examined 30-day mortality in 86 patients with surgically treated hip fractures stratified by three time periods during the ongoing pandemic. The authors found no difference in time to surgery or 30-day mortality, but, in contradiction to this study, no difference in length of stay.…”

“…The authors found no difference in time to surgery or 30-day mortality, but, in contradiction to this study, no difference in length of stay. However, the duration of Tobor et al 13 was limited to a small portion of the COVID-19 pandemic, a study period that would be contained within the early pandemic group of our analysis. As such, this study offers valuable insight into the effects on hip fracture patient care over the entire COVID-19 pandemic not presently available in the literature.…”