Hip Fracture Surgery Volumes Among Individuals 65 Years and Older During the COVID-19 Pandemic

Abstract

Hip fractures in individuals 65 years or older are common (>250 000 per year in the US) and consequential (1-year mortality rate, 12%-37%). 1 Prior studies of orthopedic trauma (ie, fractures) in the general population documented a decline at the beginning of the COVID-19 pandemic in March-April 2020, 2 followed by a return to baseline by summer 2020 once shelter-in-place orders were lifted. 3 We assessed hip fracture surgery volumes among older individuals during the pandemic.Methods | This study was approved by the Kaiser Permanente (KP) Institutional Review Board with exemption of informed consent. We used data from the KP Hip Fracture Registry (a surveillance tool with 100% coverage) along with membership data and administrative claims. 4 Patients aged 65 years or older who underwent hip fracture surgery between January 1, 2018, and September 26, 2021, in a California KP hospital (n = 31) were included.Based on COVID-19 hospitalizations and vaccinations recorded in the California COVID-19 dashboard, 8 phases were identified: presurge (1/1/20-3/15/20), spring 2020 surge (3/16-5/10), early summer 2020 (5/11-6/28), summer 2020 surge (6/29-8/23), fall 2020 (8/24-11/22), winter surge (11/23/ 20-2/21/21), early vaccination period (2/22-7/18), and Delta wave (7/19-9/26). For each phase, hip fracture surgery volume (procedures per 1 million person-weeks) was calculated as number of procedures divided by California KP health plan membership. The incidence rate during each phase was compared with the historical period 2 years prior (eg, 1/1/18-3/ 15/18 for presurge phase) using incidence rate ratios (IRRs) with Poisson regression.

The Impact of the COVID-19 Pandemic on the Neck of the Femur and Hip Fracture Surgery Volumes in the Lazio Region

“…The decline in orthopedic surgeries observed in Lazio (central Italy) during the COVID-19 pandemic was also reported by studies conducted in other countries [6,9,10,18,19]. In the USA, Zhong et al showed that the COVID-19 pandemic significantly impacted not only the volume of hip fractures (16,068 hip fractures were observed in 2019 compared with 7498 in 2020) but also other outcomes such as the length of hospital stay or complications [10].…”

“…The decline in FNF surgeries from the lockdown of 2020 to the end of 2021 mirrored a decrease in hip fractures themselves, and this could be explained by a decreased risk of falls attributable to a strong reduction in outdoor activity or by a greater presence of family members at home in the case of elderly patients, although these results deserve more research [9]. Regarding hip replacement, the huge decline in intervention during the lockdown period could be explained by the main characteristics of this intervention that, differently from the FNF, it is generally planned and not an emergency.…”

“…Indirect effects of the pandemic were also found in primary care in the UK [4]; in fact, this study showed a considerable reduction in primary care contacts, particularly for diabetic emergencies, depression, and self-harm, after the introduction of population-wide restrictions. Several studies analyzed the indirect impact of the pandemic on Orthopedic Trauma [5][6][7][8][9][10][11][12]. Studies conducted in 2020, at the beginning of the pandemic, found higher rates of inpatient mortality in hip fracture patients with concomitant COVID-19 infection than those without concomitant COVID-19 infection, along with increased morbidity and mortality in patients with hip fractures complicated by COVID-19 [7,8].…”

“…Studies conducted in 2020, at the beginning of the pandemic, found higher rates of inpatient mortality in hip fracture patients with concomitant COVID-19 infection than those without concomitant COVID-19 infection, along with increased morbidity and mortality in patients with hip fractures complicated by COVID-19 [7,8]. A recent study conducted in California analyzed hip fracture surgery volumes in 2020 and 2021 by periods compared to previous years [9]. They found a significant decrease in intervention rates from March 2020 to the end of the summer, and also between November 2020 and the end of February 2021.…”

“…Both hip fracture injuries and fractures of the neck of the femur account for 100,000 hospitalizations per year in Italy and particularly affect the older population [13]. Several studies have demonstrated the importance of timely intervention in reducing adverse events in patients hospitalized for hip fractures [9,14,15]. In Italy, both surgeries are offered free of charge for all citizens through direct reimbursement of the national health service (NHS) to both private and public hospitals.…”