Prolonged social lockdown during COVID-19 pandemic and hip fracture epidemiology

Abstract

Purpose To analyse the impact of prolonged mandatory lockdown due to COVID-19 on hip fracture epidemiology. Methods Retrospective case-control study of 160 hip fractures operated upon between December 2019 and May 2020. Based on the date of declaration of national lockdown, the cohort was separated into two groups: 'pre-COVID time' (PCT), including 86 patients, and 'COVID time' (CT), consisting of 74 patients. All CT patients tested negative for SARS-CoV-2. Patients were stratified based on demographic characteristics. Outcome measures were 30-day complications, readmissions and mortality. A logistic regression model was run to evaluate factors associated with mortality. Results Age, female/male ratio, body mass index and American Society of Anaesthesia score were similar between both groups (p > 0.05). CT patients had a higher percentage of Charlson ≥ 5 and Rockwood Frailty Index ≥ 5 scores (p < 0.05) as well as lower UCLA and Instrumental Activities of Daily Living scores (p < 0.05). This translated into a higher hemiarthroplasty/total hip arthroplasty ratio during CT (p = 0.04). Thromboembolic disease was higher during CT (p = 0.02). Readmissions (all negative for SARS-CoV-2) were similar between both groups (p = 0.34). Eight (10.8%) casualties were detected in the CT group, whereas no deaths were seen in the control group. Logistic regression showed that frailer (p = 0.006, OR 10.46, 95%CI 8.95-16.1), less active (p = 0.018, OR 2.45, 95%CI 1.45-2.72) and those with a thromboembolic event (p = 0.005, OR 30, 95%CI 11-42) had a higher risk of mortality.

Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: A systematic review and meta-analysis

“…A total of 45 studies were retrieved after the search of electronic databases using the keywords; of which, eight studies were eligible for review after screening[ 9 , 19 , 20 , 27 - 29 , 38 , 39 ] (Figure 1 ). There were three prospective studies and five retrospective comparative studies.…”

“…The preoperative morbidity status of the patients in both pandemic and pre-pandemic periods were compared using the American Society of Anesthesiologists (ASA) classification. Pooled analysis of five studies ( n = 1159) revealed significantly increased number of severely morbid (ASA grade > 3) hip fracture patients who were treated during the pandemic period (OR, 1.43; 95%CI, 1.08, 1.89; P = 0.01)[ 9 , 27 , 29 , 38 , 39 ]. Egol et al [ 20 ] (2020) did not observe a significant difference in preoperative morbidity using the Charlson Co-morbidity index between 2020 hip fracture cohort and 2019 hip fracture cohort.…”

“…After pooling of the data from five studies[ 9 , 20 , 27 , 38 , 39 ], it was observed that there was no difference in time to surgery following the injury (MD, 6.57; 95%CI, −0.25, 13.39; P = 0.06). The high grade of heterogeneity ( I 2 = 88%) among the studies was addressed by the random effect model (Figure 2 ).…”

“…Pooled analysis of 30-d mortality from the eight studies ( n = 1586) revealed a significantly increased death among hip fracture patients during the pandemic time (9.63% vs 6.33%; OR, 0.62; 95%CI, 0.33, 1.17; P = 0.14) (Table 3 , Figure 3 )[ 9 , 19 , 20 , 27 - 29 , 38 , 39 ]. There was no difference in 30-d mortality rate between COVID-19 negative patients who were treated during the pandemic time and all hip fractured patients treated during the pre-pandemic period (6.44% vs 5.74%; OR, 1.03; 95%CI, 0.61, 1.75; P = 0.91)[ 9 , 19 , 20 , 29 , 38 ].…”

“…There was no difference in length of hospital stay among hip fracture patients treated during pandemic and pre-pandemic periods (OR, −1.52; 95%CI, −3.85, 0.81; P = 0.20)[ 9 , 20 , 38 , 39 ]. Similarly, major complications (17.98% vs 10.64%; OR, 1.62; P = 0.15) and the incidence of pulmonary complications (9.09% vs 6.78%; OR, 1.46; P = 0.38) among the hip fracture patients during these two-time frames were not different (Table 3 , Figure 4 )[ 9 , 20 , 38 , 39 ].…”