The prevalence, mortality, and associated risk factors for developing COVID-19 in hip fracture patients: a systematic review and meta-analysis

Abstract

Aims The aims of this meta-analysis were to assess: 1) the prevalence of coronavirus disease 2019 (COVID-19) in hip fracture patients; 2) the associated mortality rate and risk associated with COVID-19; 3) the patient demographics associated with COVID-19; 4) time of diagnosis; and 5) length of follow-up after diagnosis of COVID-19. Methods Searches of PubMed, Medline, and Google Scholar were performed in October 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Search terms included “hip”, “fracture”, and “COVID-19”. The criteria for inclusion were published clinical articles reporting the mortality rate associated with COVID-19 in hip fracture patients. In total, 53 articles were identified and following full text screening 28 articles satisfied the inclusion criteria. Results A total of 28 studies reported the mortality of COVID-19-positive patients, of which 21 studies reported the prevalence of COVID-19-positive patients and compared the mortality rate to COVID-19-negative patients. The prevalence of COVID-19 was 13% (95% confidence interval (CI) 11% to 16%) and was associated with a crude mortality rate of 35% (95% CI 32% to 39%), which was a significantly increased risk compared to those patients without COVID-19 (odds ratio (OR) 7.11, 95% CI 5.04 to 10.04; p < 0.001). COVID-19-positive patients were more likely to be male (OR 1.51, 95% CI 1.16 to 1.96; p = 0.002). The duration of follow-up was reported in 20 (71.4%) studies. A total of 17 studies reported whether a patient presented with COVID-19 (n = 108 patients, 35.1%) or developed COVID-19 following admission (n = 200, 64.9%), of which six studies reported a mean time to diagnosis of post-admission COVID-19 at 15 days (2 to 25). Conclusion The prevalence of COVID-19 was 13%, of which approximately one-third of patients were diagnosed on admission, and was associated with male sex. COVID-19-positive patients had a crude mortality rate of 35%, being seven times greater than those without COVID-19. Due to the heterogenicity of the reported data minimum reporting standards of outcomes associated with COVID-19 are suggested. Cite this article: Bone Joint Res 2020;9(12):873–883.

Hip Fractures in the Elderly During the COVID-19 Pandemic: A Latin-American Perspective With a Minimum 90-Day Follow-Up

“…Our series revealed a 15% incidence of COVID-19 disease in elderly patients admitted for a hip fracture, similar to other published reports. 8 , 20 Furthermore, overall mortality was increased, with a 5-fold mortality rate for COVID-19 (+) patients (67%) when compared to COVID-19 (-) patients (14%). Other reports have addressed early mortality rates in this scenario, with values ranging from 10 to 53% 7 - 10 , 12 , 20 , 21 at 30 days.…”

“… 8 , 20 Furthermore, overall mortality was increased, with a 5-fold mortality rate for COVID-19 (+) patients (67%) when compared to COVID-19 (-) patients (14%). Other reports have addressed early mortality rates in this scenario, with values ranging from 10 to 53% 7 - 10 , 12 , 20 , 21 at 30 days. However, most studies report only crude mortality rates, with a short follow-up, especially after the SARS-CoV-2 virus infection, which could influence survival rates and overall outcomes.…”

Diagnosis and Management of Osteoporosis During COVID-19: Systematic Review and Practical Guidance

“…The author speculated that impaired respiratory function and kyphosis associated with VF’s may decrease vital lung capacity and increase the risk of severe SARS Cov2 infection. In a recent meta-analysis the prevalence of SARS Cov2 infection in hip fracture patients ranged from 1 to 28%, with a mean of 13% [ 45 ]. Data from 21 studies which reported mortality following hip fracture showed that COVID-19 positive patients have a seven-fold increased risk of death compared to COVID-19 negative patients.…”

“…However, the studies did not adjust for confounders such as age, sex, co-morbidities, level of independence, frailty which are known to be associated with mortality risk after a hip fracture. [ 45 ].…”

COVID-19 infection is related to differences in the use of personal protective equipment by orthopaedic specialist trainees caring for hip fracture patients during the second surge of COVID-19 in the North West of England

“…Patients admitted with hip fracture have a higher prevalence of COVID-19 and up to a sixfold increase in mortality compared to patients without COVID-19 [5]. Furthermore, 35% of all patients with hip fractures who died within 30 days of testing positive for COVID-19 caught the virus in hospital [6].…”