Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study

Abstract

Purpose Thirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients. Methods A multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019. Results Actual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57-5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification. Conclusion COVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.

Delayed Hospital Admission for Traumatic Hip Fracture During the COVID-19 Pandemic&nbsp;

“…Several studies have reported an increased mortality rate among patients with hip fractures who were diagnosed with COVID-19 [3,11,16,24,[27][28][29][30][31]. In this study none of the con rmed or suspected COVID-19 patients died in-hospital so the COVID-19 diagnosis may not be driving this increased risk for mortality.…”

“…Egol et al reported also no difference in the time from arrival to surgical intervention for hip fracture patients during the pandemic [23]. Alternatively Narang et al reported a signi cant increase in the proportion of patients who experienced a delay to operation during the pandemic [24]. Slullitel et al…”

“…Egol et al reported also no difference in the time from arrival to surgical intervention for hip fracture patients during the pandemic [23]. Alternatively Narang et al reported a signi cant increase in the proportion of patients who experienced a delay to operation during the pandemic [24]. Slullitel et al also reported a signi cant increase in the time to surgery among patients admitted during the pandemic when compared to 2019, 24 hours vs 16.5 hours, respectively p < 0.0001 [25].…”

Hip fracture care and mortality among patients treated in dedicated COVID-19 and non-COVID-19 circuits

“…Controversy remains regarding the management of patients suffering a hip fracture with coronavirus infectious disease-19 in the acute preoperative phase, especially concerning the timing of surgery and perioperative measures. Narang [25] had a lower surgical delay for COVID-19( +) Fig. 2 Kaplan-Meier survival curves for the four groups described: historic controls treated in 2018-19 (black), pre-cohorting in 2020 (blue, dotted), non-COVID circuit of 2020 (green, dashed) and COVID-19 circuit of 2020 (red, solid).…”

Mortality escalates in patients of proximal femoral fractures with COVID-19: A systematic review and meta-analysis of 35 studies on 4255 patients

“…1 However, early limited evidence published so far suggests poor outcomes with high postoperative mortality in patients with a hip fracture and concomitant COVID-19 infection (available studies indicate a mortality rate greater than 30%). 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 We have undertaken a ...…”