Thirty-Day Mortality for Proximal Femoral Fractures Treated at a U.K. Elective Center with a Site-Streaming Policy During the COVID-19 Pandemic

Abstract

Background: COVID-19 led to the reconfiguration of U.K. orthopaedic trauma services because surgical capacity was threatened in acute centers. We report the 30-day mortality of proximal femoral fractures in older adults treated at an elective orthopaedic center. Methods: Patients >60 years old who presented with a proximal femoral fracture to any of 4 sites in the regional trauma network were transferred to our elective center for emergency surgery. Care was modeled according to the National Institute for Health and Care Excellence guidelines, and efforts were made to treat all patients within 36 hours. Data were collected prospectively, and mortality outcomes were recorded. Results: Of the 192 patients who presented to the elective orthopaedic center, 167 were treated there. The median age of the latter patients was 88 years (interquartile range, 83 to 79 years). The median Charlson Comorbidity Index was 4 (interquartile range, 4 to 6). The median time from emergency department admission to surgical treatment was 24.5 hours (interquartile range, 18.8 to 34.7 hours). The 30-day rate of mortality was 10.2%. A total of 29 (17.4%) tested positive for COVID-19 during their admission, of whom 10 died, for a case-fatality rate of 34.5%. There were no significant differences in age (p = 0.33) or Charlson Comorbidity Index (p = 0.13) between patients who tested positive and those who did not. There was no significant difference in age between those who tested positive and died and those who tested positive and did not die (p = 0.13), but there was a significant difference in Charlson Comorbidity Index between those subgroups (p = 0.03). Conclusions: During a pandemic, an elective orthopaedic center can be reconfigured to a surgical center for older patients with proximal femoral fractures with acceptable health-care quality outcomes. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

The impact of COVID-19 on mortality in trauma patients undergoing orthopedic surgery: a systematic review and meta-analysis

“…The majority of patients in these investigations were > 60 years old. The study characteristics and postoperative mortality findings are shown in Table 2 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. The most common injury sites were the hip and femur, followed by other lowerlimb sites such as the patella, tibia, ankle, foot, and upper limb.…”

“…Surgery within 48 hours of hospital admission does not correlate with a lower mortality rate in COVID-19-positive patients [13]. As shown in Table 3 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], the mean hospital stay length among COVID-19-positive patients undergoing hip and femur surgery was longer than that among COVID-19-negative patients. This result is in line with the study by Kayani et al [37], which stated that hip surgery in COVID-19-positive patients was associated with a longer hospital stay, longer immobilization, more hospitalizations in the intensive care unit, an increased chance of peri-operative complications, and greater mortality rates.…”

“…We included observational studies like cohort, cross-sectional, and case-control studies but excluded review articles. The validity of the papers included in this study was evaluated using a series of inquiries based on a checklist in line with the kind of study created by the Joanna Briggs Institute [7,8], as shown in Supplementary Table 1 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] and Supplementary Table 2 [24]. Articles that did not fit the requirements for inclusion were rejected.…”

“…According to Table 2 Complications due to COVID-19 were most commonly reported as the primary cause of postoperative death among COVID-19positive patients. The reported primary causes of postoperative death, complications, underlying disease, and mean hospital stay in both groups are shown in Table 3 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Eight studies [11][12][13][14][15]19,20,22] did not report the cause of death in their research.…”

“…A total of 1,616 reported surgeries from seven studies [13,[16][17][18][20][21][22] are shown in Supplementary Table 4. In contrast, nine studies [9][10][11][12]14,15,19,23,24] did not specify the surgeries performed in their studies. Only Lim et al [18] reported the type of anesthesia used in both groups.…”