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Imaging of the Microstructural Failure Mechanism in the Human Hip
Published on: September 29, 2023
Prolonged social lockdown during COVID-19 pandemic and hip fracture epidemiology
Pablo A Slullitel1, Carlos M Lucero2, Maria L Soruco3
1'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina. pablo.slullitel@hospitalitaliano.org.ar.
Insights
The COVID-19 lockdown led to an epidemiological shift in hip fracture patients, who became frailer and less active. This shift was associated with a higher mortality rate, even in patients who tested negative for SARS-CoV-2.
Area of Science:
- Orthopedics
- Epidemiology
- Geriatrics
Background:
- The COVID-19 pandemic necessitated prolonged mandatory lockdowns globally.
- Hip fractures represent a significant public health concern, particularly in the elderly population.
- Understanding the impact of societal changes on fracture epidemiology is crucial for healthcare planning.
Purpose of the Study:
- To analyze the impact of the COVID-19 mandatory lockdown on hip fracture epidemiology.
- To compare patient characteristics and outcomes between pre-lockdown and lockdown periods.
- To identify factors associated with mortality in hip fracture patients during the lockdown.
Main Methods:
- A retrospective case-control study was conducted on 160 hip fracture patients operated on between December 2019 and May 2020.
- Patients were divided into 'pre-COVID time' (PCT) and 'COVID time' (CT) groups based on the lockdown declaration.
- Demographic characteristics, comorbidities, functional status, surgical procedures, and 30-day outcomes (complications, readmissions, mortality) were analyzed.
Main Results:
- COVID time (CT) patients exhibited higher rates of frailty (Charlson and Rockwood scores) and lower functional status (UCLA and ADL scores) compared to pre-COVID time (PCT) patients.
- A higher proportion of hemiarthroplasty versus total hip arthroplasty was observed during CT.
- Thromboembolic events were more frequent during CT, and mortality was significantly higher in the CT group (10.8% vs. 0%).
- Logistic regression identified frailty, reduced activity, and thromboembolic events as significant predictors of mortality.
Conclusions:
- The COVID-19 lockdown induced an epidemiological shift in hip fracture patients, characterized by increased frailty and decreased activity.
- Despite testing negative for SARS-CoV-2, patients during the lockdown period faced a higher mortality risk.
- These findings highlight the substantial indirect impact of the pandemic and lockdowns on vulnerable patient populations requiring surgical intervention.
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.
Conclusion:
Despite testing negative for SARS-CoV-2, CT patients were less active and frailer than PCT patients, depicting an epidemiological shift that was associated with higher mortality rate.
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