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COVID-19 pandemic and hip fractures: impact and lessons learned

Mohamed Arafa1, Samia Nesar1, Hamza Abu-Jabeh1

  • 1Luton and Dunstable University Hospital, Luton, UK.

Bone & Joint Open
|November 20, 2020
PubMed

Insights

The COVID-19 pandemic significantly increased hip fracture rates and mortality in the UK. This study highlights the need for improved theatre processes and further research to mitigate risks associated with COVID-19 in hip fracture care.

Area of Science:

  • Orthopaedic Surgery
  • Geriatric Trauma
  • Epidemiology of Infectious Diseases

Background:

  • Hip fractures are a major public health concern in the UK, affecting approximately 76,000 elderly individuals annually.
  • The COVID-19 pandemic presented unprecedented challenges to healthcare systems, including the National Health Service (NHS) in the UK.
  • Orthopaedic units manage a substantial workload related to hip fractures, making efficient care crucial.

Purpose of the Study:

  • To assess the impact of the COVID-19 pandemic on hip fracture care services within the UK's NHS.
  • To identify emerging lessons and strategies for healthcare systems to withstand future outbreaks affecting hip fracture management.
  • To compare hip fracture care outcomes between pre-pandemic (2019) and pandemic (2020) periods, considering COVID-19 status.

Main Methods:

  • Retrospective data collection on 157 hip fractures admitted between March and May 2019 and 2020.
  • The 2020 cohort was stratified into COVID-positive and COVID-negative subgroups.
  • Analysis included Key Performance Indicators (KPIs) such as 4-hour target, timing to imaging and operation, anaesthetic/operative details, complications, length of stay, and 30-day mortality, using electronic records and National Hip Fracture Database (NHFD) data.

Main Results:

  • A significant increase in hip fractures (61.7%) and inpatient falls (7.2%) was observed in 2020 compared to 2019.
  • Significant differences were noted in anaesthetic preparation, anaesthetic, and recovery times across the study groups.
  • The 30-day mortality rate was substantially higher in the COVID-positive group (36.8%) versus COVID-negative (11.5%) and 2019 (11.7%) groups. Hospital stay was also significantly longer in COVID-positive patients (mean 24.21 days).

Conclusions:

  • The COVID-19 pandemic led to a significant rise in hip fracture incidence and highlighted inefficiencies in theatre processes, suggesting the need for alternate theatre utilization.
  • COVID-19 infection was associated with increased 30-day mortality and prolonged hospital stays for hip fracture patients.
  • Further research is imperative to develop strategies for reducing the risks and improving outcomes for hip fracture patients during infectious disease outbreaks.
Abstract

Keywords:
COVID-19Hip fracturesPandemic

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