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Early mortality after hip fracture surgery in COVID-19 patients: A systematic review and meta-analysis
Kevin C Wang1, Ryan Xiao1, Zoe B Cheung1
1Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Objective:
The aim of this systematic review and meta-analysis was to assess the risk of early mortality in hip fracture patients with COVID-19 infection who undergo surgical intervention.
Data Sources:
MEDLINE (PubMed) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases.
Study Selection:
Studies were included in the systematic review if they reported postoperative mortality in patients with COVID-19 infection who underwent operative intervention for hip fracture. From this selection of studies, only investigations that reported postoperative mortality in a COVID-positive and a non-COVID group were included in the meta-analysis.
Data Extraction:
Data regarding patient demographics, age, and sex were recorded. Additional data that was extracted included study location, data collection period, length of follow-up, COVID testing methodology, COVID testing results, and number of patients who underwent operative versus nonoperative management. The primary outcome of interest was postoperative mortality.
Data Synthesis:
Random effects meta-analyses were performed to assess the pooled relative risk of postoperative mortality according to COVID status. Odds ratios and 95% confidence intervals (CI) were calculated.
Conclusions:
The overall pooled mortality rate in the early postoperative period for hip fracture patients with concomitant COVID-19 infection was 32.6%. The relative risk for postoperative mortality in COVID-positive patients compared to non-COVID patients was 5.66 (95% CI 4.01-7.98; p < 0.001). The currently available literature demonstrates that COVID-19 infection represents a substantial risk factor for early postoperative mortality in the already susceptible hip fracture population. Further investigations will be needed to assess longer-term morbidity and mortality in this patient population.
Level Of Evidence:
Therapeutic Level IV.
