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The prevalence, mortality, and associated risk factors for developing COVID-19 in hip fracture patients: a systematic
Nicholas D Clement1, Nathan Ng1, Cameron J Simpson1
1Orthopaedics and Trauma, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.
Insights
Hip fracture patients with coronavirus disease 2019 (COVID-19) had a 13% prevalence and a significantly increased mortality risk. This study highlights the severe outcomes of COVID-19 in this vulnerable patient group.
Area of Science:
- Orthopedics
- Infectious Diseases
- Epidemiology
Background:
- Hip fractures are common in elderly populations, a demographic also vulnerable to severe outcomes from COVID-19.
- Understanding the intersection of hip fractures and COVID-19 is crucial for patient management and public health strategies.
Purpose of the Study:
- To determine the prevalence of COVID-19 in hip fracture patients.
- To assess the mortality rate and risk associated with COVID-19 in this cohort.
- To analyze patient demographics, diagnosis timing, and follow-up duration related to COVID-19 in hip fracture cases.
Main Methods:
- A systematic literature search was conducted on PubMed, Medline, and Google Scholar for studies published up to October 2020.
- Inclusion criteria focused on clinical articles reporting mortality rates of COVID-19 in hip fracture patients.
- Twenty-eight studies, identified from an initial 53, met the inclusion criteria for this meta-analysis.
Main Results:
- The prevalence of COVID-19 among hip fracture patients was 13% (95% CI: 11%-16%).
- COVID-19 was associated with a crude mortality rate of 35% (95% CI: 32%-39%), a seven-fold increase compared to non-COVID-19 patients (OR 7.11).
- Male patients were more likely to test positive for COVID-19 (OR 1.51). Approximately 35% of COVID-19 cases were diagnosed on admission, with a mean diagnosis time of 15 days for hospital-acquired infections.
Conclusions:
- COVID-19 infection in hip fracture patients is prevalent (13%) and significantly increases mortality risk (35%).
- Male sex is associated with higher COVID-19 rates in this population.
- The heterogeneity of data necessitates standardized reporting for future research on COVID-19 outcomes in hip fracture patients.
Aims:
The aims of this meta-analysis were to assess: 1) the prevalence of coronavirus disease 2019 (COVID-19) in hip fracture patients; 2) the associated mortality rate and risk associated with COVID-19; 3) the patient demographics associated with COVID-19; 4) time of diagnosis; and 5) length of follow-up after diagnosis of COVID-19.
Methods:
Searches of PubMed, Medline, and Google Scholar were performed in October 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Search terms included "hip", "fracture", and "COVID-19". The criteria for inclusion were published clinical articles reporting the mortality rate associated with COVID-19 in hip fracture patients. In total, 53 articles were identified and following full text screening 28 articles satisfied the inclusion criteria.
Results:
A total of 28 studies reported the mortality of COVID-19-positive patients, of which 21 studies reported the prevalence of COVID-19-positive patients and compared the mortality rate to COVID-19-negative patients. The prevalence of COVID-19 was 13% (95% confidence interval (CI) 11% to 16%) and was associated with a crude mortality rate of 35% (95% CI 32% to 39%), which was a significantly increased risk compared to those patients without COVID-19 (odds ratio (OR) 7.11, 95% CI 5.04 to 10.04; p < 0.001). COVID-19-positive patients were more likely to be male (OR 1.51, 95% CI 1.16 to 1.96; p = 0.002). The duration of follow-up was reported in 20 (71.4%) studies. A total of 17 studies reported whether a patient presented with COVID-19 (n = 108 patients, 35.1%) or developed COVID-19 following admission (n = 200, 64.9%), of which six studies reported a mean time to diagnosis of post-admission COVID-19 at 15 days (2 to 25).
Conclusion:
The prevalence of COVID-19 was 13%, of which approximately one-third of patients were diagnosed on admission, and was associated with male sex. COVID-19-positive patients had a crude mortality rate of 35%, being seven times greater than those without COVID-19. Due to the heterogenicity of the reported data minimum reporting standards of outcomes associated with COVID-19 are suggested. Cite this article: Bone Joint Res 2020;9(12):873-883.
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