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Hip fracture care during Covid-19: a regional trauma centre's experience
Geoff Crozier-Shaw1, Andrew J Hughes2, Breda Conlon2
1Department of Trauma and Orthopaedics, Midland Regional Hospital, Tullamore, Co Offaly, Ireland. gcrozshaw@hotmail.com.
Insights
The COVID-19 crisis saw fewer hip fracture patients but higher mortality rates. Despite improved care standards, COVID-19 infection significantly increased 30-day mortality for hip fracture patients.
Area of Science:
- Orthopaedic surgery
- Trauma care
- Epidemiology
Background:
- The COVID-19 pandemic significantly disrupted healthcare services globally, including trauma and orthopaedic care.
- Hip fractures (fragility fractures of the proximal femur) are a critical area within trauma services, with established performance indicators (Blue Book Standards).
- Assessing care quality and patient outcomes during the pandemic is crucial for service adaptation.
Purpose of the Study:
- To evaluate compliance with hip fracture Blue Book Standards during the COVID-19 crisis.
- To analyze hip fracture patient outcomes, including 30-day mortality and COVID-19 infection rates, during the pandemic.
- To identify factors influencing mortality in hip fracture patients during the COVID-19 pandemic.
Main Methods:
- Retrospective review of the International Hip Fracture Database (IHFD) data.
- Collection of demographic data, adherence to IHFD standards of care, 30-day mortality, and complications.
- Comparison of data from March 23rd to May 20th, 2020, with the same period in 2019, including COVID-19 infection rates for 2020.
Main Results:
- A 20% reduction in hip fracture presentations was observed in 2020 (36 cases) compared to 2019 (45 cases).
- Thirty-day mortality for hip fracture patients increased to 8.3% during the COVID-19 crisis in 2020, compared to 2.2% in 2019.
- Statistically significant improvements were noted in time-dependent key performance indicators (time to ward and time to surgery) in 2020, despite the crisis.
- COVID-19 infection was statistically associated with increased 30-day mortality in the 2020 cohort.
Conclusions:
- The COVID-19 crisis was associated with a significant increase in 30-day mortality for hip fracture patients, despite improvements in care KPIs.
- A positive COVID-19 test result was a significant predictor of higher mortality in this patient group.
- Findings underscore the need for robust service planning to manage potential future waves of infection and ensure optimal care for hip fracture patients.
Introduction:
The Covid-19 pandemic has caused worldwide upheaval from early 2020. Trauma and orthopaedic services are no different. A fundamentally important and significant portion of trauma services is the treatment of fragility fractures of the proximal femur, otherwise known as hip fractures. The hip fracture "Blue book Standards", the key performance indicators (KPIs) associated with appropriate hip fracture care are challenging during non-crisis times. We aim to review Blue Book compliance during the Covid-19 crisis and review outcomes of hip fractures, including Covid-19 infection rates.
Methods:
We retrospectively reviewed IHFD data to collection demographic data, IHFD standards of care, 30-day mortality rates and complications between 23rd March and 20th May 2020 and 2019. Covid-19 rates in 2020 were also recorded.
Results:
A total of 36 hip fractures were recorded in 2020, compared with 45 in 2019, resulting in a 20% reduction in presentations. Thirty-day mortality in hip fractures during the Covid-19 crisis was 8.3% compared with 2.2% in 2020. Covid-19 infection was statistically associated with 30-day mortality in the 2020 cohort. Statistically significant improvements in time-dependent KPIs (time to ward and time to surgery) were noted in the 2020 cohort.
Conclusions:
Despite improvements in hip fracture care KPIs, the Covid-19 crisis was associated with increased 30-day mortality in hip fracture patients. A positive Covid-19 swab was associated with higher mortality. These observations are of paramount importance to ensure adequate service planning and provision in the face of a potential "second wave" of Covid-19 infections leading into the winter months of 2020.
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