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Imaging of the Microstructural Failure Mechanism in the Human Hip
Published on: September 29, 2023
IMPACT-Scot 2 report on COVID-19 in hip fracture patients
Andrew J Hall1,2,3, Nick D Clement2,4, Alasdair M J MacLullich3,5
1Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK.
Insights
COVID-19 significantly increased 30-day mortality in hip fracture patients by three times. Hospital-acquired infections were common, highlighting the need for timely care to reduce length of stay and associated risks.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Epidemiology
Background:
- Hip fractures are common, particularly in older adults.
- The COVID-19 pandemic presented unique challenges for patient care and outcomes.
- Understanding the impact of COVID-19 on hip fracture patients is crucial for optimizing management.
Purpose of the Study:
- To assess the influence of COVID-19 on 30-day mortality after hip fracture.
- To identify predictors of COVID-19 status in hip fracture patients.
- To determine the rate of hospital-acquired COVID-19 and the accuracy of admission swabs.
Main Methods:
- Nationwide multicentre retrospective cohort study.
- Inclusion of all hip fracture patients from 17 Scottish centers (March-April 2020).
- Data collection included demographics, clinical factors, COVID-19 status, and mortality outcomes.
Main Results:
- 9.4% of hip fracture patients were diagnosed with COVID-19.
- COVID-19 was independently associated with a threefold increase in 30-day mortality.
- Hospital-acquired COVID-19 accounted for approximately 58.5% of cases, with male sex and longer hospital stays as risk factors.
Conclusions:
- COVID-19 significantly elevates 30-day mortality risk in hip fracture patients.
- Nosocomial transmission of COVID-19 was a substantial contributor during the early pandemic.
- Optimizing care to reduce length of stay is a critical modifiable factor for improving outcomes.
Aims:
The primary aim was to determine the influence of COVID-19 on 30-day mortality following hip fracture. Secondary aims were to determine predictors of COVID-19 status on presentation and later in the admission; the rate of hospital acquired COVID-19; and the predictive value of negative swabs on admission.
Methods:
A nationwide multicentre retrospective cohort study was conducted of all patients presenting with a hip fracture to 17 Scottish centres in March and April 2020. Demographics, presentation blood tests, COVID-19 status, Nottingham Hip Fracture Score, management, length of stay, and 30-day mortality were recorded.
Results:
In all, 78/833 (9.4%) patients were diagnosed with COVID-19. The 30-day survival of patients with COVID-19 was significantly lower than for those without (65.4% vs 91%; p < 0.001). Diagnosis of COVID-19 within seven days of admission (likely community acquired) was independently associated with male sex (odds ratio (OR) 2.34, p = 0.040, confidence interval (CI) 1.04 to 5.25) and symptoms of COVID-19 (OR 15.56, CI 6.61 to 36.60, p < 0.001). Diagnosis of COVID-19 made between seven and 30 days of admission to hospital (likely hospital acquired) was independently associated with male sex (OR 1.73, CI 1.05 to 2.87, p = 0.032), Nottingham Hip Fracture Score ≥ 7 (OR 1.91, CI 1.09 to 3.34, p = 0.024), pulmonary disease (OR 1.68, CI 1.00 to 2.81, p = 0.049), American Society of Anesthesiologists (ASA) grade ≥ 3 (OR 2.37, CI 1.13 to 4.97, p = 0.022), and length of stay ≥ nine days (OR 1.98, CI 1.18 to 3.31, p = 0.009). A total of 38 (58.5%) COVID-19 cases were probably hospital acquired infections. The false-negative rate of a negative swab on admission was 0% in asymptomatic patients and 2.9% in symptomatic patients.
Conclusion:
COVID-19 was independently associated with a three times increased 30-day mortality rate. Nosocomial transmission may have accounted for approximately half of all cases during the first wave of the pandemic. Identification of risk factors for having COVID-19 on admission or acquiring COVID-19 in hospital may guide pathways for isolating or shielding patients respectively. Length of stay was the only modifiable risk factor, which emphasizes the importance of high-quality and timely care in this patient group. Cite this article: Bone Joint J 2021;103-B(5):888-897.
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