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Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review
Haoyan Zhong1, Jashvant Poeran2, Jiabin Liu3
1Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA.
Insights
The COVID-19 pandemic reduced hip fracture cases but worsened outcomes for those infected. Patients with hip fractures and COVID-19 faced longer hospital stays, higher mortality, and more complications.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic has disproportionately affected vulnerable populations.
- Limited data exist on the pandemic's impact on hip fractures, a common injury in older adults.
Purpose of the Study:
- To describe the epidemiology of hip fractures during the initial COVID-19 wave in the USA.
- To compare patient and healthcare characteristics, and outcomes for hip fracture patients in 2020 versus 2019.
Main Methods:
- Utilized national claims data to compare hip fracture admissions in March-April 2020 with the same period in 2019.
- Analyzed patient demographics, healthcare utilization (ICU admission, LOS, ventilation), and postoperative complications.
- Compared outcomes between COVID-19-positive and COVID-19-negative hip fracture patients.
Main Results:
- Hip fracture cases decreased from 16,068 in 2019 to 7,498 in 2020.
- Patients in 2020 had shorter hospital stays and were less likely to be admitted to the ICU.
- Among 83 COVID-19-positive hip fracture patients, mortality increased over 10-fold, LOS doubled, and complication rates were higher compared to negative patients.
Conclusions:
- The COVID-19 pandemic altered hip fracture care patterns and patient outcomes.
- Findings highlight the significant negative impact of COVID-19 on hip fracture patients, informing future public health strategies for vulnerable groups.
Background:
The COVID-19 pandemic has impacted healthcare in various vulnerable patient subpopulations. However, data are lacking on the impact of COVID-19 on hip fractures, seen mainly in older patients. Using national claims data, we aimed to describe the epidemiology during the first COVID-19 wave in the USA.
Methods:
We compared patients admitted for hip fractures during March and April of 2020 with those admitted in 2019 in terms of patient and healthcare characteristics, COVID-19 diagnosis, and outcomes. An additional comparison was made between COVID-19-positive and -negative patients. Outcomes included length of hospital stay (LOS), admission to an ICU, ICU LOS, use of mechanical ventilation, 30-day readmission, discharge disposition, and a composite variable of postoperative complications.
Results:
Overall, 16 068 hip fractures were observed in 2019 compared with 7498 in 2020. Patients with hip fractures in 2020 (compared with 2019) experienced earlier hospital discharge and were less likely to be admitted to ICU, but more likely to be admitted to home. Amongst 83 patients with hip fractures with concomitant COVID-19 diagnosis, we specifically observed more non-surgical treatments, almost doubled LOS, a more than 10-fold increased mortality rate, and higher complication rates compared with COVID-19-negative patients.
Conclusions:
The COVID-19 pandemic significantly impacted not only volume of hip fractures, but also patterns in care and outcomes. These results may inform policymakers in future outbreaks and how this may affect vulnerable patient populations, such as those experiencing a hip fracture.
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