Related Experiment Video
Updated: Oct 31, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Evidence-based approach to providing informed consent for hip fracture surgery during the COVID-19 era
Rory Cuthbert1, David Ferguson2, Babar Kayani3
1Department of Trauma & Orthopaedic Surgery, Queen's Hospital-Romford, London RM7 0AG, United Kingdom. rory.cuthbert@nhs.net.
Insights
Hip fracture surgery in COVID-19 positive patients significantly increases risks, including intensive care needs, longer hospital stays, and higher mortality. Informed consent must detail these enhanced perioperative complications and potential unknown long-term outcomes.
Area of Science:
- Orthopaedic Surgery
- Infectious Disease Epidemiology
- Patient Safety
Background:
- Hip fractures are a leading cause of orthopaedic trauma admissions, with urgent surgery prioritized even during the COVID-19 pandemic.
- Limited clinical guidance exists for informed consent in COVID-19 positive patients undergoing hip fracture surgery, posing medicolegal challenges.
Purpose of the Study:
- To quantify perioperative risks for COVID-19 positive patients undergoing hip fracture surgery.
- To establish an evidence-based framework for informed consent in this high-risk population.
Main Methods:
- A cohort of 259 hip fracture patients across four UK hospitals was analyzed.
- 51 patients tested positive for COVID-19 and were compared to negative patients for 30-day postoperative outcomes.
Main Results:
- COVID-19 positive patients experienced higher intensive care admission rates (27% vs 5%), longer hospital stays (23 vs 9 days), and increased 30-day mortality (29% vs 10%).
- 74.5% of COVID-19 positive patients faced postoperative complications, including lower respiratory tract infections (35.3%), acute respiratory distress syndrome (ARDS) (13.7%), and thromboembolic events (9.8%).
Conclusions:
- COVID-19 positive patients undergoing hip fracture surgery face significantly elevated risks of complications, intensive care, prolonged hospitalization, and mortality.
- Informed consent must transparently communicate these known risks and acknowledge potential unknown long-term outcomes as research evolves.
Background:
Hip fractures are the most common reason for inpatient orthopaedic trauma admission. Urgent surgical intervention for hip fractures has remained a clinical priority throughout the coronavirus disease 2019 (COVID-19) pandemic. Despite this, there is a paucity of clinical guidance addressing the informed consent process for hip fracture surgery in COVID-19 positive patients. This is of paramount medicolegal importance in a high-risk patient population.
Aim:
To quantify the additional perioperative risks for COVID-19 positive patients undergoing hip fracture surgery and provide clinicians with an evidence-based framework to establish an informed consent process.
Methods:
Two hundred and fifty nine consecutive patients undergoing surgical intervention for hip fractures in four hospitals in the United Kingdom were recruited. 51 patients were confirmed positive for COVID-19. Predefined outcomes were analyzed over a 30-d postoperative period. COVID-19 positive and COVID-19 negative patients were compared after adjustment for confounding factors.
Results:
COVID-19 positive patients had more intensive care admissions (27% vs 5%, P < 0.001), longer inpatient stays (median 23 d vs 9 d, P < 0.001) and a higher 30-d mortality (29% vs 10%, P = 0.001) than COVID-19 negative patients. Postoperative complications were evident in 74.5% of COVID-19 positive patients. 35.3% of COVID-19 positive patients suffered postoperative lower respiratory tract infections with 13.7% developing acute respiratory distress syndrome (ARDS) and 9.8% experiencing symptomatic thromboembolic events.
Conclusion:
The COVID-19 pandemic has created uncertainty in the medical community worldwide and poses unique challenges in providing informed consent for surgery. COVID-19 positive patients undergoing hip fracture surgery should be consented for the additional risk of postoperative complications (including lower respiratory tract infection, ARDS, deep vein thrombosis and pulmonary embolism), increased requirement for intensive care admission, longer inpatient stay and higher risk of mortality. Further, clinicians must be transparent about the potential for unknown risks as research into the long-term surgical outcomes of COVID-19 positive patients continues to evolve.
More Related Videos
04:19Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
04:41Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
