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Hip Fractures during the COVID-19 Pandemic: Demographics, Treatment Pathway, and Outcomes
Nissan Amzallag1,2, Shai Factor1,2, Ittai Shichman1,2
1Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Insights
During the COVID-19 pandemic, hip fracture surgery quality remained high despite reduced staff. Patients experienced shorter hospital stays and a notable decrease in 90-day mortality rates.
Area of Science:
- Orthopedic Surgery
- Epidemiology
- Public Health
Background:
- Standard hip fracture care involves surgery within 48 hours.
- The COVID-19 pandemic led to reduced medical staff availability.
- This study examines hip fracture treatment during a pandemic lockdown.
Purpose of the Study:
- Compare hip fracture patient demographics during COVID-19 lockdown versus routine times.
- Evaluate differences in treatment pathways and outcomes.
- Assess the impact of pandemic conditions on surgical care quality.
Main Methods:
- Retrospective study comparing hip fracture patients during March-June 2020 (COVID-19 lockdown) and March-June 2019.
- Data collected included demographics, time to surgery, surgery type, hospitalization duration, discharge destination, and complications.
- 30- and 90-day mortality rates were key outcome measures.
Main Results:
- No demographic differences between the COVID-19 and control periods.
- Higher rate of surgeries within 48 hours during COVID-19 (92% vs. 76%).
- Shorter hospitalizations (10 vs. 12 days) and a shift to home rehabilitation were observed.
- Lower 90-day mortality rates correlated with the COVID-19 period (P = 0.034).
- No significant differences in postoperative complications or 30-day mortality.
Conclusions:
- Hip fracture treatment quality was maintained during the COVID-19 epidemic despite staff limitations.
- A significant reduction in 90-day mortality was observed during the pandemic lockdown.
- Pandemic conditions did not negatively impact overall hip fracture surgical care quality.
Background:
Surgery for hip fractures within 48 hours of admission is considered standard. During the lockdown period due to the coronavirus disease-2019 (COVID-19) epidemic, our medical staff was reduced.
Objectives:
To compare the demographics, treatment pathways, and outcomes of patients with hip fractures during the COVID-19 epidemic and lockdown with the standard at routine times.
Methods:
A retrospective study was conducted of all patients who were treated surgically for hip fracture in a tertiary center during the COVID-19 lockdown period between 01 March and 01 June 2020 and the equivalent period in 2019. Demographic characteristics, time to surgery, surgery type, hospitalization time, discharge destination, postoperative complications, and 30- and 90-day mortality rates were collected for all patients.
Results:
During the COVID-19 period, 105 patients were operated due to hip fractures compared to 136 in the equivalent period with no statistical difference in demographics. The rate of surgeries within 48 hours of admission was significantly higher in the COVID-19 period (92% vs. 76%, respectively; P = 0.0006). Mean hospitalization time was significantly shorter (10 vs. 12 days, P = 0.037) with diversion of patient discharge destinations from institutional to home rehabilitation (P < 0.001). There was a significant correlation between the COVID-19 period and lower 90-day mortality rates (P = 0.034). No statistically significant differences in postoperative complications or 30-day mortality rates were noted.
Conclusions:
During the COVID-19 epidemic, despite the limited staff and the lack of therapeutic sequence, there was no impairment in the quality of treatment and a decrease in 90-day mortality was noted.
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