Related Experiment Video
Updated: Oct 23, 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
Mortality Following Hip Fracture Surgery During COVID-19 Pandemic Compared to Pre-COVID-19 Period: A Case Matched
C De1, P K Harbham1, C Postoyalko1
1Department of Trauma and Orthopaedics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
Insights
Hip fracture patients during the COVID-19 pandemic faced higher 30-day mortality, especially those testing positive or operated in COVID-19 designated theaters. Cemented hemiarthroplasty and intracapsular fractures showed increased risks.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Infectious Disease Epidemiology
Background:
- The COVID-19 pandemic significantly impacted healthcare delivery, necessitating evaluation of its effect on vulnerable patient groups.
- Neck of femur fractures represent a critical orthopedic emergency with substantial morbidity and mortality.
Purpose of the Study:
- To assess clinical outcomes and 30-day mortality in hip fracture patients during the COVID-19 pandemic.
- To compare these outcomes with a pre-pandemic cohort.
Main Methods:
- Retrospective cohort study comparing 66 hip fracture patients (March-May 2020) with 75 controls (March-May 2019).
- Data collected included demographics, comorbidities, COVID-19 status, surgical procedures, and mortality.
- Patients were over 60 years old.
Main Results:
- Thirty-day mortality was 13.6% during the pandemic, exclusively in patients with ASA Grade 3 and 4.
- COVID-19 positive patients had a 55.5% 30-day mortality rate.
- Higher mortality was observed for intracapsular fractures (20%) and cemented hemiarthroplasty (20%), particularly in COVID-19 designated theaters.
Conclusions:
- A strong association exists between 30-day mortality and operating theater designation (Clean/COVID).
- Intracapsular neck of femur fractures and cemented hemiarthroplasty carry significant mortality risks, especially in COVID-19 positive patients.
- A multidisciplinary approach is crucial for optimizing risk-benefit in hip fracture management during pandemics.
Introduction:
This study aims to report on clinical outcomes and 30-day mortality of patients with neck of femur fracture during COVID-19 pandemic and compare the outcomes in a cohort during the same period prior to the pandemic.
Material And Methods:
The study included 66 patients with hip fracture over the age of 60 years, presented between 1st March and 15th May 2020 and matched with the patients with hip fractures (75 patients) managed during the corresponding period in 2019 as control. Data was collected on demographics, comorbidities, COVID-19 status, procedures and mortality and complications.
Results:
Thirty-day mortality following hip surgery was 13.6% during COVID-19 pandemic with all the mortalities in patients with ASA Grade 3 and 4. Mortality was considerably high for intracapsular fracture (20%) but highest in cemented hemiarthroplasty (20%). One third of the hip fractures operated in COVID-19 designated theatre died within 30 days of surgery. Thirty-day mortality rate for COVID-19 positive hip fracture patients were 55.5%. There has been higher 30-day mortality for hip surgeries during COVID-19 pandemic with positive correlation between patient's COVID-19 test status and 30-day mortality following hip surgeries.
Conclusion:
There is strong association between 30-day mortality and the designated theatre (Clean/COVID) where the patients were operated on with higher mortality for intracapsular neck of femur fractures with significant mortality associated with cemented hemiarthroplasty particularly among symptomatic or COVID-19 positive patients. Therefore, adoption of a multidisciplinary approach is recommended to optimally balance the risk-benefit ratio for planning of management of hip fractures while considering patient's peri-operative outcomes.
