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Increased Comorbidity Burden Among Hip Fracture Patients During the COVID-19 Pandemic in New York City
Drake G LeBrun1, Maxwell A Konnaris2, Gregory C Ghahramani2,3
1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Insights
Hip fracture patients during the COVID-19 pandemic had more health issues and worse functional status. Inpatient mortality significantly increased compared to the prior year.
Area of Science:
- Orthopedic Surgery
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic severely impacted New York City, with early reports indicating worse outcomes for COVID-positive hip fracture patients.
- Limited data exists comparing comorbidities in hip fracture patients during the pandemic versus non-pandemic periods.
Purpose of the Study:
- To compare baseline comorbidities and outcomes of hip fracture patients treated during the COVID-19 pandemic with those treated the previous year.
- To assess the impact of the pandemic on patient characteristics and inpatient mortality for hip fractures.
Main Methods:
- A multicenter retrospective cohort study compared 67 hip fracture patients (March-April 2020) with 76 patients from the prior year (March-April 2019).
- Data included demographics, comorbidities (Charlson Comorbidity Index, ASA scores), functional status, treatment, and inpatient mortality.
Main Results:
- Pandemic patients had higher comorbidity scores (CCI: 6.0 vs 5.0, P=.03) and ASA scores (2.7 vs 2.4, P=.04).
- Patients during the pandemic showed decreased ambulatory status (P<.01) and increased inpatient mortality (12% vs 0%, P=.002).
- Pandemic patients had longer hospital stays (7 vs 5 days, P=.01) but were more likely discharged home (61% vs 9%, P<.01).
Conclusions:
- Hip fracture patients during the COVID-19 pandemic presented with worse comorbidity profiles and functional status.
- Increased inpatient mortality was observed in hip fracture patients during the pandemic.
- Findings may inform healthcare reimbursement discussions for COVID-19 positive hip fracture patients requiring more intensive care.
Background:
The coronavirus disease 19 (COVID-19) pandemic had a devastating effect on New York City in the spring of 2020. Several global reports suggested worse early outcomes among COVID-positive patients with hip fractures. However, there is limited data comparing baseline comorbidities among patients treated during the pandemic relative to those treated in non-pandemic conditions.
Materials And Methods:
A multicenter retrospective cohort study was performed at two Level 1 Trauma centers and one orthopedic specialty hospital to assess demographics, comorbidities, and outcomes among 67 hip fracture patients treated (OTA/AO 31, 32.1) during the peak of the COVID-19 pandemic in New York City (March 20, 2020 to April 24, 2020), including 9 who were diagnosed with COVID-19. These patients were compared to a cohort of 76 hip fracture patients treated 1 year prior (March 20, 2019 to April 24, 2019). Baseline demographics, comorbidities, treatment characteristics, and respiratory symptomatology were evaluated. The primary outcome was inpatient mortality.
Results:
Relative to patients treated in 2019, patients with hip fractures during the pandemic had worse Charlson Comorbidity Indices (median 5.0 vs 6.0, P = .03) and American Society of Anesthesiologists (ASA) scores (mean 2.4 vs 2.7, P = .04). Patients during the COVID-19 pandemic were more likely to have decreased ambulatory status (P<.01) and a smoking history (P = .04). Patients in 2020 had longer inpatient stays (median 5 vs 7 days, P = .01), and were more likely to be discharged home (61% vs 9%, P<.01). Inpatient mortality was significantly increased during the COVID-19 pandemic (12% vs 0%, P = .002).
Conclusions:
Patients with hip fractures during the COVID-19 pandemic had worse comorbidity profiles and decreased functional status compared to patients treated the year prior. This information may be relevant in negotiations regarding reimbursement for cost of care of hip fracture patients with COVID-19, as these patients may require more expensive care.
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