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Hip Fracture Trends and Outcomes During the COVID-19 Pandemic
Insights
During the COVID-19 pandemic, hip fracture cases decreased, and presentation time doubled. Patients were discharged home more often, but outcomes remained high quality, with no increase in complications or mortality.
Area of Science:
- Orthopedic Surgery
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted healthcare delivery, especially for vulnerable populations like the elderly.
- Hip fractures in the elderly present unique challenges, exacerbated by the pandemic's strain on healthcare resources.
- Understanding changes in hip fracture patient care and outcomes during the pandemic is crucial for adapting healthcare strategies.
Purpose of the Study:
- To compare the trends and outcomes of hip fracture patients during the COVID-19 pandemic versus the pre-pandemic period.
- To analyze demographic data, presentation times, and hospital outcomes for hip fracture patients during the pandemic.
- To evaluate the quality of care provided to hip fracture patients amidst the healthcare crisis.
Main Methods:
- Retrospective chart review of hip fracture patients from a suburban academic hospital on Long Island, New York.
- Data collected for patients presenting between March 1 and May 30, 2020 (pandemic cohort) and compared to a 2019 control group.
- Analysis included patient COVID-19 status, demographics, and hospital outcomes using heteroscedastic t tests and chi-square tests.
Main Results:
- A 29.9% decrease in hip fracture cases was observed during the pandemic (82 patients in 2020 vs. 111 in 2019).
- Time from injury to hospital presentation doubled during the pandemic (2.77 days in 2020 vs. 1.15 days in 2019).
- Patients in 2020 were more likely to be discharged home (vs. rehabilitation) and received oral anticoagulation more frequently; no increase in complications or mortality was noted.
Conclusions:
- The COVID-19 pandemic led to a reduction in hip fracture admissions and a delay in presentation to the hospital.
- Discharge patterns shifted, with more patients returning home, and increased use of oral anticoagulation.
- High-quality care for hip fracture patients was maintained during the pandemic, with no adverse impact on short-term outcomes or mortality.
Abstract:
Coronavirus disease 2019 (COVID-19) rapidly changed the landscape of health care, particularly in the New York City area. The elderly population is particularly vulnerable to both the novel coronavirus and the effects of a fracture. The goal of this study was to compare trends and outcomes of hip fracture patients during the pandemic. This was a retrospective chart review of hip fracture patients from a suburban academic hospital on Long Island, New York, who presented from March 1 to May 30, 2020. Patient COVID-19 status, demographics, and hospital outcome measures were recorded. Statistical analysis was performed using heteroscedastic t tests for quantitative variables and chi-square tests for qualitative variables. There were 82 patients in the 2020 cohort and 111 in the 2019 control group, representing a 29.9% decrease in cases. The 2020 cohort presented to the hospital an average of 2.77 days after injury compared with 1.15 days for the 2019 control group (P=.0976). Patients in the 2020 cohort were more likely to be discharged home than to rehabilitation (P<.0001) and tended to be discharged with oral anticoagulation (P=.0809). There was no increase in 1-, 3-, or 6-month complications or mortality. During the pandemic, fewer patients were admitted with hip fractures, and the time from injury to presentation doubled. Patients were significantly less likely to be discharged to rehabilitation and more were discharged with oral anticoagulants. Overall, there was no increase in complications, and these data indicate that the authors were successfully able to provide high-quality care to hip fracture patients during the pandemic. [Orthopedics. 2021;44(5):293-298.].
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