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Association Between COVID-19 and Mortality in Hip Fracture Surgery in the National COVID Cohort Collaborative (N3C):
Eli B Levitt1, David A Patch, Scott Mabry
1From the Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL (Mr. Levitt, Dr. Patch, Dr. Mabry, Dr. Quade, Dr. Theiss, Dr. Spitler, and Dr. Johnson); the Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL (Mr. Levitt and Dr. Terrero); the Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (Dr. Jaeger); the Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO (Dr. Haendel); the Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (Dr. Chute); and the Department of Orthopaedics, Hughston Clinic, Columbus, GA (Dr. Ponce).
Insights
Hip fracture surgery patients with coronavirus disease (COVID-19) had higher mortality. This national study found 30-day mortality was 14.6% for COVID-19 positive versus 3.8% for negative patients.
Area of Science:
- Geriatric Surgery
- Infectious Diseases
- Orthopedic Surgery
Background:
- Investigated outcomes of hip fracture surgery in patients with coronavirus disease (COVID-19).
- Utilized a national database for comprehensive data analysis.
Purpose of the Study:
- To compare hip fracture surgery outcomes between COVID-19 positive and negative patient cohorts.
- To assess the impact of COVID-19 on mortality following hip fracture surgery.
Main Methods:
- Retrospective cohort study design.
- Inclusion of patients aged 65 and older undergoing hip fracture surgery between March 15 and December 31, 2020.
- Matched cohorts from 46 US sites, comparing COVID-19 positive and negative groups.
Main Results:
- 30-day all-cause mortality was significantly higher in COVID-19 positive patients (14.6%) compared to COVID-19 negative patients (3.8%).
- All-cause mortality for hip fracture surgery in the COVID-19 positive group was 27.0% during the study period.
- A notable difference in mortality was observed between the two groups.
Conclusions:
- Patients with COVID-19 undergoing hip fracture surgery experience a higher incidence of all-cause mortality.
- Mortality rates in this national analysis were lower than some reported local and regional studies.
- Findings can inform clinical management strategies for hip fracture patients diagnosed with COVID-19.
Background:
This study investigated the outcomes of coronavirus disease (COVID-19)-positive patients undergoing hip fracture surgery using a national database.
Methods:
This is a retrospective cohort study comparing hip fracture surgery outcomes between COVID-19 positive and negative matched cohorts from 46 sites in the United States. Patients aged 65 and older with hip fracture surgery between March 15 and December 31, 2020, were included. The main outcomes were 30-day all-cause mortality and all-cause mortality.
Results:
In this national study that included 3303 adults with hip fracture surgery, the 30-day mortality was 14.6% with COVID-19-positive versus 3.8% in COVID-19-negative, a notable difference. The all-cause mortality for hip fracture surgery was 27.0% in the COVID-19-positive group during the study period.
Dicussion:
We found higher incidence of all-cause mortality in patients with versus without diagnosis of COVID-19 after undergoing hip fracture surgery. The mortality in hip fracture surgery in this national analysis was lower than other local and regional reports. The medical community can use this information to guide the management of hip fracture patients with a diagnosis of COVID-19.
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