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Mortality and Epidemiological Changes in Proximal Hip Fractures in the Course of a Pandemic
Domenik Popp1, Arastoo Nia1, Sara Silvaieh2
1Clinical Division of Traumatology, Department of Orthopedics and Traumatology, Medical University of Vienna, 1090 Vienna, Austria.
Insights
The COVID-19 pandemic did not increase mortality rates for hip fracture patients, even with potential surgical delays. Surgeons can confidently implement COVID-19 precautions without worsening patient outcomes.
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted orthopedic and trauma care protocols.
- The effect of pandemic-related surgical delays on hip fracture patient mortality remained unclear.
Purpose of the Study:
- To investigate the impact of the COVID-19 pandemic on mortality rates in hip fracture patients.
- To determine if pandemic-related measures worsened outcomes for hip fracture cases.
Main Methods:
- A prospective cohort of 175 hip fracture patients during the Austrian COVID-19 state of emergency (March 2020-May 2021) was analyzed.
- This cohort was compared to a retrospective control group of 339 hip fracture patients from 2017-2019.
Main Results:
- A 22% reduction in admissions was observed during the COVID-19 period compared to pre-COVID periods (p=0.018).
- The 30-day mortality rate was similar: 14.67% (pre-COVID) vs. 15.18% (COVID period) (p=0.381).
- No significant differences in surgical complications or the relationship between comorbidity and survival were found.
Conclusions:
- The study reassures surgeons that COVID-19 precautions do not elevate perioperative mortality for hip fracture patients.
- Hip fracture care continues to demand significant resources, even amidst pandemic-related challenges like reduced surgical and bed capacity.
Background:
Coronavirus disease 2019 (COVID-19) has had an immense impact on the treatment protocols of orthopedic and trauma departments, yet its specific effect on mortality in patients with hip fractures due to possible surgical delays is still unclear. The purpose of this paper was to investigate whether the COVID-19 pandemic worsened the mortality rate of hip fracture patients.
Patients And Methods:
This study comprised 175 prospectively included patients who (1) suffered from hip fractures, (2) presented during the Austrian state of emergency period from 15 March 2020 to 30 May 2021, and (3) were admitted to a level I trauma center. This cohort was compared with a retrospective control group of 339 patients admitted for hip fractures during the same timeframe in 2017, 2018, and 2019.
Results:
An admission reduction of 22% in the COVID period compared with the pre-COVID period was evident (p = 0.018). The 30-day mortality rate was 14.67% (pre-COVID) compared with 15.18% (p = 0.381). No differences in surgical complication rates or relationships between comorbidity burden and survival were observed. There were no significant changes in demographic variables, except for admission rate, gender (p = 0.013), and place of accident (p = 0.049).
Conclusion:
Surgeons should be reassured to take COVID-19 precautions, as this study did not show higher perioperative mortality due to COVID-19 measures. Under the current circumstances, with possibly reduced surgical and hospital bed capacities, it is expected that hip fractures may continue to require a high degree of resources.
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