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Risk of Mortality for Proximal Femoral Fracture in Patients With and Without COVID-19. A Retrospective Cohort Study
Ashley Holub1, Montsant Jornet-Gibert2, Jill Ruppenkamp1
1Epidemiology & Real-World Data Sciences, Johnson & Johnson MedTech, New Brunswick, NJ, USA.
Insights
COVID-19 infection significantly increased mortality odds in patients undergoing proximal femoral fracture (PFF) repair. This highlights the critical need to consider infection status in hip fracture patient management for better outcomes.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Public Health
Background:
- Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus causing COVID-19, has led to significant mortality and healthcare system disruption.
- Hip fractures (proximal femoral fractures - PFF) are emergencies requiring prompt intervention to mitigate risks of mortality and morbidity.
- The impact of SARS-CoV-2 infection on mortality following PFF repair is a critical area of investigation due to infection's role in immune response and patient outcomes.
Purpose of the Study:
- To investigate the impact of COVID-19 infection on mortality rates in patients undergoing proximal femoral fracture (PFF) repair.
- To compare mortality risks between patients with and without COVID-19-like illness undergoing PFF repair during pre-pandemic and pandemic periods.
Main Methods:
- A retrospective cohort study design was employed.
- Data were extracted from the Premier Healthcare Database for patients undergoing PFF repair in 2019 (control) and February-September 2020 (COVID period).
- Patient cohorts included N = 73,953 for 2019 and N = 34,842 for the COVID period.
Main Results:
- In 2019, patients with flu/COVID-like illness undergoing PFF repair had 2.47 times the odds of mortality compared to those without such illness.
- During the COVID period, patients with flu/COVID-like illness undergoing PFF repair had 2.85 times the odds of mortality compared to those without.
- In the COVID period, even without PFF repair, flu/COVID-like illness increased mortality odds by 2.26 times.
Conclusions:
- Hip fractures carry a high risk of mortality and morbidity, making timely intervention essential.
- The presence of infections, such as flu/COVID-like illness, significantly influences mortality in patients undergoing hip fracture repair.
- Incorporating infection status as a critical comorbidity is vital for effective management and optimizing outcomes in hip fracture patients.
Background:
SARS-CoV-2 (COVID-19) has resulted in a widespread loss of lives, morbidity, and major disruptions to the healthcare system. Hip fractures are an emergent condition which require early intervention to reduce increased risk of mortality and morbidity. Infection of SARS-CoV-2 may contribute to increased mortality due to the role of infection and immune response. This study investigated the impact of COVID-19 infection (defined by clinical symptoms) on mortality following proximal femoral fracture (PFF) repair procedures.
Methods:
This study was a retrospective cohort study. Data from the Premier Healthcare Database® was extracted for patients presenting for PFF during 2019 for control, and February 2020-September 2020 to represent a COVID time-period.
Results:
A total of N = 73 953 subjects were enrolled for the 2019 period, and a total of N = 34 842 subjects were enrolled for the COVID period. For the 2019 period, subjects who had a PFF procedure and who had flu/COVID-like illness had 2.47 (CI:2.11, 2.88) times the odds of mortality compared to those who did not have flu/COVID-like illness. Subjects who had a PFF procedure and who had flu/COVID-like illness during the COVID period had 2.85 times (CI:2.36, 3.42) the odds of mortality compared to those who did not have flu/COVID-like illness. For the COVID period, within subjects who did not have a PFF procedure, those with flu/COVID-like illness had increased odds of mortality compared to those who did not have flu/COVID-like illness (OR:2.26, CI:1.57, 3.21).
Conclusions:
Hip fractures present high risk for mortality and morbidity, where timely intervention is critical to improved outcomes. Presence of infection such as flu/COVID-like illness may influence mortality in patients undergoing hip fracture repair procedures. Consideration of infection status as a comorbidity is important to proper management and achieving optimal outcomes.
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