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COVID-19 Vaccination: Does It Alter Postoperative Mortality and Morbidity in Hip Fractures?
Nuthan Jagadeesh1,2, Jabez Gnany2, Sachindra Kapadi3
1Trauma and Orthopaedics, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND.
Insights
COVID-19 vaccination significantly reduced mortality and complications in hip fracture patients. Vaccinated individuals, even if infected, experienced lower death rates compared to unvaccinated patients.
Area of Science:
- Geriatric Medicine
- Infectious Disease Epidemiology
- Surgical Outcomes Research
Background:
- Hip fractures are associated with high mortality and morbidity, particularly in elderly populations.
- The impact of coronavirus disease 2019 (COVID-19) vaccination on outcomes in this vulnerable group remains a critical area of investigation.
Purpose of the Study:
- To evaluate the effect of COVID-19 vaccination on mortality in patients undergoing hip fracture surgery.
- To compare postoperative morbidity, including length of hospital stay and complication rates, between vaccinated and unvaccinated hip fracture patients.
Main Methods:
- A comparative study of 619 hip fracture patients, divided into a vaccinated group (300) and an unvaccinated group (319).
- Data collected included demographic variables, Nottingham hip fracture score, American Society of Anesthesiologists (ASA) grade, anesthesia type, and Charlson Comorbidity Index.
- Primary outcomes were 30- and 90-day mortality; secondary outcomes included postoperative complications and mortality among COVID-positive patients.
Main Results:
- Thirty-day mortality was 5.3% in the vaccinated group versus 13.2% in the unvaccinated group; 90-day mortality was 14.7% versus 24.8% respectively (p<0.001).
- The vaccinated group exhibited fewer postoperative cardiac, thromboembolic, and neurological complications, as well as less electrolyte imbalance and acute kidney injury (AKI).
- Among vaccinated patients who contracted COVID-19 perioperatively, 30-day mortality was 10% compared to 31.2% in unvaccinated controls (p<0.001); 90-day mortality was 25% vs 43.75%.
Conclusions:
- COVID-19 vaccination independently reduces mortality and morbidity in hip fracture patients.
- Vaccination also lowers the risk of perioperative COVID-19 infection and subsequent complications.
- Even in vaccinated individuals who contract COVID-19, mortality risk is significantly diminished.
Abstract:
Introduction The primary aim of our study was to evaluate the impact of coronavirus disease 2019 (COVID-19) vaccination on mortality in patients with hip fractures by comparing it to those who are unvaccinated. Our secondary objective was to compare the impact on postoperative morbidity parameters like length of hospital stay and complications. Methods A total of 619 hip fractures were divided into the 'Vaccinated group' consisting of 300 patients who had COVID-19 vaccination and the 'Unvaccinated group' consisting of 319 patients who were not vaccinated. Patient demographic variables, Nottingham hip fracture score, American Society of Anesthesiologists (ASA) grade, type of anaesthesia used, and Charlson Comorbidity Index were collected. Our primary outcome measures were 30- and 90-day mortality. Secondary outcome measures included postoperative complications like thromboembolic complications, cardiac, and respiratory complications, etc. Mortality among the COVID-positive patients was also compared between the groups. Results Thirty-day postoperative mortality was higher in the unvaccinated group at 13.2% than in the vaccinated group at 5.3%. A similar increase in 90-day mortality was also observed in the unvaccinated group at 24.8% when compared to 14.7% in the vaccinated group(p<0.001). Despite having a higher baseline prevalence of cardiac comorbidities, the Vaccinated group had fewer post-operative cardiac, thromboembolic, and neurological complications (p>0.05). Moreover, electrolyte imbalance and AKI were also seen in fewer patients in the vaccinated group compared to the control group (p<0.05). Furthermore, it was found that among the vaccinated patients who did have perioperative COVID-19 infection, the 30-day mortality was significantly lower (10%) compared to the control group (31.2%) (p<0.001). Similarly, 90-day mortality was significantly lower (25%) compared to the control group (43.75%) (p<0.001). Conclusion Vaccination against COVID-19 independently reduced mortality and morbidity among patients with hip fractures when compared to those who are not vaccinated. Furthermore, it decreased the risk of acquiring COVID-19, and subsequent postoperative complications. Among those who are infected with COVID-19 despite vaccination, the mortality was significantly lesser.
