Hip Fracture Care during COVID-19: Evolution through the Pandemic

Area of Science:

• Geriatric Medicine
• Epidemiology
• Orthopedic Surgery

Background:

• Hip fractures pose significant health risks for middle-aged and geriatric populations.
• The COVID-19 pandemic presented unprecedented challenges to healthcare systems globally.
• Understanding the pandemic's impact on hip fracture patient care is crucial for maintaining optimal treatment standards.

Purpose of the Study:

• To analyze hip fracture patient care at an institution during the COVID-19 pandemic.
• To compare care and outcomes between pre-pandemic, early pandemic (pre-vaccine), and later pandemic (post-vaccine) stages.
• To assess the influence of COVID-19 and vaccination status on hip fracture patient management.

Main Methods:

• Epidemiologic study of 2,633 hip fracture patients (>55 years) from October 2014 to January 2022.
• Patients categorized into Pre-COVID-19 (PRECOV), COVID-19 Pre-Vaccine (PREVAX), and COVID-19 Post-Vaccine (POSTVAX) cohorts.
• Comparative analysis of demographics, COVID-19 status, injury characteristics, quality measures, and outcomes, with a sub-analysis excluding COVID-19 positive patients.

Main Results:

• No significant difference in inpatient deaths across cohorts (PRECOV, PREVAX, POSTVAX).
• PRECOV cohort showed lower 30-day mortality (p=0.012) and longer hospital stays (p<0.01).
• PREVAX patients required more ICU care (p<0.01); complication rates varied (p<0.01). Excluding COVID-19 positive patients revealed similar mortality rates across cohorts.

Conclusions:

• Institutional hip fracture care protocols remained consistent throughout the pandemic.
• Elevated mortality in the PREVAX cohort was attributed to COVID-19 effects, decreasing post-vaccine introduction.
• Continuation of pre-pandemic hip fracture care protocols is recommended.