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The impact of COVID-19 infection on hip fractures 30-day mortality
Ahmed Fadulelmola1, Rob Gregory1, Gavin Gordon1
1University Hospital of North Durham, County Durham & Darlington NHSF, Newcastle upon Tyne, UK.
Insights
COVID-19 infection significantly increases 30-day mortality for hip fracture patients. Early COVID-19 testing and chest X-rays are crucial for managing these high-risk surgical cases and informing prognosis.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Orthopedic Surgery
Background:
- The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic poses a significant threat, particularly to the elderly and individuals with comorbidities.
- Hip fractures are common in the elderly, requiring hospitalization and increasing vulnerability to COVID-19 infection.
Purpose of the Study:
- To investigate the impact of COVID-19 infection on 30-day mortality rates in patients with hip fractures.
- To analyze the relationship between COVID-19 status, time to surgery, and mortality outcomes in hip fracture patients.
Main Methods:
- Retrospective review of 75 adult hip fracture patients admitted between March and April 2020.
- Primary outcome: 30-day mortality in COVID-19 positive versus negative patients.
Main Results:
- COVID-19 infection rate was 26.7% (20 patients).
- 30-day mortality was significantly higher in COVID-19 positive patients (50%) compared to negative patients (7.3%).
- Hypoxia was the cause of death in all COVID-19 positive fatalities; 70% had radiological signs of viral pneumonitis.
Conclusions:
- Hip fractures combined with COVID-19 infection are associated with a high 30-day mortality rate.
- Prompt COVID-19 testing and chest X-rays are essential for early risk assessment and surgical planning in hip fracture patients.
- Accurate prognosis and patient/family counseling are vital when managing hip fracture patients with COVID-19.
Introduction:
A novel virus, SARS-CoV-2 has caused a fatal global pandemic which particularly affects the elderly and those with co-morbidities. Hip fractures affect elderly populations, necessitate hospital admissions, and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality.
Method:
Data related to seventy-five adult hip fractures admitted to two units during March and April 2020 was reviewed. The mean age was 83.5 years (range 65-98 years) and most (53, 70.7%) were females. The primary outcome measure was 30-day mortality associated with COVID-19 infection.
Results:
The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in COVID-19 positive group (10/20, 50%) compared to COVID-19 negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval 17.0-22.5). The mean time from admission to surgery was 43.1 hours and 38.3 hours, in COVID-19 positive and COVID-19 negative groups, respectively. All COVID-19 positive patients had shown symptoms of fever and cough, and all ten cases who died were from hypoxia. Seven (35%) cases had radiological lung findings consistent with viral pneumonitis which resulted in mortality (70% of mortality). 30% (n = 6) contracted the COVID-19 infection in the community and 70% (n = 14) developed symptoms after hospital admission.
Conclusion:
Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest x-ray for patients presenting with hip fractures, helps in early planning of high-risk surgeries and allows counselling of the patients and family using realistic prognosis.
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