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The impact of COVID-19 infection on hip fracture 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.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Geriatric Medicine
Background:
- The COVID-19 pandemic poses a significant risk to elderly individuals, especially those with comorbidities.
- Hip fractures are common in the elderly, requiring hospitalization and increasing vulnerability to severe COVID-19 outcomes.
Purpose of the Study:
- To investigate the impact of COVID-19 infection on 30-day mortality rates in patients with hip fractures.
Main Methods:
- Retrospective review of 75 adult hip fracture patients admitted between March and April 2020.
- Analysis of 30-day mortality in relation to COVID-19 infection status.
Main Results:
- COVID-19 infection rate was 26.7% (20/75 patients).
- 30-day mortality was significantly higher in COVID-19 positive patients (50%) compared to negative patients (7.3%).
- Hypoxia and viral pneumonitis were common in fatal COVID-19 cases.
Conclusions:
- COVID-19 infection is associated with a substantially increased risk of 30-day mortality in hip fracture patients.
- Prompt COVID-19 testing and chest X-rays are recommended for hip fracture patients to guide surgical planning and patient counseling.
Introduction:
A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. 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 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65-98 years), and most (53, 70.7%) were women. 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 the COVID-19-positive group (10/20, 50%) compared to the 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 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of 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 help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.
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