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90-Day Complication and Readmission Rates for Geriatric Patients With Hip Fracture at Different Time Points From
Joshua G Sanchez1, Will M Jiang, Meera M Dhodapkar
1From the Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT.
Insights
For geriatric hip fracture patients, COVID-19 infection within one week of surgery increases complication risks. However, diagnoses over one week preoperatively show no increased odds of adverse events, offering reassurance for care timing.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Geriatric Medicine
Background:
- Geriatric patients with hip fractures face concurrent risks of COVID-19 infection.
- Timing of COVID-19 diagnosis relative to hip fracture surgery requires investigation for optimal patient care.
Purpose of the Study:
- To evaluate the association between preoperative COVID-19 diagnosis timing and 90-day postoperative complications in geriatric hip fracture patients.
Main Methods:
- Retrospective analysis of geriatric hip fracture patients from the PearlDiver M157 database.
- Classification of patients based on time from COVID-19 diagnosis to surgery (≤1 week, >1-≤4 weeks, >4-≤7 weeks, >7-≤10 weeks, >10-≤13 weeks).
- Multivariable analysis to assess the impact of COVID-19 timing on 90-day complication rates.
Main Results:
- Out of 263,771 hip fracture patients, 976 had COVID-19 within 13 weeks of surgery.
- COVID-19 diagnosis within ≤1 week preoperatively was linked to higher rates of minor adverse events (OR=1.50), all adverse events (OR=1.59), sepsis (OR=1.70), and pneumonia (OR=2.35).
- No significant differences in complication rates were observed for COVID-19 diagnoses occurring more than 1 week before surgery.
Conclusions:
- COVID-19 infection within one week of hip fracture surgery increases the likelihood of 90-day complications.
- Diagnoses of COVID-19 more than one week prior to surgery were not associated with increased complication risks.
Introduction:
Geriatric patients with hip fracture are at risk of having COVID-19 while needing fracture treatment. Understanding the associated risks of variable timing of COVID-19 before surgery may help direct care algorithms.
Methods:
Geriatric patients with documented hip fracture surgery were identified within the PearlDiver M157 database. Patients with a preoperative COVID-19 diagnosis were classified based on time from diagnosis to surgery: ≤ 1 week, > 1 to ≤ 4 weeks, > 4 to ≤ 7 weeks, > 7 to ≤ 10 weeks, and > 10 to ≤ 13 weeks. The association of COVID-19 diagnoses with 90-day complications was evaluated.
Results:
Overall, 263,771 patients with hip fracture were identified, of which COVID-19 within 13 weeks of surgery was documented for 976. On multivariable analysis, patients with COVID-19 infection within ≤ 1 week preoperatively demonstrated increased rates of minor adverse events (odds ratio (OR) = 1.50), all adverse events (OR = 1.59), sepsis (OR = 1.70), and pneumonia (OR = 2.35) (P ≤ 0.0007 for each). For time points greater than 1 week, there were no differences in complication rates.
Discussion:
Patients with COVID-19 within 1 week of hip fracture surgery demonstrated greater odds of 90-day complications. Reassuringly, patients with COVID-19 diagnoses more than 1 week preoperatively were not associated with increased odds of any assessed complication.
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