Rasidovic, Damir, Ahmed, Imran, Thomas, Christopher M., Kimani, Peter K., Wall, Peter D. H. and Mangat, Karanjit (2020) Impact of COVID-19 on clinical outcomes for patients with fractured hip. Bone & Joint Open, 1 (11). pp. 697-705. doi:10.1302/2633-1462.111.BJO-2020-0132.R1 ISSN 2633-1462.

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Abstract

AIMS:
There are reports of a marked increase in perioperative mortality in patients admitted to hospital with a fractured hip during the COVID-19 pandemic in the UK, USA, Spain, and Italy. Our study aims to describe the risk of mortality among patients with a fractured neck of femur in England during the early stages of the COVID-19 pandemic.

Methods:
We completed a multicentre cohort study across ten hospitals in England. Data were collected from 1 March 2020 to 6 April 2020, during which period the World Health Organization (WHO) declared COVID-19 to be a pandemic. Patients ≥ 60 years of age admitted with hip fracture and a minimum follow-up of 30 days were included for analysis. Primary outcome of interest was mortality at 30 days post-surgery or postadmission in nonoperative patients. Secondary outcomes included length of hospital stay and discharge destination.

Results:
In total, 404 patients were included for final analysis with a COVID-19 diagnosis being made in 114 (28.2%) patients. Overall, 30-day mortality stood at 14.4% (n = 58). The COVID-19 cohort experienced a mortality rate of 32.5% (37/114) compared to 7.2% (21/290) in the non-COVID cohort (p < 0.001). In adjusted analysis, 30-day mortality was greatest in patients who were confirmed to have COVID-19 (odds ratio (OR) 5.64, 95% confidence interval (CI) 2.95 to 10.80; p < 0.001) with an adjusted excess risk of 20%, male sex (OR 2.69, 95% CI 1.37 to 5.29; p = 0.004) and in patients with ≥ two comorbidities (OR 4.68, CI 1.5 to 14.61; p = 0.008). Length of stay was also extended in the COVID-19 cohort, on average spending 17.6 days as an inpatient versus 12.04 days in the non-COVID-19 group (p < 0.001).

Conclusion:
This study demonstrates that patients who sustain a neck of femur fracture in combination with COVID-19 diagnosis have a significantly higher risk of mortality than would be normally expected.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RD Surgery
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	COVID-19 (Disease), Hip joint -- Fractures, Hip joint -- Fractures -- Patients , Hip joint -- Fractures -- Patients -- Treatment
Journal or Publication Title:	Bone & Joint Open
Publisher:	British Editorial Society of Bone and Joint Surgery
ISSN:	2633-1462
Official Date:	4 November 2020
Dates:	Date Event 4 November 2020 Available 30 September 2020 Accepted
Volume:	1
Number:	11
Page Range:	pp. 697-705
DOI:	10.1302/2633-1462.111.BJO-2020-0132.R1
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	16 November 2020
Date of first compliant Open Access:	17 November 2020
Contributors:	Contribution Name Contributor ID Research Group NOF-COV19 Study Collaborative Group, UNSPECIFIED

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