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Webb EJ, King N, Howdon D, Carrol ED, Euden J, Howard P, Pallmann P, Llewelyn MJ, Thomas-Jones E, Shinkins B, Sandoe J. Evidence of quality of life for hospitalised patients with COVID-19: a scoping review. Health Technol Assess 2024:1-23. [PMID: 38798077 DOI: 10.3310/atpr4281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Background Information on the quality of life of people hospitalised with COVID-19 is important, both in assessing the burden of disease and the cost-effectiveness of treatments. However, there were potential barriers to collecting such evidence. Objective To review the existing evidence on quality of life for people hospitalised with COVID-19, with a focus on the amount of evidence available and methods used. Design A scoping review with systematic searches. Results A total of 35 papers were selected for data extraction. The most common study type was economic evaluation (N = 13), followed by cross-sectional (N = 10). All economic evaluations used published utility values for other conditions to represent COVID-19 inpatients' quality of life. The most popular quality-of-life survey measure was the Pittsburgh Sleep Quality Index (N = 8). There were 12 studies that used a mental health-related survey and 12 that used a sleep-related survey. Five studies used EQ-5D, but only one collected responses from people in the acute phase of COVID-19. Studies reported a negative impact on quality of life for people hospitalised with COVID-19, although many studies did not include a formal comparison group. Limitations Although it used systematic searches, this was not a full systematic review. Conclusion Quality-of-life data were collected from people hospitalised with COVID-19 from relatively early in the pandemic. However, there was a lack of consensus as to what survey measures to use, and few studies used generic health measures. Economic evaluations for COVID-19 treatments did not use utilities collected from people with COVID-19. In future health crises, researchers should be vigilant for opportunities to collect quality-of-life data from hospitalised patients but should try to co-ordinate as well as ensuring generic health measures are used more. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR132254.
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Affiliation(s)
- Edward Jd Webb
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Natalie King
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Enitan D Carrol
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Joanne Euden
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Philip Howard
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Department of Medicines Management and Pharmacy, Leeds Teaching Hospitals, Leeds General Infirmary, Leeds, UK
| | - Philip Pallmann
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Martin J Llewelyn
- Brighton and Sussex Medical School, University of Sussex and University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK
| | - Jonathan Sandoe
- Healthcare Associated Infection Group, Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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2
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Knauf T, Eschbach D, Bücking B, Knobe M, Rascher K, Schoeneberg C, Bliemel C, Ruchholtz S, Aigner R, Bökeler U. [Effects of the COVID-19 pandemic on the course of geriatric trauma patients with proximal femoral fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:228-234. [PMID: 37994922 DOI: 10.1007/s00113-023-01384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND/OBJECTIVE In 2020 the COVID-19 pandemic posed a major challenge to the healthcare system. The hypothesis is that the COVID-19 pandemic in 2020 had an impact on the care of older adults with proximal femoral fractures due to resource scarcity, regardless of whether or not the patient was infected. MATERIAL AND METHODS This study analyzed the data of 87 hospitals which entered 15,289 patients in the Geriatric Trauma Register ("AltersTraumaRegister DGU®", ATR-DGU) in Germany in 2019 and 2020. In this study we analyzed the influence of the COVID-19 pandemic on the inpatient treatment of hip fractures as well as the mid-term follow-up during the first 120 days. For the main analysis, we compared patients documented during the COVID-19 pandemic in 2020 (April-December) with a control group in 2019 (April-December). Additionally, we performed a subgroup analysis of the periods with high COVID-19 incidence rates. RESULTS Between 2019 and 2020 a total of 11,669 patients (2020: n = 6002 patients vs. 2019: n = 5667 patients) were included in this study. Only minor differences were found between the patients treated during the pandemic; however, when the COVID-19 incidence in Germany was greater than 50/100,000 residents, significantly fewer patients (p < 0.001) were discharged to a geriatric rehabilitation ward (27.2% vs. 36.3%) and an increased mortality rate during inpatient treatment was determined (8.4% vs. 4.6%) (p < 0.001). DISCUSSION The healthcare system was able to respond to the pandemic and patients' clinical courses were not impaired as long as the incidences were low. Nevertheless, the healthcare system reached its limits in times of higher incidence, which was also directly reflected in the patient outcome, mortality and place of discharge.
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Affiliation(s)
- Tom Knauf
- Orthopädische Klinik Hessisch Lichtenau, Am Mühlenberg, 37235, Hessisch Lichtenau, Deutschland.
| | - Daphne Eschbach
- MVZ Hessisch Lichtenau e.V., Kaufungen und Kassel, Deutschland
| | | | - Matthias Knobe
- Abteilung für Unfallchirurgie, Klinikum Hochsauerland, Arnsberg, Deutschland
| | - Katherine Rascher
- AUC - Akademie der Unfallchirurgie GmbH, 80538, München, Deutschland
| | - Carsten Schoeneberg
- Abteilung für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Essen, Deutschland
| | - Christopher Bliemel
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Marburg, Deutschland
| | - Steffen Ruchholtz
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Marburg, Deutschland
| | - Rene Aigner
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Marburg, Deutschland
| | - Ulf Bökeler
- Marienhospital Stuttgart, Stuttgart, Deutschland
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3
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Manasa M, Yeates EO, Grigorian A, Barrios C, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Coimbra R, Brenner M, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Tay-Lasso E, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. The Effect of 2019 Coronavirus Stay-at-Home Order on Geriatric Trauma Patients in Southern California. Am Surg 2023; 89:6053-6059. [PMID: 37347234 DOI: 10.1177/00031348221124329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND California issued stay-at-home (SAH) orders to mitigate COVID-19 spread. Previous studies demonstrated a shift in mechanisms of injuries (MOIs) and decreased length of stay (LOS) for the general trauma population after SAH orders. This study aimed to evaluate the effects of SAH orders on geriatric trauma patients (GTPs), hypothesizing decreased motor vehicle collisions (MVCs) and LOS. METHODS A post-hoc analysis of GTPs (≥65 years old) from 11 level-I/II trauma centers was performed, stratifying patients into 3 groups: before SAH (1/1/2020-3/18/2020) (PRE), after SAH (3/19/2020-6/30/2020) (POST), and a historical control (3/19/2019-6/30/2019) (CONTROL). Bivariate comparisons were performed. RESULTS 5486 GTPs were included (PRE-1756; POST-1706; CONTROL-2024). POST had a decreased rate of MVCs (7.6% vs 10.6%, P = .001; vs 11.9%, P < .001) and pedestrian struck (3.4% vs 5.8%, P = .001; vs 5.2%, P = .006) compared with PRE and CONTROL. Other mechanisms of injury, LOS, mortality, and operations performed were similar between cohorts. However, POST had a lower rate of discharge to skilled nursing facility (SNF) (20% vs 24.5%, P = .001; and 20% vs 24.4%, P = .001). CONCLUSION This retrospective multicenter study demonstrated lower rates of MVCs and pedestrian struck for GTPs, which may be explained by decreased population movement as a result of SAH orders. Contrary to previous studies on the generalized adult population, no differences in other MOIs and LOS were observed after SAH orders. However, there was a lower rate of discharge to SNF, which may be related to a lack of resources due to the COVID-19 pandemic, and thus potentially negatively impacted recovery of GTPs.Keywords.
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Affiliation(s)
- Morgan Manasa
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Eric O Yeates
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | - Cristobal Barrios
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Galinos Barmparas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Margulies
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Juillard
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kent Garber
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Henry Cryer
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sigrid Burruss
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Ann Lin
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Raul Coimbra
- Riverside University Health System, Moreno Valley, CA, USA
| | - Megan Brenner
- Riverside University Health System, Moreno Valley, CA, USA
| | - Todd Costantini
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Jarrett Santorelli
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Terry Curry
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA
| | - Walter L Biffl
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Kathryn B Schaffer
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Thomas K Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Casey Barbaro
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | | | - Erika Tay-Lasso
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Justine Chinn
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Ariana Naaseh
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Amanda Leung
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Christina Grabar
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
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4
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Putera HD, Halim V, Panghiyangani R. The impact of COVID-19 on mortality in trauma patients undergoing orthopedic surgery: a systematic review and meta-analysis. Clin Exp Emerg Med 2023; 10:315-326. [PMID: 37188360 PMCID: PMC10579729 DOI: 10.15441/ceem.22.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/19/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE The global spread of the COVID-19 pandemic has affected all aspects of medicine, including orthopedic trauma surgery. This study aims to investigate whether COVID-19 patients who underwent orthopedic surgery trauma had a higher risk of postoperative mortality. METHODS ScienceDirect, the Cochrane COVID-19 Study Register, and MEDLINE were searched for original publications. This study adhered to the PPRISMA 2020 statement. The validity of the studies was evaluated using a checklist developed by the Joanna Briggs Institute. Study and participant characteristics, as well as the odds ratio, were extracted from selected publications. Data were analyzed using RevMan ver. 5.4.1. RESULTS After applying the inclusion and exclusion criteria, 16 articles among 717 total were deemed eligible for analysis. Lower-extremity injuries were the most common condition, and pelvic surgery was the most frequently performed intervention. There were 456 COVID-19 patients (6.12%) and 134 deaths among COVID-19 patients, revealing an increase in mortality (29.38% vs. 5.30%; odds ratio, 7.72; 95% confidence interval, 6.01-9.93; P<0.001). CONCLUSION Among COVID-19 patients who received orthopedic surgery due to trauma, the postoperative death rate increased by 7.72 times.
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Affiliation(s)
- Husna Dharma Putera
- Department of Orthopedic and Traumatology, Faculty of Medicine, Ulin General Hospital, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
| | - Valentina Halim
- Department of Emergency, Siloam Hospital, Banjarmasin, Indonesia
| | - Roselina Panghiyangani
- Biomedical Department, Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
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5
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Konda SR, Esper GW, Meltzer-Bruhn AT, Ganta A, Leucht P, Tejwani NC, Egol KA. Implications of COVID-19 on hip fracture care discharge locations during the early stages of the pandemic. OTA Int 2023; 6:e277. [PMID: 37122587 PMCID: PMC10145965 DOI: 10.1097/oi9.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/28/2023] [Indexed: 05/02/2023]
Abstract
Objectives To document discharge locations for geriatric patients treated for a hip fracture before and during the COVID pandemic and subsequent changes in outcomes seen between each cohort. Design Retrospective cohort study. Setting Academic medical center. Patients/Participants Two matched cohorts of 100 patients with hip fracture treated pre-COVID (February-May 2019) and during COVID (February-May 2020). Intervention Discharge location and COVID status on admission. Discharge locations were home (home independently or home with health services) versus facility [subacute nursing facility (SNF) or acute rehabilitation facility]. Main Outcome Measurements Readmissions, inpatient and 1-year mortality, and 1-year functional outcomes (EQ5D-3L). Results In COVID+ patients, 93% (13/14) were discharged to a facility, 62% (8/13) of whom passed away within 1 year of discharge. Of COVID+ patients discharged to an SNF, 80% (8/10) died within 1 year. Patients discharged to an SNF in 2020 were 1.8x more likely to die within 1 year compared with 2019 (P = 0.029). COVID- patients discharged to an SNF in 2020 had a 3x increased 30-day mortality rate and 1.5x increased 1-year mortality rate compared with 2019. Patients discharged to an acute rehabilitation facility in 2020 had higher rates of 90-day readmission. There was no difference in functional outcomes. Conclusions All patients, including COVID- patients, discharged to all discharge locations during the onset of the pandemic experienced a higher mortality rate as compared with prepandemic. This was most pronounced in patients discharged to a skilled nursing facility in 2020 during the early stages of the pandemic. If this trend continues, it suggests that during COVID waves, discharge planning should be conducted with the understanding that no options eliminate the increased risks associated with the pandemic. Level of Evidence III.
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Affiliation(s)
- Sanjit R. Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY; and
- Corresponding author. Address: Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, 301 E. 17th St, 14th Floor, New York, NY 10003. E-mail address: (Sanjit R. Konda)
| | - Garrett W. Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Ariana T. Meltzer-Bruhn
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Abhishek Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY; and
| | - Philipp Leucht
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
- Department of Orthopedic Surgery, Bellevue Hospital, New York, NY
| | - Nirmal C. Tejwani
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
- Department of Orthopedic Surgery, Bellevue Hospital, New York, NY
| | - Kenneth A. Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY; and
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6
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Qin HC, He Z, Luo ZW, Zhu YL. Management of hip fracture in COVID-19 infected patients. World J Orthop 2022; 13:544-554. [PMID: 35949705 PMCID: PMC9244961 DOI: 10.5312/wjo.v13.i6.544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/07/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Given that the global population of elderly individuals is expanding and the difficulty of recovery, hip fractures will be a huge challenge and a critical health issue for all of humanity. Although people have spent more time at home during the coronavirus disease 2019 (COVID-19) pandemic, hip fractures show no sign of abating. Extensive studies have shown that patients with hip fracture and COVID-19 have a multifold increase in mortality compared to those uninfected and a more complex clinical condition. At present, no detailed research has systematically analyzed the relationship between these two conditions and proposed a comprehensive solution. This article aims to systematically review the impact of COVID-19 on hip fracture and provide practical suggestions. We found that hip fracture patients with COVID-19 have higher mortality rates and more complicated clinical outcomes. Indirectly, COVID-19 prevents hip fracture patients from receiving regular medical treatment. With regard to the problems we encounter, we provide clinical recommendations based on existing research evidence and a clinical flowchart for the management of hip fracture patients who are COVID-19 positive. Our study will help clinicians adequately prepare in advance when dealing with such patients and optimize treatment decisions.
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Affiliation(s)
- Hao-Cheng Qin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhong He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu-Lian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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COVID-19 Elderly Patients Treated for Proximal Femoral Fractures during the Second Wave of Pandemic in Italy and Iran: A Comparison between Two Countries. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060781. [PMID: 35744044 PMCID: PMC9231012 DOI: 10.3390/medicina58060781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
Background and objevtive: The worldwide spread of SARS-CoV-2 has affected the various regions of the world differently. Italy and Iran have experienced a different adaptation to coexistence with the pandemic. Above all, fractures of the femur represent a large part of the necessary care for elderly patients. The aim of this study was to compare the treatment in Italy and Iran of COVID-19-positive patients suffering from proximal femur fractures in terms of characteristics, comorbidities, outcomes and complications. Materials and Methods: Medical records of COVID-19-positive patients with proximal femoral fractures treated at IRCCS Istituto Ortopedico Galeazzi in Milan (Italy) and at Salamat Farda and Parsa hospitals in the province of Tehran (Iran), in the time frame from 1 October 2020 to 16 January 2021, were analyzed and compared. Results: Records from 37 Italian patients and 33 Iranian patients were analyzed. The Italian group (mean age: 83.89 ± 1.60 years) was statistically older than the Iranian group (mean age: 75.18 ± 1.62 years) (p value = 0.0003). The mean number of transfusions for each patient in Italy was higher than the Iranian mean number (p value = 0.0062). The length of hospital stay in Italy was longer than in Iran (p value < 0.0001). Furthermore, laboratory values were different in the post-operative value of WBC and admission and post-operative values of CRP. Conclusions: The present study shows that differences were found between COVID-19-positive patients with proximal femoral fractures in these two countries. Further studies are required to validate these results and to better explain the reasons behind these differences.
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Sloane PD, Portelli Tremont JN, Brasel KJ, Dhesi J, Hewitt J, Joseph BA, Ko FC, Kow AW, Lagoo-Deenadelayan SA, Levy CR, Louie RJ, McConnell ES, Neuman MD, Partridge J, Rosenthal RA. Surgery and Geriatric Medicine: Toward Greater Integration and Collaboration. J Am Med Dir Assoc 2022; 23:525-527. [DOI: 10.1016/j.jamda.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/27/2022]
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