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Foster JA, Landy DC, Pectol RW, Annamalai RT, Aneja A. A multi-institutional study of short-term mortality in COVID-positive patients undergoing hip fracture surgery: is survival better than expected? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:285-291. [PMID: 37462783 DOI: 10.1007/s00590-023-03620-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] [Received: 03/31/2023] [Accepted: 06/11/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE Early reports of 30-day mortality in COVID-positive patients with hip fracture were often over 30% and were higher than historical rates of 10% in pre-COVID studies. We conducted a multi-institutional retrospective cohort study to determine whether the incidence of 30-day mortality and complications in COVID-positive patients undergoing hip fracture surgery is as high as initially reported. METHODS A retrospective chart review was performed at 11 level I trauma centers from January 1, 2020 to May 1, 2022. Patients 50 years or older undergoing hip fracture surgery with a positive COVID test at the time of surgery were included. The primary outcome measurements were the incidence of 30-day mortality and complications. Post-operative outcomes were reported using proportions with 95% confidence interval (C.I.). RESULTS Forty patients with a median age of 71.5 years (interquartile range, 50-87 years) met the criteria. Within 30-days, four patients (10%; 95% C.I. 3-24%) died, four developed pneumonia, three developed thromboembolism, and three remained intubated post-operatively. Increased age was a statistically significant predictor of 30-day mortality (p = 0.01), with all deaths occurring in patients over 80 years. CONCLUSION In this multi-institutional analysis of COVID-positive patients undergoing hip fracture surgery, 30-day mortality was 10%. The 95% C.I. did not include 30%, suggesting that survival may be better than initially reported. While COVID-positive patients with hip fractures have high short-term mortality, the clinical situation may not be as dire as initially described, which may reflect initial publication bias, selection bias introduced by testing, or other issues. LEVELS OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Jeffrey A Foster
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA.
| | - David C Landy
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Richard W Pectol
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Ramkumar T Annamalai
- Department of Biomedical Engineering, University of Kentucky College of Engineering, Lexington, KY, USA
| | - Arun Aneja
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
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Jun C, Cho YJ, Quinn PM, Song SK. Acute respiratory distress syndrome after treating ipsilateral femoral shaft and neck fracture with reamed intramedullary nailing in an asymptomatic COVID-19 patient. SAGE Open Med Case Rep 2023; 11:2050313X231168290. [PMID: 37113390 PMCID: PMC10119647 DOI: 10.1177/2050313x231168290] [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: 06/13/2022] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Currently, it is quite difficult to determine the best timeframe of operative treatment, as well as conduct surgery on asymptomatic COVID-19 patients due to misunderstandings and unawareness of the patient's inflammation state. Caution needs to be taken in specific patient cohorts, particularly those with femoral shaft fractures, who are more likely to develop diseases like acute respiratory distress syndrome after a procedure like intramedullary nailing. In this case report, a 36-year-old patient suffered a motorcycle accident in which he suffered an ipsilateral femoral shaft and neck fracture of the hip. The patient's screening test for COVID-19 was positive before admission. Because the patient did not display any COVID-19-related symptoms upon arrival to the hospital, surgical fixation with a reamed intramedullary femoral nail was performed. Despite having a successful post-surgical outcome, the patient was diagnosed with acute respiratory distress syndrome 36 h after surgery, recovering fully after about 2 weeks. To prevent subsequent complications such as acute respiratory distress syndrome in a high inflammatory state patient like COVID-19, the respiratory status and the degree of systemic inflammation should be considered precisely when determining the surgical timing and method.
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Affiliation(s)
- Chungmu Jun
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - Young-Jae Cho
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - Patrick Michael Quinn
- Department of Orthopaedic Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Suk-Kyoon Song
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
- Suk-Kyoon Song, Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea.
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Pectol RW, Kavolus MW, Sneed CR, Albano AY, Landy DC, Aneja A. Outcomes of Reamed Intramedullary Nailing for Lower Extremity Diaphyseal Fractures in COVID-Positive Patients: A Multi-institutional Observational Study. J Orthop Trauma 2022; 36:628-633. [PMID: 35916777 DOI: 10.1097/bot.0000000000002468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if reamed intramedullary nailing (IMN) of tibial and femoral shaft fractures exacerbated the hypercoagulable state of COVID infection, resulting in increased thromboembolic and pulmonary complications. DESIGN Retrospective chart review. SETTING Eleven Level I trauma centers. PATIENTS From January 1, 2020, to December 1, 2022, 163 patients with orthopaedic trauma and COVID positivity and 36 patients with tibial and femoral shaft fractures were included. INTERVENTION Reamed IMN. MAIN OUTCOME MEASURES Incidence of postoperative thromboembolic and respiratory complications. RESULTS Thirty-six patients with a median age of 52 years (range, 18-92 years; interquartile range, 29-72 years) met criteria. There were 21 and 15 patients with femoral and tibial shaft fractures. There were 15 patients sustaining polytrauma; of which, 10 had a new injury severity score of >17. All patients underwent reamed IMN in a median of 1 day (range, 0-12 days; interquartile range = 1-2 days) after injury. Two patients developed acute respiratory distress syndrome (ARDS) and 3 pneumonia. No patients had pulmonary embolism, deep vein thrombosis, or died within 30 days. CONCLUSION In this multi-institutional review of COVID-positive patients undergoing reamed IMN, there were no thromboembolic events. All patients developing pulmonary complications (ARDS or pneumonia) had baseline chronic obstructive pulmonary disease, were immune compromised, or sustained polytraumatic injuries with new injury severity score of >20. Given this, it seems reasonable to continue using reamed IMN for tibial and femoral shaft fractures after evaluation for COVID severity, comorbidities, and other injuries. LEVELS OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Richard W Pectol
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY
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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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Postoperative mortality in the COVID-positive hip fracture patient, a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:927-935. [PMID: 35195751 PMCID: PMC8864596 DOI: 10.1007/s00590-022-03228-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/04/2022] [Indexed: 11/12/2022]
Abstract
Purpose The extent to which concomitant COVID-19 infection increases short-term mortality following hip fracture is not fully understood. A systemic review and meta-analysis of COVID-19 positive hip fracture patients (CPHFPs) undergoing surgery was conducted to explore the association of COVID-19 with short-term mortality. Methods Review of the literature identified reports of short-term 30-day postoperative mortality in CPHFPs. For studies including a contemporary control group of COVID-19 negative patients, odds ratios of the association between COVID-19 infection and short-term mortality were calculated. Short-term mortality and the association between COVID-19 infection and short-term mortality were meta-analyzed and stratified by hospital screening type using random effects models. Results Seventeen reports were identified. The short-term mortality in CPHFPs was 34% (95% C.I., 30–39%). Short-term mortality differed slightly across studies that screened all patients, 30% (95% C.I., 22–39%), compared to studies that conditionally screened patients, 36% (95% C.I., 31–42%), (P = 0.22). The association between COVID-19 infection and short-term mortality produced an odds ratio of 7.16 (95% C.I., 4.99–10.27), and this was lower for studies that screened all patients, 4.08 (95% C.I., 2.31–7.22), compared to studies that conditionally screened patients, 8.32 (95% C.I., 5.68–12.18), (P = 0.04). Conclusion CPHFPs have a short-term mortality rate of 34%. The odds ratio of short-term mortality was significantly higher in studies that screened patients conditionally than in studies that screened all hip fracture patients. This suggests mortality prognostication should consider how COVID-19 infection was identified as asymptomatic patients may fare slightly better. Supplementary Information The online version contains supplementary material available at 10.1007/s00590-022-03228-9.
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Fouladseresht H, Ghamar Talepoor A, Eskandari N, Norouzian M, Ghezelbash B, Beyranvand MR, Nejadghaderi SA, Carson-Chahhoud K, Kolahi AA, Safiri S. Potential Immune Indicators for Predicting the Prognosis of COVID-19 and Trauma: Similarities and Disparities. Front Immunol 2022; 12:785946. [PMID: 35126355 PMCID: PMC8815083 DOI: 10.3389/fimmu.2021.785946] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
Although cellular and molecular mediators of the immune system have the potential to be prognostic indicators of disease outcomes, temporal interference between diseases might affect the immune mediators, and make them difficult to predict disease complications. Today one of the most important challenges is predicting the prognosis of COVID-19 in the context of other inflammatory diseases such as traumatic injuries. Many diseases with inflammatory properties are usually polyphasic and the kinetics of inflammatory mediators in various inflammatory diseases might be different. To find the most appropriate evaluation time of immune mediators to accurately predict COVID-19 prognosis in the trauma environment, researchers must investigate and compare cellular and molecular alterations based on their kinetics after the start of COVID-19 symptoms and traumatic injuries. The current review aimed to investigate the similarities and differences of common inflammatory mediators (C-reactive protein, procalcitonin, ferritin, and serum amyloid A), cytokine/chemokine levels (IFNs, IL-1, IL-6, TNF-α, IL-10, and IL-4), and immune cell subtypes (neutrophil, monocyte, Th1, Th2, Th17, Treg and CTL) based on the kinetics between patients with COVID-19 and trauma. The mediators may help us to accurately predict the severity of COVID-19 complications and follow up subsequent clinical interventions. These findings could potentially help in a better understanding of COVID-19 and trauma pathogenesis.
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Affiliation(s)
- Hamed Fouladseresht
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefe Ghamar Talepoor
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Eskandari
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Norouzian
- Department of Laboratory Sciences, School of Allied Medical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Behrooz Ghezelbash
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Beyranvand
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- *Correspondence: Mohammad Reza Beyranvand,
| | - Seyed Aria Nejadghaderi
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Kristin Carson-Chahhoud
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Safiri
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Raheman FJ, Rojoa DM, Nayan Parekh J, Berber R, Ashford R. Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic. Sci Rep 2021; 11:10157. [PMID: 33980936 PMCID: PMC8115062 DOI: 10.1038/s41598-021-89617-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
Incidence of hip fractures has remained unchanged during the pandemic with overlapping vulnerabilities observed in patients with hip fractures and those infected with COVID-19. We aimed to investigate the independent impact of COVID-19 infection on the mortality of these patients. Healthcare databases were systematically searched over 2-weeks from 1st-14th November 2020 to identify eligible studies assessing the impact of COVID-19 on hip fracture patients. Meta-analysis of proportion was performed to obtain pooled values of prevalence, incidence and case fatality rate of hip fracture patients with COVID-19 infection. 30-day mortality, excess mortality and all-cause mortality were analysed using a mixed-effects model. 22 studies reporting 4015 patients were identified out of which 2651 (66%) were assessed during the pandemic. An excess mortality of 10% was seen for hip fractures treated during the pandemic (OR 2.00, p = 0.007), in comparison to the pre-pandemic controls (5%). Estimated mortality of COVID-19 positive hip fracture patients was four-fold (RR 4.59, p < 0.0001) and 30-day mortality was 38.0% (HR 4.73, p < 0.0001). The case fatality rate for COVID-19 positive patients was 34.74%. Between-study heterogeneity for the pooled analysis was minimal (I2 = 0.00) whereas, random effects metaregression identified subgroup heterogeneity for male gender (p < 0.001), diabetes (p = 0.002), dementia (p = 0.001) and extracapsular fractures (p = 0.01) increased risk of mortality in COVID-19 positive patients.
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Affiliation(s)
- Firas J Raheman
- The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK.
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, Balmoral Building, Infirmary Square, Leicester, LE1 5WW, UK.
| | - Djamila M Rojoa
- The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | | | - Reshid Berber
- Nottingham University Hospitals, NHS Trust, Nottingham, UK
| | - Robert Ashford
- The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
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Wang KC, Xiao R, Cheung ZB, Barbera JP, Forsh DA. Early mortality after hip fracture surgery in COVID-19 patients: A systematic review and meta-analysis. J Orthop 2020; 22:584-591. [PMID: 33223732 PMCID: PMC7670234 DOI: 10.1016/j.jor.2020.11.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023] Open
Abstract
Objective The aim of this systematic review and meta-analysis was to assess the risk of early mortality in hip fracture patients with COVID-19 infection who undergo surgical intervention. Data sources MEDLINE (PubMed) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Study selection Studies were included in the systematic review if they reported postoperative mortality in patients with COVID-19 infection who underwent operative intervention for hip fracture. From this selection of studies, only investigations that reported postoperative mortality in a COVID-positive and a non-COVID group were included in the meta-analysis. Data extraction Data regarding patient demographics, age, and sex were recorded. Additional data that was extracted included study location, data collection period, length of follow-up, COVID testing methodology, COVID testing results, and number of patients who underwent operative versus nonoperative management. The primary outcome of interest was postoperative mortality. Data synthesis Random effects meta-analyses were performed to assess the pooled relative risk of postoperative mortality according to COVID status. Odds ratios and 95% confidence intervals (CI) were calculated. Conclusions The overall pooled mortality rate in the early postoperative period for hip fracture patients with concomitant COVID-19 infection was 32.6%. The relative risk for postoperative mortality in COVID-positive patients compared to non-COVID patients was 5.66 (95% CI 4.01–7.98; p < 0.001). The currently available literature demonstrates that COVID-19 infection represents a substantial risk factor for early postoperative mortality in the already susceptible hip fracture population. Further investigations will be needed to assess longer-term morbidity and mortality in this patient population. Level of evidence Therapeutic Level IV.
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Affiliation(s)
- Kevin C Wang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ryan Xiao
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Zoe B Cheung
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Joseph P Barbera
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - David A Forsh
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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