COVID-19 Is Associated With a 4 Fold Increase in 30-day Mortality Risk in Hip Fracture Patients in the United Kingdom: A Systematic Review and Meta-analysis

COVID-19 hip fracture outcomes: The role of Ct values and D-dimer levels?

Introduction

The COVID-19 pandemic has caused high mortality rates in hip fracture patients, but data for Asian patients are lacking. Whilst Cycle threshold (Ct) values and D-dimer have been reported as predictors of mortality in COVID-19 patients, their prognostic roles in those with concomitant hip fracture remain unknown. The objectives of this study were to i) assess the clinical outcomes of COVID-19 hip fractures patients in the Chinese population, ii) identify risk factors of mortality and complications, and iii) determine the prognostic roles of Ct values and D-dimer levels.

Methodology

This cohort study was conducted during the 5th wave of the COVID-19 pandemic. Inclusion criteria were 1) hip fracture 2) ​≥ ​60 years old 3) low-energy trauma. Outcomes were 90-day all-cause mortality, complications, length of stay, discharge destination and mobility status. Logistic regression analysis was performed to identify risk factors for mortality and complications. Subgroup analysis was performed for patients with Ct ​< ​30 and Ct ​> ​30, comparing their outcomes of operations performed within 48 ​h vs beyond 48 ​h.

Results

159 hip fracture patients were included, 42 patients were COVID-19 positive. COVID-19 group had significantly higher 90-day mortality rates (21.4% vs 9.4%), complication rates (45.2% vs 28.2%) and longer length of stay (17.06 vs 10.84 nights). COVID-19 was an independent risk factor for mortality and complications. Amongst the COVID-19 group, risk factors for poor outcomes were advanced age, steroids use, conservative treatment and American Society of Anaesthesiologists (ASA) score ≥ 3. Conservative treatment was associated with higher mortality (OR ​= ​16.00; p ​= ​0.025) in COVID-19 hip fracture patients. There was no significant difference between Ct values ​< ​30 and >30 regarding mortality and complication rate. D-dimer and timing to operation did not affect outcomes.

Conclusions

Patients with concomitant COVID-19 and hip fracture are at high risk of mortality and complications. Ct values and D-dimer levels have no prognostic roles for hip fracture outcomes. Early operative treatment is recommended as soon as patients are medically fit.

COVID-19 Infection Was Associated with the Functional Outcomes of Hip Fracture among Older Adults during the COVID-19 Pandemic Apex

Background and Objectives: Hip fractures are associated with mortality and poor functional outcomes. The COVID-19 pandemic has affected patterns of care and health outcomes among fracture patients. This study aimed to determine the influence of COVID-19 infection on hip fracture recovery. Materials and Methods: We prospectively collected data on patients with hip fractures who presented at Hualien Tzu Chi Hospital between 9 March 2022 and 9 September 2022. The data included demographic information and functional scores taken before, during, and after surgery. The patients were divided into two groups: COVID-19 (+) and COVID-19 (-). Results: This study recruited 85 patients, 12 of whom (14.12%) were COVID-19 (+). No significant differences in preoperative or perioperative parameters between the two groups were observed. The postoperative Barthel index score was significantly impacted by COVID-19 infection (p = 0.001). The incidence of postoperative complications was significantly correlated with general anesthesia (p = 0.026) and the length of stay (p = 0.004) in hospital. Poor postoperative functional scores were associated with lower preoperative Barthel index scores (p < 0.001). Male sex (p = 0.049), old age (p = 0.012), a high American Society of Anesthesiologists grade (p = 0.029), and a high Charlson comorbidity index score (p = 0.028) were associated with mortality. Conclusions: Hip fracture surgeries were not unduly delayed in our hospital during the COVID-19 pandemic, but the patients' postoperative Barthel index scores were significantly influenced by COVID-19 (+). The preoperative Barthel index score may be a good predictive tool for the postoperative functional recovery of these patients.

COVID-19 Vaccination: Does It Alter Postoperative Mortality and Morbidity in Hip Fractures?

Introduction The primary aim of our study was to evaluate the impact of coronavirus disease 2019 (COVID-19) vaccination on mortality in patients with hip fractures by comparing it to those who are unvaccinated. Our secondary objective was to compare the impact on postoperative morbidity parameters like length of hospital stay and complications. Methods A total of 619 hip fractures were divided into the 'Vaccinated group' consisting of 300 patients who had COVID-19 vaccination and the 'Unvaccinated group' consisting of 319 patients who were not vaccinated. Patient demographic variables, Nottingham hip fracture score, American Society of Anesthesiologists (ASA) grade, type of anaesthesia used, and Charlson Comorbidity Index were collected. Our primary outcome measures were 30- and 90-day mortality. Secondary outcome measures included postoperative complications like thromboembolic complications, cardiac, and respiratory complications, etc. Mortality among the COVID-positive patients was also compared between the groups. Results Thirty-day postoperative mortality was higher in the unvaccinated group at 13.2% than in the vaccinated group at 5.3%. A similar increase in 90-day mortality was also observed in the unvaccinated group at 24.8% when compared to 14.7% in the vaccinated group(p<0.001). Despite having a higher baseline prevalence of cardiac comorbidities, the Vaccinated group had fewer post-operative cardiac, thromboembolic, and neurological complications (p>0.05). Moreover, electrolyte imbalance and AKI were also seen in fewer patients in the vaccinated group compared to the control group (p<0.05). Furthermore, it was found that among the vaccinated patients who did have perioperative COVID-19 infection, the 30-day mortality was significantly lower (10%) compared to the control group (31.2%) (p<0.001). Similarly, 90-day mortality was significantly lower (25%) compared to the control group (43.75%) (p<0.001). Conclusion Vaccination against COVID-19 independently reduced mortality and morbidity among patients with hip fractures when compared to those who are not vaccinated. Furthermore, it decreased the risk of acquiring COVID-19, and subsequent postoperative complications. Among those who are infected with COVID-19 despite vaccination, the mortality was significantly lesser.

Greater length of hospital stay for concurrent hip and upper limb fractures compared to isolated hip fractures: a systematic review of 13 studies including 210,289 patients and meta-analysis

BACKGROUND

The impact of concurrent upper limb and fragility hip fractures has not been well defined. A greater understanding of this can guide decision making in the early peri-operative period and subsequent rehabilitation of such patients.

AIMS

To identify if patients with concurrent upper limb and fragility hip fractures have different outcomes and demographics than those with an isolated hip fracture.

METHODS

A search of MEDLINE and EMBASE was performed to identify cohort and case-control studies, comparing concurrent hip and upper limb fractures with isolated hip fractures. Meta-analysis was conducted using RevMan 5.4. Subgroup analyses were performed for concurrent distal radius and concurrent proximal humerus fractures.

RESULTS

13 studies were included reporting on 196,916 patients with an isolated hip fracture and 13,373 with concurrent hip and upper limb fractures. Patients with concurrent upper limb fractures had a significantly longer length of hospital stay (mean difference: 3.97 days, 95% CI: 1.36, 6.57, P=0.003) as compared to those with isolated hip fractures. Patients with concurrent upper limb fractures were significantly more likely to be female (OR: 0.57, 95% CI: 0.46, 0.70, P<0.00001), reside at home pre-injury (OR: 0.6, 95% CI: 0.37, 0.96, P=0.03) and have no cognitive impairment (OR: 0.54, 95% CI: 0.35, 0.84, P=0.006). Patients with concurrent distal radius fractures had significantly lower 90-day mortality (OR: 0.70, 95% CI: 0.49, 0.99, P=0.04) and 1-year mortality (OR: 0.68, 95% CI: 0.51, 0.90, P=0.008).

CONCLUSIONS

Concurrent fragility hip and upper limb fractures are associated with increased length of hospital stay. We recommend early, aggressive, individualised rehabilitation to help improve outcomes and early hospital discharge in this highly vulnerable patient group.