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Chung HJ, Lee BS, Sohn HS. Mortality Rate and Outcomes of Omicron Variant Positive Patients with Osteoporotic Fractures: A Retrospective Study. J Bone Metab 2024; 31:40-47. [PMID: 38485240 PMCID: PMC10940107 DOI: 10.11005/jbm.2024.31.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND During the lockdown period associated with the coronavirus disease 2019 (COVID-19) pandemic, increased mortality rates among patients with COVID-19 have been reported. This study aimed to analyze the mortality rate of osteoporotic hip fractures in patients who were COVID-19-positive after the lockdown during the Omicron period. METHODS A retrospective study was performed with 194 patients who were aged 70 years or more and diagnosed with osteoporotic hip fracture. The patients were divided into two groups according to their COVID-19 diagnoses. Surgery was performed within 10 days of diagnosis. Age, sex, past medical history, time until surgery, postoperative complications, and the primary outcome of mortality rate at 30 and 90 days were analyzed. RESULTS Among the 194 patients, 13 and 181 were in the COVID-19-positive and negative group, respectively. The total, 30-day, and 90-day mortality rates in the control and COVID-positive group were 11% and 0% (P=0.368), 1.7% and 0% (P=1.000), and 5.0% and 0% (P=1.000), respectively. No significant differences were observed in age, sex, history, time to surgery, postoperative complications, or postoperative mortality. In 1:1 propensity score matching, the time to surgery was 5.34 days in patients who were COVID-19-positive, and 3.00 days in patients who were COVID-19 negative, with no statistical significance (P=0.09). Age, sex, medical history, postoperative complications, and postoperative mortality were not significantly different between the groups. CONCLUSIONS Regardless of the COVID-19 diagnosis, surgical treatment without delay is believed to result in positive outcomes in older patients with osteoporotic hip fractures, as no significant differences in mortality rate and respiratory complications were observed between patients who were COVID-19-positive and those who were COVID-19 negative.
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Affiliation(s)
- Hoe Jeong Chung
- Department of Orthopedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Bum Seok Lee
- Department of Orthopedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hoon-Sang Sohn
- Department of Orthopedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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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? Eur J Orthop Surg Traumatol 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chan JP, Hoang H, Hashmi SZ, Lee YP, Bhatia NN. A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed? N Am Spine Soc J 2023; 16:100262. [PMID: 37720242 PMCID: PMC10504527 DOI: 10.1016/j.xnsj.2023.100262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 09/19/2023]
Abstract
Background Context COVID-19 has been shown to adversely affect multiple organ systems, yet little is known about its effect on perioperative complications after spine surgery or the optimal timing of surgery after an infection. We used the NIH National COVID Cohort Collaborative (N3C) database to characterize the risk profile in patients undergoing spine surgery during multiple time windows following COVID-19 infection. Methods We queried the National COVID Cohort Collaborative, a database of 17.4 million persons with 6.9 million COVID-19 cases, for patients undergoing lumbar spinal fusion surgery. Patients were stratified into those with an initial documented COVID-19 infection within 3 time periods: 0 to 2 weeks, 2 to 6 weeks, or 6 to 12 weeks before surgery. Results A total of 60,541 patients who underwent lumbar spinal fusion procedures were included. Patients who underwent surgery within 2 weeks of their COVID-19 diagnosis had a significantly increased risk for venous thromboembolic events (OR 2.29, 95% CI 1.58-3.32), sepsis (OR 1.56, 95% CI 1.03-2.36), 30-day mortality (OR 5.55, 95% CI 3.53-8.71), and 1-year mortality (OR 2.70, 95% CI 1.91-3.82) compared with patients who were COVID negative during the same period. There was no significant difference in the rates of acute kidney injury or surgical site infection. Patients undergoing surgery between 2 and 6 weeks or between 6 and 12 weeks from the date of COVID-19 infection did not show significantly elevated rates of any complication analyzed. Conclusions Patients undergoing lumbar spinal fusion within 2 weeks from initial COVID-19 diagnosis are at increased risk for perioperative venous thromboembolic events and sepsis. This effect does not persist beyond 2 weeks, however, so it may be warranted to postpone non-urgent spine surgeries for at least 2 weeks following a COVID-19 infection or to consider a more aggressive VTE chemoprophylaxis regimen for urgent surgery in COVID-19 patients.
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Affiliation(s)
- Justin P. Chan
- Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States
| | - Henry Hoang
- Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States
| | - Sohaib Z. Hashmi
- Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States
| | - Nitin N. Bhatia
- Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Casiraghi E, Wong R, Hall M, Coleman B, Notaro M, Evans MD, Tronieri JS, Blau H, Laraway B, Callahan TJ, Chan LE, Bramante CT, Buse JB, Moffitt RA, Stürmer T, Johnson SG, Raymond Shao Y, Reese J, Robinson PN, Paccanaro A, Valentini G, Huling JD, Wilkins KJ. A method for comparing multiple imputation techniques: A case study on the U.S. national COVID cohort collaborative. J Biomed Inform 2023; 139:104295. [PMID: 36716983 PMCID: PMC10683778 DOI: 10.1016/j.jbi.2023.104295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 02/01/2023]
Abstract
Healthcare datasets obtained from Electronic Health Records have proven to be extremely useful for assessing associations between patients' predictors and outcomes of interest. However, these datasets often suffer from missing values in a high proportion of cases, whose removal may introduce severe bias. Several multiple imputation algorithms have been proposed to attempt to recover the missing information under an assumed missingness mechanism. Each algorithm presents strengths and weaknesses, and there is currently no consensus on which multiple imputation algorithm works best in a given scenario. Furthermore, the selection of each algorithm's parameters and data-related modeling choices are also both crucial and challenging. In this paper we propose a novel framework to numerically evaluate strategies for handling missing data in the context of statistical analysis, with a particular focus on multiple imputation techniques. We demonstrate the feasibility of our approach on a large cohort of type-2 diabetes patients provided by the National COVID Cohort Collaborative (N3C) Enclave, where we explored the influence of various patient characteristics on outcomes related to COVID-19. Our analysis included classic multiple imputation techniques as well as simple complete-case Inverse Probability Weighted models. Extensive experiments show that our approach can effectively highlight the most promising and performant missing-data handling strategy for our case study. Moreover, our methodology allowed a better understanding of the behavior of the different models and of how it changed as we modified their parameters. Our method is general and can be applied to different research fields and on datasets containing heterogeneous types.
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Affiliation(s)
- Elena Casiraghi
- AnacletoLab, Department of Computer Science "Giovanni degli Antoni", Università degli Studi di Milano, Milan, Italy; CINI, Infolife National Laboratory, Roma, Italy; Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Rachel Wong
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Margaret Hall
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Ben Coleman
- The Jackson Laboratory for Genomic Medicine, Farmington, USA; Institute for Systems Genomics, University of Connecticut, Farmington, CT, USA
| | - Marco Notaro
- AnacletoLab, Department of Computer Science "Giovanni degli Antoni", Università degli Studi di Milano, Milan, Italy; CINI, Infolife National Laboratory, Roma, Italy
| | - Michael D Evans
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Jena S Tronieri
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah Blau
- The Jackson Laboratory for Genomic Medicine, Farmington, USA
| | - Bryan Laraway
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | - Lauren E Chan
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
| | - Carolyn T Bramante
- Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - John B Buse
- NC Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Endocrinology, Department of Medicine, University of North Carolina School of Medicine, USA
| | - Richard A Moffitt
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven G Johnson
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Yu Raymond Shao
- Harvard-MIT Division of Health Sciences and Technology (HST), 260 Longwood Ave, Boston, USA; Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Justin Reese
- Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, USA; Institute for Systems Genomics, University of Connecticut, Farmington, CT, USA
| | - Alberto Paccanaro
- School of Applied Mathematics (EMAp), Fundação Getúlio Vargas, Rio de Janeiro, Brazil; Department of Computer Science, Royal Holloway, University of London, Egham, UK
| | - Giorgio Valentini
- AnacletoLab, Department of Computer Science "Giovanni degli Antoni", Università degli Studi di Milano, Milan, Italy; CINI, Infolife National Laboratory, Roma, Italy
| | - Jared D Huling
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth J Wilkins
- Biostatistics Program, Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
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Jawad MU, Delman CM, Campbell ST, Fitzpatrick EP, Soles GLS, Lee MA, Randall RL, Thorpe SW. Traumatic Proximal Femoral Fractures during COVID-19 Pandemic in the US: An ACS NSQIP ® Analysis. J Clin Med 2022; 11:jcm11226778. [PMID: 36431255 PMCID: PMC9697726 DOI: 10.3390/jcm11226778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/06/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022] Open
Abstract
In order to determine the impact of COVID-19 on the treatment and outcomes in patients with proximal femoral fracture’s (PFF), we analyzed a national US sample. This is a retrospective review of American College of Surgery’s (ACS) National Surgical Quality Improvement Program (NSQIP) for patients with proximal femoral fractures. A total of 26,830 and 26,300 patients sustaining PFF and undergoing surgical treatment were sampled during 2019 and 2020, respectively. On multivariable logistic regression, patients were less likely to have ‘presence of non-healing wound’ (p < 0.001), functional status ‘independent’ (p = 0.012), undergo surgical procedures of ‘hemiarthroplasty’(p = 0.002) and ‘ORIF IT, Peritroch, Subtroch with plates and screws’ (p < 0.001) and to be ‘alive at 30-days post-op’ (p = 0.001) in 2020 as compared to 2019. Patients were more likely to have a case status ‘emergent’, ‘loss of ≥10% body weight’, discharge destination of ‘home’ (p < 0.001 for each) or ‘leaving against medical advice’ (p = 0.026), postoperative ‘acute renal failure (ARF)’ (p = 0.011), ‘myocardial infarction (MI)’ (p = 0.006), ‘pulmonary embolism (PE)’ (p = 0.047), and ‘deep venous thrombosis (DVT)’ (p = 0.049) in 2020 as compared to 2019. Patients sustaining PFF and undergoing surgical treatment during pandemic year 2020 differed significantly in preoperative characteristics and 30-day postoperative complications when compared to patients from the previous year.
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Affiliation(s)
- Muhammad Umar Jawad
- Department of Orthopedic Surgery, Good Samaritan Regional Medical Center, Corvallis, OR 97330, USA
| | - Connor M. Delman
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Sean T. Campbell
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Ellen P. Fitzpatrick
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Gillian L. S. Soles
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Mark A. Lee
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - R. Lor Randall
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Steven W. Thorpe
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
- Correspondence:
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Fotopoulou C, Khan T, Bracinik J, Glasbey J, Abu-Rustum N, Chiva L, Fagotti A, Fujiwara K, Ghebre R, Gutelkin M, Konney TO, Ng J, Pareja R, Kottayasamy Seenivasagam R, Sehouli J, Surappa ST, Bhangu A, Leung E, Sundar S. Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study. Am J Obstet Gynecol 2022; 227:735.e1-735.e25. [PMID: 35779589 PMCID: PMC9242690 DOI: 10.1016/j.ajog.2022.06.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. OBJECTIVE This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. STUDY DESIGN This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. RESULTS We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P=.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. CONCLUSION One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed.
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Affiliation(s)
- Christina Fotopoulou
- Department of Surgery and Cancer, Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - Tabassum Khan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Juraj Bracinik
- Particle Physics Group, School of Physics and Astronomy, University of Birmingham, Birmingham, United Kingdom
| | - James Glasbey
- National Institute for Health and Care Research Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
| | | | - Luis Chiva
- University Clinic of Navarra, Madrid, Spain
| | - Anna Fagotti
- Division Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center and on behalf of GOTIC and APGOT, Saitama, Japan
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology and Women's Health and Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Murat Gutelkin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Thomas O. Konney
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Joseph Ng
- Gynecologic Oncology Department, National University Cancer Institute, Singapore, Singapore
| | - Rene Pareja
- Gynecologic Oncology Unit, National Cancer Institute, Bogotá and Astorga Oncology Clinic, Medellín, Colombia
| | | | - Jalid Sehouli
- Department of Gynecology with Center of Surgical Oncology, Charité Campus Virchow Klinikum, Berlin, Germany
| | | | - Aneel Bhangu
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Elaine Leung
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom,Corresponding author: Sudha Sundar, MD, PhD
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8
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Mataloni F, Pinnarelli L, Colais P, Savastano J, Fusco D, Davoli M. The Impact of the COVID-19 Pandemic on the Neck of the Femur and Hip Fracture Surgery Volumes in the Lazio Region. Int J Environ Res Public Health 2022; 19:4704. [PMID: 35457568 DOI: 10.3390/ijerph19084704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
This study compares surgery volumes for fractures of the neck of the femur (FNF) and hip replacements during the COVID-19 pandemic compared with previous years. Historical (2018–2019) and pandemic (2020–2021) surgery rates for FNF and hip replacement in Lazio, adjusted for age and gender, were calculated per period and compared with a Poisson regression model. For hip replacement surgery, a comparison of different types of hospitals was also made. Before COVID-19’s spread, no difference was found in the volume of surgery of both interventions. From the lockdown to the end of 2021, a decrease in surgery volumes for FNF with stabilization between summer 2020 and summer 2021, as well as an additional decline beginning at the start of Omicron’s spread, were found. Hip replacement surgeries showed a greater decline during the lockdown period and increased during summer 2020 and during the Delta wave period. The increment in hip replacements, mainly observed in 2021, is due to private and religious hospitals. These results highlight that the pandemic emergency, caused by SARS-CoV-2, has had an important indirect effect on the population’s health assistance in the field of orthopedics.
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Pitts CC, Levitt EB, Patch DA, Mihas AK, Terrero A, Haendel MA, Chute CG, Ponce BA, Theiss SM, Spitler CA, Johnson MD. Ankle Fracture and Length of Stay in US Adult Population Using Data From the National COVID Cohort Collaborative. Foot & Ankle Orthopaedics 2022; 7:24730114221077282. [PMID: 35237737 PMCID: PMC8883310 DOI: 10.1177/24730114221077282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The National COVID Cohort Collaborative (N3C) is an innovative approach to integrate real-world clinical observations into a harmonized database during the time of the COVID-19 pandemic when clinical research on ankle fracture surgery is otherwise mostly limited to expert opinion and research letters. The purpose of this manuscript is to introduce the largest cohort of US ankle fracture surgery patients to date with a comparison between lab-confirmed COVID-19–positive and COVID-19–negative. Methods: A retrospective cohort of adults with ankle fracture surgery using data from the N3C database with patients undergoing surgery between March 2020 and June 2021. The database is an NIH-funded platform through which the harmonized clinical data from 46 sites is stored. Patient characteristics included body mass index, Charlson Comorbidity Index, and smoking status. Outcomes included 30-day mortality, overall mortality, surgical site infection (SSI), deep SSI, acute kidney injury, pulmonary embolism, deep vein thrombosis, sepsis, time to surgery, and length of stay. COVID-19–positive patients were compared to COVID-19–negative controls to investigate perioperative outcomes during the pandemic. Results: A total population of 8.4 million patient records was queried, identifying 4735 adults with ankle fracture surgery. The COVID-19–positive group (n=158, 3.3%) had significantly longer times to surgery (6.5 ± 6.6 vs 5.1 ± 5.5 days, P = .001) and longer lengths of stay (8.3 ± 23.5 vs 4.3 ± 7.4 days, P < .001), compared to the COVID-19–negative group. The COVID-19–positive group also had a higher rate of 30-day mortality. Conclusion: Patients with ankle fracture surgery had longer time to surgery and prolonged hospitalizations in COVID-19–positive patients compared to those who tested negative (average delay was about 1 day and increased length of hospitalization was about 4 days). Few perioperative events were observed in either group. Overall, the risks associated with COVID-19 were measurable but not substantial. Level of Evidence: Level III, retrospective cohort study.
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Affiliation(s)
- Charles C. Pitts
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eli B. Levitt
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - David A. Patch
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexander K. Mihas
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Alfredo Terrero
- Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
- Department of Translational Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Melissa A. Haendel
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher G. Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Steven M. Theiss
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Clay A. Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael D. Johnson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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