Are Hospitals Safe? A Prospective Study on SARS-CoV-2 Prevalence and Outcome on Surgical Fracture Patients: A Closer Look at Hip Fracture Patients.

Abstract

Objectives:To describe clinical characteristics of fracture patients, including a closer look to hip fracture patients, and determine how epidemiological variables may have influenced on a higher vulnerability to SARS-CoV-2 infection, as the basis for the considerations needed to reintroduce elective surgery during the pandemic.Design:Longitudinal prospective cohort study.Setting:Level I Trauma Center in the East of Spain.Patients/Participants:One hundred forty-four consecutive fracture patients 18 years or older admitted for surgery.Intervention:Patients were tested for SARS-CoV-2 with either molecular and/or serological techniques and screened for presentation of COVID-19.Main Outcome Measurements:Patients were interviewed and charts reviewed for demographic, epidemiological, clinical, and surgical characteristics.Results:We interviewed all patients and tested 137 (95.7%) of them. Three positive patients for SARS-CoV-2 were identified (2.1%). One was asymptomatic and the other 2 required admission due to COVID-19-related symptoms. Mortality for the whole cohort was 13 patients (9%). Significant association was found between infection by SARS-CoV-2 and epidemiological variables including: intimate exposure to respiratory symptomatic patients (P = 0.025) and intimate exposure to SARS-CoV-2-positive patients (P = 0.013). No association was found when crowding above 50 people was tested individually (P = 0.187). When comparing the 2020 and 2019 hip fracture cohorts we found them to be similar, including 30-day mortality. A significant increase in surgical delay from 1.5 to 1.8 days was observed on the 2020 patients (P = 0.034).Conclusions:Patients may be treated safely at hospitals if strict recommendations are followed. Both cohorts of hip fracture patients had similar 30-day mortality.Level of Evidence:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.