Hip fracture care and mortality among patients treated in dedicated COVID-19 and non-COVID-19 circuits.

Abstract

To analyze the effect of the COVID-19 pandemic on the provision of fragility hip fracture care, comparing patients treated before cohorting and in separate COVID-19 and non-COVID-19 circuits with the corresponding months in 2018 and 2019. Retrospective single-center cohort study including 64 patients with fragility hip fractures treated during the COVID-19 pandemic (March 1st-May 1st, 2020), compared to 172 patients treated in 2018 and 2019. Dedicated COVID-19 and non-COVID-19 circuits were established on March 14th. Patients treated before cohorting (17 patients), in COVID-19 (14 patients) and non-COVID-19 circuits (33 patients) were included. Baseline characteristics were similar for 2018-19 and 2020. Patients in 2020 had a lower median surgical delay (50.5 vs. 91.3h) and length of stay (9.0 vs. 14.0days), while those with COVID-19, had longer surgical delays and length of stay (87.7h and 15.0days, respectively). Thirty-days mortality was higher among patients before cohorting, but similar in Covid-19 and non-Covid-19 pathways compared to 2018-19 (7.1% and 3.0% vs 5.2%, respectively). 23.5% of patients treated before circuiting suffered coronavirus infectious disease-19 disease after discharge. Following separation, no secondary cases of coronavirus infectious disease-19 were observed. Separate circuits for patients with and without coronavirus infectious disease-19 provided adequate hip fracture care. We did not observe increased mortality rates among hip fracture patients with preoperatively confirmed or suspected coronavirus infectious disease-19, compared to negative cases and 2018-19. Delaying surgery among patients with severe respiratory illness until a favourable trend could be observed did not lead to increased mortality.