Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

Firas J Raheman,Robert Ashford,Reshid Berber,Jvalant Nayan Parekh,Djamila M Rojoa

doi:10.1038/s41598-021-89617-2

Firas J Raheman, Robert Ashford + Show 3 more

Open Access

https://doi.org/10.1038/s41598-021-89617-2

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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.

Highlights

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
Studies reporting COVID-19 positive patients only, as well as those comparing them to a COVID-19 non-positive cohort and a pre-pandemic cohort were included
We identified independent predictors of poor outcomes in hip fracture patients testing positive for COVID-19 and have demonstrated a four-fold increased risk of mortality in this cohort following admission (RR 4.59) and a 30-day mortality of 38% (HR 4.73)

Summary

Introduction

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. 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. Hip fractures constitutes a large proportion of emergency orthopaedic workload globally with approximately 1.66 million cases per y ear[2] They represent the commonest injury sustained by patients over 50 years of age with an incidence of 1.1% in the USA and 1.6% in Europe[3]. The aim of our systematic review, meta-analysis and meta-regression is to quantitatively assess the independent impact of COVID-19 on the mortality of hip fracture patients and identify characteristics predictive of poor outcomes. Further analysis of additional variables which may worsen prognosis of these patients is considered in view of a second and possible third ‘wave’ of COVID-19 until a definitive treatment of COVID-19 is a vailable[17]

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