Older patients with proximal femur fractures and SARS-CoV-2 infection - An observational study.

Abdus S Burahee,Veronica E Barry,Robert P Sutcliffe,Sabreena Mahroof

doi:10.1051/sicotj/2021001

Abdus S Burahee, Veronica E Barry + Show 2 more

Open Access

https://doi.org/10.1051/sicotj/2021001

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Abstract

Background: Older patients are at increased risk of severe COVID-19 infection and associated mortality. There are limited data evaluating the outcome of older patients with hip fractures treated during the COVID-19 pandemic, and it has been suggested that these patients should be treated non-operatively due to high mortality risk. The aim of this study was to report the outcomes of COVID-19 infected hip fracture patients treated at a single centre. Methods: This was a retrospective cohort study. Data were collected from February 2020 (after the first confirmed COVID-19 infected patient was reported in the Midlands region of the UK). All patients admitted to the hospital with femoral neck fractures were included. Patient demographics, comorbidity, COVID-19 status, and short-term clinical outcomes were obtained by review of electronic medical records. The outcomes of COVID-19 infected patients were compared with non-COVID-19 patients treated during the study period. Results: Twenty-nine patients were included (mean age of 80 years), of whom 14 (48%) were tested positive for COVID-19 infection in the postoperative period. Overall, 26 patients (90%) underwent surgical treatment. COVID-19 infected patients had significantly higher Charlson comorbidity scores compared to the control group (5 vs. 4; p = 0.047). Only 5 COVID-19 infected patients (36%) required supplemental oxygen therapy in the postoperative period, and no patients required respiratory or other organ support. The 30-day mortality rate in COVID-19 patients was 14% compared to 0% in the negative controls (p = 0.22). Interpretation: COVID-19 infection did not increase the mortality rate of older patients undergoing surgery for hip fractures during the pandemic. The authors recommend careful assessment of patient fitness and prompt surgical treatment. In addition, it was noted that nearly all admissions were either given large boluses of Vitamin D or were on maintenance supplementation, which may have affected the severity of the response to COVID-19 infections.

Highlights

In December 2019, the World was introduced to a novel coronavirus disease (COVID-19) that originated in China and subsequently developed into a pandemic
The vast majority of patients in this study were older with significant medical comorbidity, typical of patients who sustain hip fractures, and would be considered at high risk of mortality from COVID-19 [8]
Two COVID-19 infected patients in this study died, the cause of death in both patients was unknown and not definitively due to COVID-19. It is not clear whether patients were COVID-19 positive at the time of hospital admission since testing was only performed in the postoperative period in patients who developed potential COVID-19 related symptoms

Summary

Introduction

In December 2019, the World was introduced to a novel coronavirus disease (COVID-19) that originated in China and subsequently developed into a pandemic. The majority of cases of COVID-19 are mild and self-limiting, European data shows 32% of patients require hospitalisation, and 2.4% require respiratory support and/or ventilation. Hip fractures in older patients carry a significant mortality rate, and it is well established that patients should undergo urgent surgery to facilitate early mobilisation and reduce morbidity [3]. Despite concerns that older patients with hip fractures may be susceptible to developing severe COVID-19 infection in the perioperative period, there is currently little evidence to support this. There is limited data available on the outcome of fracture patients with COVID-19 infection. A recent small study from Wuhan, China reported a mortality of 40% for patients with COVID-19 infection and concomitant fractures, and the authors recommended non-operative management of older patients with hip fractures [4]. The aim of this study was to report the outcomes of a consecutive series of

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