Abstract
IntroductionA novel virus, SARS-CoV-2 has caused a fatal global pandemic which particularly affects the elderly and those with co-morbidities. Hip fractures affect elderly populations, necessitate hospital admissions, and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality.MethodData related to seventy-five adult hip fractures admitted to two units during March and April 2020 was reviewed. The mean age was 83.5 years (range 65-98 years) and most (53, 70.7%) were females. The primary outcome measure was 30-day mortality associated with COVID-19 infection.ResultsThe COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in COVID-19 positive group (10/20, 50%) compared to COVID-19 negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval 17.0-22.5). The mean time from admission to surgery was 43.1 hours and 38.3 hours, in COVID-19 positive and COVID-19 negative groups, respectively. All COVID-19 positive patients had shown symptoms of fever and cough, and all ten cases who died were from hypoxia. Seven (35%) cases had radiological lung findings consistent with viral pneumonitis which resulted in mortality (70% of mortality). 30% (n = 6) contracted the COVID-19 infection in the community and 70% (n = 14) developed symptoms after hospital admission.ConclusionHip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest x-ray for patients presenting with hip fractures, helps in early planning of high-risk surgeries and allows counselling of the patients and family using realistic prognosis.
Highlights
A novel virus, SARS-CoV-2 has caused a fatal global pandemic which affects the elderly and those with co-morbidities
The hip fractures 30-day mortality associated with COVID-19 infection was assessed, but due to the small sample size, the analysis was limited to descriptive statistics to avoid Type I error.[15]
There was a significant difference of mortality rate in the COVID-19 positive group (n 1⁄4 10, 50%) compared to COVID-19 negative group (n 1⁄4 4, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5 days, Figure 1)
Summary
A novel virus, SARS-CoV-2 has caused a fatal global pandemic which affects the elderly and those with co-morbidities. Hip fractures affect elderly populations, necessitate hospital admissions, and place this group at particular risk from COVID-19 infection. At the time of writing, the death toll from COVID-19 infection in the UK has surpassed 30,000 and represents the highest record of national deaths in Europe.[1] The overall estimates of COVID-19 death rate in the UK is 0.66% increasing to 7.8% in the population of over 80 years of age[2]; higher death rates have been reported in cases with underlying health conditions or those of older age.[3,4] The virus spreads mainly via close contact and respiratory droplets that lead to a high transmission rate in groups in close contact such as hospitalised patients.[5,6]. Fragility hip fractures have an estimated incidence of 70,000 cases per year in the UK and are expected to reach 6.3 million world-wide by the year 2050.7,8 This injury affects elderly populations, necessitates hospital admission, and makes this group prone to COVID-19 infection. The 30-day mortality rate ranges from 3.5%–10%,10,11 with the National Hip Fracture Database (NHFD) showing a UK 30-day mortality rate of 7%.12 Different predictors and risk
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