Abstract
BackgroundOn the 11th March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. Multiple new guidelines were proposed and existing models of social, domestic and hospital care altered. Most healthcare systems were largely unprepared for this, and the pandemic has tested their adaptability. This study aimed to assess the impact of COVID-19 on the demographics, presentation, clinical management and outcomes of patients with proximal femoral (hip) fractures comparing them to a similar cohort of patients admitted a year earlier.MethodsThis retrospective multi-centre cohort study compared all patients admitted with hip fractures between 1st March and 30th May 2019 (group PC: pre-COVID-19) with hip fracture patients admitted over the same time period during the pandemic in 2020 (group C: COVID-19). The data was obtained from the hospitals’ local and National Hip Fracture Databases. Mortality data was checked with the Office for National Statistics (ONS). Primary outcomes were time to theatre, in-patient length of stay and 30-day mortality.ResultsA total of 580 patients were included (304 group PC, 276 group C). Patient demographics including Charlson Comorbidity Index and Nottingham Hip Fracture Scores were broadly similar across the two cohorts. There was a significant reduction in the percentage of total hip replacements (11 to 5%, p = 0.006) in group C. There was an increase in conservative management (1 to 5%, p = 0.002) in group C. Time to theatre was significantly delayed in group C (43.7 h) vs group PC (34.6 h) (p ≤ 0.001). The overall length of hospital stay was significantly longer in group PC (16.6 days) vs group C (15 days) (p = 0.025). The 30-day mortality rate in group C was 9.8% compared to 8.2% in group PC (p = 0.746), but for COVID-19 (+) patients, it was significantly higher at 38.2% vs 5.8% in COVID-19 (−) patients (p < 0.001).ConclusionThis is one of the largest multi-centre comparative cohort study in the literature to date examining the impact of the COVID-19 pandemic on the management of hip fracture patients. Whilst mortality rates were similar in both groups, COVID-19-positive patients were almost seven times more likely to die, reflecting the seriousness of the COVID-19 infection and its sequelae in such elderly, vulnerable patients.
Highlights
On the 11th March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic
Wignall et al Journal of Orthopaedic Surgery and Research (2021) 16:155 (Continued from previous page). This is one of the largest multi-centre comparative cohort study in the literature to date examining the impact of the COVID-19 pandemic on the management of hip fracture patients
Whilst mortality rates were similar in both groups, COVID-19-positive patients were almost seven times more likely to die, reflecting the seriousness of the COVID-19 infection and its sequelae in such elderly, vulnerable patients
Summary
On the 11th March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has spread to most countries in the world, with the World Health Organization (WHO) declaring a COVID-19 pandemic on March 11, 2020 [1]. This has placed enormous strains on National Health Systems (NHS), leading to significant changes in the way many conditions are managed [2,3,4,5,6,7]. In the United Kingdom (UK), this has led to unprecedented pressures on the NHS [8] Even during this pandemic, patients with hip fractures remain one of the commonest reasons for admissions [9,10,11]. Changes to standard management plans may be required to minimise patient exposure to disease and overall impact on resources” [18]
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