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OBJECTIVES@#Presence of COVID-19 infection in patients with acute fragility hip fracture complicates the decision-making process in the management of these patients. This study aims to describe outcomes of patients with coexisting fragility hip fracture and COVID-19 infection who underwent surgery.@*METHODS@#In this retrospective study, the patient database of a university hospital designated as a COVID-19 referral center with an orthogeriatric team was reviewed to determine the mortality and morbidity rates, and short-term functional outcomes of patients with coexisting COVID-19 and acute fragility hip fracture who underwent surgery.@*RESULTS@#A total of 18 patients were admitted with COVID-19 infection and acute fragility hip fracture – 12 had surgery. Mean injury-to-admission and admission-to-surgery intervals were 6.5 and 4.8 days, respectively. Most patients (91.7%) had an incidental finding of SARS-CoV-2 infection. Mean ASA score was 2.9. Arthroplasty was done in all patients with a mean operative time of 155.8 minutes and an average blood loss of 366.7 mL. Thirty-day mortality and morbidity rates were 16.7% and 33.3%, respectively. Mean EuroQoL overall health score was 79.3.@*CONCLUSION@#A multidisciplinary team approach is recommended to expedite timely surgery prior to the onset of clinical deterioration. Asymptomatic and mildly symptomatic patients with acute fragility hip fracture are candidates for urgent surgical intervention even in the presence of COVID-19 infection
ABSTRACT
Objectives@#Fragility hip fractures present not only as a significant cause of morbidity and mortality to the elderly population but also as an important source of financial burden due to staggering costs for treatment. This study is designed to determine the effects of timing of hospitalization to the treatment costs of patients with acute fragility hip fractures. @*Methods@#In this retrospective cohort study, the patient database of the University of the Philippines Manila-Philippine General Hospital Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service was reviewed to investigate the effects of timing of hospitalization to the treatment cost of patients with acute fragility hip fractures admitted in a tertiary government hospital. The economic burden of this group of patients was also computed. @*Results@#A total of 118 patients were enrolled in the study with 54 patients in the early hospitalization (EH) group ( 3 days from injury) and 64 in the delayed hospitalization (DH) group (4e28 days). Median treatment cost is less among the EH group than those who were in the DH group (P ¼ 0.0362). The computed economic burden of patients with acute fragility hip fractures is PhP 1,094,048,363.00 (USD 22,595,007.79) per year in the Philippines. @*Conclusions@#Fragility hip fractures impose significant financial impact; and therefore, recommend early hospitalization to lessen treatment cost. Future studies should also be undertaken to investigate other interventions that may help alleviate this burden.
ABSTRACT
Objectives@#Fragility hip fractures present not only as a significant cause of morbidity and mortality to the elderly population but also as an important source of financial burden due to staggering costs for treatment. This study is designed to determine the effects of timing of hospitalization to the treatment costs of patients with acute fragility hip fractures. @*Methods@#In this retrospective cohort study, the patient database of the University of the Philippines Manila-Philippine General Hospital Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service was reviewed to investigate the effects of timing of hospitalization to the treatment cost of patients with acute fragility hip fractures admitted in a tertiary government hospital. The economic burden of this group of patients was also computed. @*Results@#A total of 118 patients were enrolled in the study with 54 patients in the early hospitalization (EH) group ( 3 days from injury) and 64 in the delayed hospitalization (DH) group (4e28 days). Median treatment cost is less among the EH group than those who were in the DH group (P ¼ 0.0362). The computed economic burden of patients with acute fragility hip fractures is PhP 1,094,048,363.00 (USD 22,595,007.79) per year in the Philippines. @*Conclusions@#Fragility hip fractures impose significant financial impact; and therefore, recommend early hospitalization to lessen treatment cost. Future studies should also be undertaken to investigate other interventions that may help alleviate this burden.
ABSTRACT
@#<p style="text-align: justify;"><strong>Objective.</strong> The study compared functional outcomes among post-operative geriatric fragility hip fracture patients who received complete and incomplete rehabilitation.</p><p style="text-align: justify;"><strong>Methods.</strong> This is an ambispective cohort study of 50 acute fragility hip fractures over a 40-month period (October 2017 to November 2020) treated with either arthroplasty or internal fixation under the UP-PGH Orthogeriatric Fracture Liaison Service (FLS). Patients were contacted and interviewed through Telemedicine. They were asked to answer two questionnaires - the Modified Harris Hip Score (MHHS) and the EuroQol-5D-5L (EQ-5D-5L). The scores were tallied and used to describe and compare the post-operative functional outcomes between the two rehabilitation pathways.</p><p style="text-align: justify;"><strong>Results.</strong> Among the 50 patients included in this study, twenty-three (46%) patients underwent complete rehabilitation, while 27 (54%) underwent incomplete rehabilitation. The average corrected MHHS was at 82.5 suggesting good outcomes among all patients, with a higher-than-average outcome of 83.6 among patients who underwent complete rehabilitation, and an outcome of 75.9 among patients who underwent incomplete rehabilitation. Results to the EQ-5D--5L survey showed that a majority of patients who underwent complete rehabilitation reported having 'no problems' in terms of self-care, and anxiety or depression. However, the same group had more patients reporting 'any problems' in terms of mobility. On the other hand, a bigger proportion of patients from the incomplete rehabilitation group presented with 'any problems' in terms of usual activities. Proportions were similar for both groups in terms of pain or discomfort, with neither group having patients who reported extreme pain or discomfort.</p><p style="text-align: justify;"><strong>Conclusion.</strong> In spite of the heterogenous nature of the hip fracture population, functional outcome measures show generally good outcomes of patients under the UP-PGH Orthogeriatric FLS, with no significant difference among patients who receive complete rehabilitation from those who undergo incomplete rehabilitation. Continuing this study may better describe and differentiate the functional outcomes in order to pave the way for evidence-based protocols dedicated to providing the highest quality of care for acute fragility fracture patients.</p>