Early Outcomes of Elderly Hip Fracture Management during the COVID-19 Pandemic: A Report from the Philippines

Introduction: The multidisciplinary model of management for fragility hip fractures has only been recently introduced in the Philippines. Its development at the national and local level is made more difficult by the COVID-19 pandemic. To our knowledge, this is the first study to provide a comprehensive report on the clinical characteristics, current management and early outcomes of fragility hip fracture patients admitted during the COVID-19 pandemic in the setting of a country with an emerging economy. Methods: A multicenter prospective cohort study was conducted in the Philippines involving 12 hospitals from June 16, 2020 to February 28, 2021 during the Extended Community Quarantine Period during the COVID-19 pandemic. The clinico-demographic characteristics, treatments, and follow-up data at 30 days post-injury were gathered using the Research Electronic Data Capture (REDCAP) database system, using a minimum common data (MCD) which was adopted from the FFN MCD. Results: A total of 158 elderly patients (>60 years old) with fragility hip fractures were eligible for the study. 9 patients (5.7%) were confirmed or suspected to have COVID-19 infection. The median time of injury-to-admission was at least 3 (IQR: 1.0-13.7) days. 80% of the patients underwent surgical intervention with a median time from admission-to-surgery of at least 5 (IQR: 2.5-13.6) days. Notably, all non-COVID admitted patients had not been reported to have contracted the virus during their hospital stay. The 30-day mortality and morbidity rate for acute fragility fractures were 3.7%. Only the presence of a COVID-19 infection was found to be an independent and poor predictor for early mortality (P = 0.010). Conservatively managed patients had a significantly higher morbidity rate than surgically treated patients (13.6% vs 1.8%;P = 0.031). All five deaths occurred in non-surgical patients with an ASA grade of at least III. Conclusion: We recommend prompt admission and multidisciplinary care for elderly hip fracture patients even during the COVID-19 pandemic. Short-term outcomes remain favorable for non-COVID patients with acute fragility fractures treated with surgery. While a suspected or confirmed COVID-19 infection was the only significant and independent pre-operative risk factor for early mortality, there is evidence in the literature as well as in this study that the benefit of surgery may well outweigh the risk of conservatively treating COVID-19 patients provided that they can be optimized appropriately for surgery.

Lessons Learned: Patient Communication During the Pandemic.

A series of mortalities among musculoskeletal tumour patients secondary to medical illnesses during the first few months of the pandemic highlighted the need to review our methods of communication with patients. Prominent among patients' concerns had been a fear of consulting at hospitals and a lack of ready access to health care. Recommendations are made for proactive consultation and patient education, identifying at-risk patients for follow-up and probing for possible co-morbidities. Telemedicine use is encouraged bearing in mind its inherent limitations. A network of physicians and pharmaceutical representatives is an added help we can offer our patients who may be isolated by community quarantine.

Treatment of osteosarcoma patients in the Philippine general hospital during the COVID-19 outbreak

Objectives. The ongoing Coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems worldwide. This study aimed to document the effect of COVID-19 on osteosarcoma treatment pathways in the Philippine General Hospital (PGH) and determine if there were any delays. Method. A retrospective review of osteosarcoma patients treated at the PGH from January 1, 2019 – January 1, 2020 (pre-COVID-19) was compared to those treated during the COVID-19 pandemic from March 1, 2020 – September 1, 2020. Rates of diagnosed osteosarcoma, admission for chemotherapy, admission for surgery, treatment abandonment, metastatic disease on presentation, 1-year mortality, and amputation were calculated and compared between the two groups. Results. From March to September 2020, 11 newly diagnosed osteosarcoma patients sought consult at the PGH. Only one patient sought consult during the initial 3-4 months of the study, suggesting that patients delayed seeking healthcare during the period of enhanced community quarantine. Patients seen during the pandemic had a higher rate of metastatic disease on presentation, reflecting the delay in diagnosis. Due to COVID-19 restrictions early in the pandemic, osteosarcoma patients were coordinated and referred to outside hospitals for intravenous chemotherapy and surgery. Normalization of services (hospital admissions, limb salvage surgeries) were seen at the later stages of the study, corresponding to the loosening of the quarantine. Conclusions. Osteosarcoma patients experienced delays in seeking consult, diagnosis, and treatment at the PGH due to the COVID-19 pandemic. Early indicators suggest worse outcomes for these patients due to the delays. Strategies employed during the pandemic, such as networking of care and telemedicine, may help in future outbreaks. © 2021 University of the Philippines Manila. All rights reserved.