Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review.

BACKGROUND: The COVID-19 pandemic has impacted healthcare in various vulnerable patient subpopulations. However, data are lacking on the impact of COVID-19 on hip fractures, seen mainly in older patients. Using national claims data, we aimed to describe the epidemiology during the first COVID-19 wave in the USA. METHODS: We compared patients admitted for hip fractures during March and April of 2020 with those admitted in 2019 in terms of patient and healthcare characteristics, COVID-19 diagnosis, and outcomes. An additional comparison was made between COVID-19-positive and -negative patients. Outcomes included length of hospital stay (LOS), admission to an ICU, ICU LOS, use of mechanical ventilation, 30-day readmission, discharge disposition, and a composite variable of postoperative complications. RESULTS: Overall, 16 068 hip fractures were observed in 2019 compared with 7498 in 2020. Patients with hip fractures in 2020 (compared with 2019) experienced earlier hospital discharge and were less likely to be admitted to ICU, but more likely to be admitted to home. Amongst 83 patients with hip fractures with concomitant COVID-19 diagnosis, we specifically observed more non-surgical treatments, almost doubled LOS, a more than 10-fold increased mortality rate, and higher complication rates compared with COVID-19-negative patients. CONCLUSIONS: The COVID-19 pandemic significantly impacted not only volume of hip fractures, but also patterns in care and outcomes. These results may inform policymakers in future outbreaks and how this may affect vulnerable patient populations, such as those experiencing a hip fracture.

The Impact of Immunization and Use of Oseltamivir on Influenza-Related Hospitalizations: A Population-Based Study.

BACKGROUND: As the COVID-19 pandemic continues into flu season, it is critical to minimize hospitalizations to maximize capacity and preserve critical care resources. We sought to identify risk factors for influenza-related hospitalization, specifically the role of immunization and oseltamivir prescriptions. METHODS: Patients with influenza diagnoses were identified from the MarketScan database (2014-2018). Primary risk factors of interest were an influenza vaccination within 6 months prior to infection and oseltamivir prescriptions (filled on the day diagnosis, the following day, or 2-5 days). A multivariable logistic regression model was run to identify risk factors for influenza-related hospitalizations within 30 days of diagnosis. RESULTS: Among 2 395 498 influenza infections, 0.27% were hospitalized. Of those prescribed oseltamivir the day of diagnosis, 0.13% were later hospitalized, compared to 0.67% among those who filled prescriptions the following day and 11.8% when filled within 2 to 5 days. Upon adjustment, oseltamivir prescriptions filled on the day of diagnosis were associated with significantly decreased odds of hospitalization (OR 0.51 CI 0.48-0.55). Prescriptions filled within 1 to 5 days of diagnosis were associated with significantly increased odds of hospitalization (1 day OR 2.01 CI 1.81-2.24; 2-5 days OR 34.1 CI 31.7-36.6). Flu vaccination was associated with a lower odds for hospitalization (OR 0.84 CI 0.74-0.95). CONCLUSIONS: We recommend oseltamivir be prescribed to patients when they first present with influenza-like symptoms to reduce the burden on the healthcare system. We also identified reduced odds of hospitalization associated with influenza vaccination, which is already well established, but particularly important this coming flu season.