[Translated article] Has the COVID-19 lockdown influenced the mortality of hip fracture? Analysis of one-year mortality.

INTRODUCTION AND OBJECTIVES: The main objective of this study is to analyse the one-year mortality in patients with intracapsular hip fracture who were admitted during severe social confinement in the first months of the COVID-19 lockdown and compare it with previous years. MATERIAL AND METHODS: Retrospective observational study in which a cohort from March 14 to June 21, 2020 (pandemic group, n=62) was compared with a control cohort on the same dates in the years 2017, 2018 and 2019 (control group, n=172). Thirty-day-mortality and one-year-mortality, orthopaedic complications, ASA grade, comorbidities, diagnosis and treatment, time to surgery and mean stay were measured. RESULTS: No significant differences were found in 30-day mortality (p=0.156; 9.7% compared to 4.7%) or in one-year mortality (p=0.47) between the pandemic group (21%) and the control one (16.9%). A decrease in surgical delay and mean stay was observed in the pandemic group, although without statistical significance. CONCLUSION: The State of Alarm modified the distribution of the type of hip fracture with a predominance of intracapsular fracture. Maintaining the same hospital management as prior to the pandemic period made it possible not to increase 30-day mortality and one-year mortality in patients with intracapsular hip fracture.

Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country). / [Artículo traducido] Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco).

OBJECTIVES: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. DESIGN: Retrospective comparative study. SETTING: Three university hospitals in Biscay province (Basque Country, Spain). PATIENTS: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). INTERVENTION: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. MAIN OUTCOME MEASUREMENTS: 30-Day mortality rate and risk factors for mortality. RESULTS: Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. CONCLUSIONS: SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality. LEVEL OF EVIDENCE: Level III study.

Impact of the COVID-19 pandemic on the mortality of the elderly patient with a hip fracture. / Impacto de la pandemia COVID-19 en la mortalidad del paciente anciano con fractura de cadera.

COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. METHODS: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d'Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. RESULTS: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). CONCLUSION: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality.

Hip fracture in elderly and COVID-19 infection. Report of 3 cases. / Fractura de cadera en el anciano e infección por COVID-19. Descripción de 3 casos.

Since its first description in china in January 2020, COVID-19 pandemia outbreak has affected health organization and conventional care in all settings as wards, intensive care and surgery. Hip fracture patients usually are older and have a lot of comorbidities. This type of patientes benefit from early surgery. However, surgery in COVID-19 patients with active infection is associate with bad outcomes and mortality. We present three patients with COVID infection undergoing hip fracture surgery. Surgery was performed tree weeks after admission. Despite have risk factor (old age, arterial hypertension, elevated inflammatory parameters) the outcome was good and were discharged from hospital without events.