Morbidity and mortality in hip surgery patients due to fracture during the COVID-19 pandemic.

BACKGROUND: The COVID-19 epidemic generated major changes in general surgical management protocols. The literature has reported high mortality rates for hip fracture surgery in patients with COVID-19. This study describes the morbidity and mortality in patients undergoing surgery due to hip fractures in 12 Colombian institutions between March and September 2020. METHODOLOGY: This was a retrospective observational descriptive study. Medical records of 12 hospitals were reviewed. Consecutive patients who underwent hip fracture surgery from March 6 to September 6, 2020, were included. Data collected were sociodemographic profile, type of fracture, surgical treatment, complications, and early (1 month) or mid-term (1-6 months) mortality associated or not with COVID-19. RESULTS: Five hundred twenty patients with hip fractures requiring surgery in the 12 institutions were included. 364 (70%) were women; mean age was 77.7 years (SD: 13.8), mean BMI was 25.1, 91.73% of patients had at least one comorbidity, 60.38% were classified as ASA II and 25.77% as ASA III. There were 267 (51.34%) pertrochanteric fractures, 227 (43.65%) femoral neck fractures, and 26 (5.0%) subtrochanteric fractures. 274 (52.69%) patients were treated with osteosynthesis, 244 (46.92%) with arthroplasty, and 2 (0.38%) with girdlestone. Surgery was performed less than 24 h after the fracture for 115 (22.11%) patients, between 24 and 72 h for 208 (40.0%) patients, and more than 72 h for 197 (37.88%) patients. One hundred six patients in total suffered a medical or surgical complication throughout the different follow-up stages, amongst the most frequent were respiratory failure, coronary events, surgical site infection, cutting-out and peri­implant fracture. 25 (4.8%) patients required attention in the Intensive Care Unit (ICU). 13 patients had COVID-19 throughout the follow-up period. 27 patients died due to any cause, and 3 of them had reported a positive COVID-19 test any time during follow-up period, of which one died during the first month, and two died between 1 and 6 months. Statistically significant associations were found between age older than 75 years old, ASA classification, ICU requirement, and death. CONCLUSION: 520 patients received surgical treatment for hip fracture during the first six months of the COVID-19 pandemic in 12 medical centers in Colombia. 21.10% suffered a complication during the early stage (30 days) and 4.77% during the midterm stage (1-6 months). 4.8% were admitted in the ICU during the early stage. All-cause death was 27 patients, early death was 11 (40.74%) and midterm death was 16 (59.25%). 13 patients were positive for COVID-19, 3 died, one (1/5=20%) on the first 30 days and the other two (2/8=25%) from month 1 to 6.

Mortality Increase after Hip Fracture in Aged Patients during the First 6 Months of the COVID-19 Epidemic

Background: The COVID-19 pandemic modified hospital functioning, social mobility and assistance to the elderly. These factors may alter hip fracture evolution. Method(s): Retrospective study of patients > 65 years suffering hip fracture fromthe 1st of March to the 31st of August of 2020, and compared with patients from the same period of 2019;199 patients from 2019 (79.4%women) (mean age: 84.9 +/- 7.72 years), and 203 patients from 2020 (69.5%women) (mean age: 85.37 +/- 8.13 years). Extracapsular fractures were 57.3% in 2019, and 58.6% in 2020. Follow-up was made until death or 6 months after surgery. Result(s): In 2019, 44 patients (22.1%) died in the six postoperative months, and 61 patients (30%) in 2020 (OR 1.513;95% CI 0.96-2.37;p = 0.199). There were no significant differences in mortality during postfracture hospitalization (11.1% in 2019;11.82% in 2020) and in the first postoperative month (16.6% in 2019;22.66% in 2020). Four patients died during hip fracture hospitalization over 8 patients presenting PCR+. In 30 patients SARS-CoV-2 infection was diagnosed during the six months after hip fracture in 13 patients thiswas the cause of death (21.3% of causes). Dementiawas associated with high mortality in patients with a SARS-CoV-2 diagnosis (6 out of 13 patients died with SARS-CoV-2 infection and dementia). Conclusion(s): An increase in the 6 postoperative months mortality in 2020 compared with the same period in 2019 was observed. An important cause of death was SARS-CoV-2 infection.Copyright © 2023, Taiwan Society of Geriatric Emergency & Critical Care Medicine.

Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists.

We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.