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1.
J Am Acad Orthop Surg Glob Res Rev ; 6(1)2022 01 04.
Article in English | MEDLINE | ID: covidwho-1606097

ABSTRACT

BACKGROUND: This study investigated the outcomes of coronavirus disease (COVID-19)-positive patients undergoing hip fracture surgery using a national database. METHODS: This is a retrospective cohort study comparing hip fracture surgery outcomes between COVID-19 positive and negative matched cohorts from 46 sites in the United States. Patients aged 65 and older with hip fracture surgery between March 15 and December 31, 2020, were included. The main outcomes were 30-day all-cause mortality and all-cause mortality. RESULTS: In this national study that included 3303 adults with hip fracture surgery, the 30-day mortality was 14.6% with COVID-19-positive versus 3.8% in COVID-19-negative, a notable difference. The all-cause mortality for hip fracture surgery was 27.0% in the COVID-19-positive group during the study period. DICUSSION: We found higher incidence of all-cause mortality in patients with versus without diagnosis of COVID-19 after undergoing hip fracture surgery. The mortality in hip fracture surgery in this national analysis was lower than other local and regional reports. The medical community can use this information to guide the management of hip fracture patients with a diagnosis of COVID-19.


Subject(s)
COVID-19 , Hip Fractures , Adult , Cohort Studies , Hip Fractures/surgery , Humans , Retrospective Studies , SARS-CoV-2 , United States/epidemiology
2.
BMC Geriatr ; 21(1): 537, 2021 10 10.
Article in English | MEDLINE | ID: covidwho-1463233

ABSTRACT

BACKGROUND: Patients with hip fracture and depression are less likely to recover functional ability. This review sought to identify prognostic factors of depression or depressive symptoms up to 1 year after hip fracture surgery in adults. This review also sought to describe proposed underlying mechanisms for their association with depression or depressive symptoms. METHODS: We searched for published (MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection) and unpublished (OpenGrey, Greynet, BASE, conference proceedings) studies. We did not impose any date, geographical, or language limitations. Screening (Covidence), extraction (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist), and quality appraisal (Quality in Prognosis Studies tool) were completed in duplicate. Results were summarised narratively. RESULTS: In total, 37 prognostic factors were identified from 12 studies included in this review. The quality of the underlying evidence was poor, with all studies at high risk of bias in at least one domain. Most factors did not have a proposed mechanism for the association. Where factors were investigated by more than one study, the evidence was often conflicting. CONCLUSION: Due to conflicting and low quality of available evidence it is not possible to make clinical recommendations based on factors prognostic of depression or depressive symptoms after hip fracture. Further high-quality research investigating prognostic factors is warranted to inform future intervention and/or stratified approaches to care after hip fracture. TRIAL REGISTRATION: Prospero registration: CRD42019138690 .


Subject(s)
Depression , Hip Fractures , Depression/diagnosis , Depression/epidemiology , Depression/etiology , Hip Fractures/diagnosis , Hip Fractures/epidemiology , Hip Fractures/surgery , Humans , Prognosis , Systematic Reviews as Topic
3.
Orthopedics ; 44(5): 293-298, 2021.
Article in English | MEDLINE | ID: covidwho-1444385

ABSTRACT

Coronavirus disease 2019 (COVID-19) rapidly changed the landscape of health care, particularly in the New York City area. The elderly population is particularly vulnerable to both the novel coronavirus and the effects of a fracture. The goal of this study was to compare trends and outcomes of hip fracture patients during the pandemic. This was a retrospective chart review of hip fracture patients from a suburban academic hospital on Long Island, New York, who presented from March 1 to May 30, 2020. Patient COVID-19 status, demographics, and hospital outcome measures were recorded. Statistical analysis was performed using heteroscedastic t tests for quantitative variables and chi-square tests for qualitative variables. There were 82 patients in the 2020 cohort and 111 in the 2019 control group, representing a 29.9% decrease in cases. The 2020 cohort presented to the hospital an average of 2.77 days after injury compared with 1.15 days for the 2019 control group (P=.0976). Patients in the 2020 cohort were more likely to be discharged home than to rehabilitation (P<.0001) and tended to be discharged with oral anticoagulation (P=.0809). There was no increase in 1-, 3-, or 6-month complications or mortality. During the pandemic, fewer patients were admitted with hip fractures, and the time from injury to presentation doubled. Patients were significantly less likely to be discharged to rehabilitation and more were discharged with oral anticoagulants. Overall, there was no increase in complications, and these data indicate that the authors were successfully able to provide high-quality care to hip fracture patients during the pandemic. [Orthopedics. 2021;44(5):293-298.].


Subject(s)
COVID-19 , Hip Fractures/epidemiology , Hip Fractures/surgery , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Length of Stay , Male , New York City/epidemiology , Pandemics/prevention & control , Patient Discharge , Postoperative Complications/epidemiology , Retrospective Studies , SARS-CoV-2 , Time-to-Treatment , Treatment Outcome
4.
Ulus Travma Acil Cerrahi Derg ; 27(5): 547-551, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1395367

ABSTRACT

BACKGROUND: This present study was designed to evaluate the effect of restrictions on fracture admission to a Level-1 tertiary trauma hospital between COVID-19 pandemic and pre-pandemic restriction time intervals that included groups of younger than <20-years-old, 20-65-years-old, and older than aged >65-years-old. METHODS: Patients who were hospitalized and treated for orthopedic treatment between 10 March and 1 June during the pandemic period were retrospectively analyzed. Control group consisted of patients admitted to the hospital in the same time interval in 2019. The patients were divided into three groups, under 20 years of age, between 20 and 65 years of age, and over 65 years of age. The patients' data included age, gender, trauma mechanism, fracture type, and any COVID-19 radiological or clinical symptoms. RESULTS: The number of patients >65-years-old admitted to the orthopedic trauma center was high at pandemic intervals compared to pre-pandemic time. When the groups were compared for patients of 20-65-years-old; there was a significant difference for the fracture type (p<0.05). Lower extremity fractures were high at pre-pandemic group, whereas multiple traumas were high at pandemic group. For sub-group 20-65 ages, low-energy traumas were higher at pre-pandemic group, whereas high-energy traumas were more frequent at the pandemic group. CONCLUSION: We observed a decrease in fracture admission to orthopedic trauma centers during COVID-19 pandemic for subgroups of <20-years-old and 20-65-years-old ages, whereas there was a significant increase for >65-years-old age, most of them related to the osteoporotic hip fractures. So that older age group should be encouraged to mobilize at home and have permission to walk and make physical activity to avoid osteoporosis for a limited time daily.


Subject(s)
COVID-19 , Hip Fractures , Adult , Aged , Hip Fractures/epidemiology , Hip Fractures/surgery , Humans , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers , Young Adult
5.
Eur J Med Res ; 26(1): 86, 2021 Aug 04.
Article in English | MEDLINE | ID: covidwho-1339151

ABSTRACT

As one of the leading causes of elderly patients' hospitalisation, proximal femur fractures (PFFs) will present an increasing socioeconomic problem in the near future. This is a result of the demographic change that is expressed by the increasing proportion of elderly people in society. Peri-operative management must be handled attentively to avoid complications and decrease mortality rates. To deal with the exceptional needs of the elderly, the development of orthogeriatric centres to support orthogeriatric co-management is mandatory. Adequate pain medication, balanced fluid management, delirium prevention and the operative treatment choice based on comorbidities, individual demands and biological rather than chronological age, all deserve particular attention to improve patients' outcomes. The operative management of intertrochanteric and subtrochanteric fractures favours intramedullary nailing. For femoral neck fractures, the Garden classification is used to differentiate between non-displaced and displaced fractures. Osteosynthesis is suitable for biologically young patients with non-dislocated fractures, whereas total hip arthroplasty and hemiarthroplasty are the main options for biologically old patients and displaced fractures. In bedridden patients, osteosynthesis might be an option to establish transferability from bed to chair and the restroom. Postoperatively, the patients benefit from early mobilisation and early geriatric care. During the COVID-19 pandemic, prolonged time until surgery and thus an increased rate of complications took a toll on frail patients with PFFs. This review aims to offer surgical guidelines for the treatment of PFFs in the elderly with a focus on pitfalls and challenges particularly relevant to frail patients.


Subject(s)
Femoral Fractures/surgery , Aged , COVID-19/epidemiology , Delirium/prevention & control , Femoral Neck Fractures/classification , Femoral Neck Fractures/surgery , Femur Neck/anatomy & histology , Hip Fractures/surgery , Humans , Postoperative Complications/prevention & control , SARS-CoV-2
6.
Orthopedics ; 44(4): 223-228, 2021.
Article in English | MEDLINE | ID: covidwho-1320604

ABSTRACT

Geriatric hip fractures benefit from timely surgery. At the onset of the corona-virus disease 2019 (COVID-19) pandemic, shelter-in-place (SIP) orders were mandated in high-risk cities. The authors hypothesized that geriatric patients with hip fractures were more likely to present to the hospital greater than 24 hours after injury during SIP orders. They retrospectively reviewed patients 65 years or older who presented with hip fractures between March 20, 2020, and May 24, 2020 (SIP group), and between March 20, 2019, and May 24, 2019 (historical group). Primary outcomes were incidence of presentation greater than 24 hours after injury and mean number of days between injury and presentation. Secondary outcomes were incidence of preoperative deep venous thrombosis (DVT) and 30- and 90-day mortality rates. Thirty-three patients comprised the SIP group, and 50 patients comprised the historical group. There were no significant differences in their demographics or medical comorbidities. The SIP group was more likely to present greater than 24 hours after injury (P=.05) and presented a greater number of days after injury (P=.02). There was a significant difference in the incidence of preoperative DVT (P=.03). There were no significant differences in 30- and 90-day mortality rates. Geriatric patients who sustained hip fractures during SIP restrictions for COVID-19 were more likely to present greater than 24 hours after injury, have a greater number of days between injury and presentation, and be diagnosed with a preoperative DVT. [Orthopedics. 2021;44(4):223-228.].


Subject(s)
COVID-19 , Hip Fractures , Venous Thrombosis , Aged , Delayed Diagnosis , Hip Fractures/surgery , Humans , Quarantine , Retrospective Studies , SARS-CoV-2 , Venous Thrombosis/diagnosis
7.
Jt Dis Relat Surg ; 32(2): 333-339, 2021.
Article in English | MEDLINE | ID: covidwho-1279004

ABSTRACT

OBJECTIVES: The aim of this study is to investigate the effect of the novel coronavirus-2019 (COVID-19) pandemic on the operational trends in the orthopedic surgery department of a tertiary referral center. PATIENTS AND METHODS: A total of 305 orthopedic surgical procedures in 245 patients (136 males, 109 females; mean age: 34±26.6 years; range, 0 to 91 years) between March 16th and June 27th, 2020 were retrospectively analyzed. The same period of the year before including 860 procedures in 783 patients (364 males, 419 females; mean age: 33.6±25.8 years; range, 0 to 95 years) was also reviewed as a pre-pandemic control group. Patient demographics, surgical indications, COVID-19 polymerase chain reaction (PCR) test status, method of anesthesia, surgical subspecialties (trauma, sports, etc.), trauma mechanisms, and surgical priorities were evaluated. The pandemic and the pre-pandemic periods were compared. RESULTS: The rate of elective surgeries decreased compared to the previous year, and priority C type surgeries had the highest frequency (42.5%). Orthopedic trauma was the leading subspecialty with 91 (29.8%) cases and had a higher share, compared to the pre-pandemic period (17.0%). Hip fractures (18.7%) were the most common cause of trauma surgery, and simple falls (42.3%) composed the largest group of trauma mechanisms, which was similar to the pre-pandemic period (hip fractures, 13.6%; simple falls, 42.5%). The distribution of surgical urgency levels and subspecialties differed significantly between the pre-pandemic and pandemic periods (p<0.001). Post-hoc analysis of subspecialty distribution revealed a significant decrease in arthroplasty (p=0.002) and hand surgery (p<0.001), and a significant increase in trauma (p<0.001) and the "other" category (p<0.001). CONCLUSION: Our experience in a tertiary referral center illustrated a shift toward performing emergent and urgent surgeries, when the severity of the outbreak increased. Prioritizing surgical urgencies during the outbreak changed the orthopedic surgery practice with an emphasis on trauma and oncology surgeries. Hip fractures were the most common cause of trauma surgery, and simple falls composed the largest group of trauma mechanisms.


Subject(s)
Anesthesia/methods , COVID-19 , Elective Surgical Procedures , Hip Fractures , Musculoskeletal Diseases , Orthopedic Procedures , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , Hip Fractures/epidemiology , Hip Fractures/surgery , Humans , Male , Musculoskeletal Diseases/epidemiology , Musculoskeletal Diseases/etiology , Musculoskeletal Diseases/surgery , Orthopedic Procedures/methods , Orthopedic Procedures/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers/statistics & numerical data , Turkey/epidemiology , Wounds and Injuries/epidemiology , Wounds and Injuries/surgery
8.
Medicine (Baltimore) ; 100(23): e26283, 2021 Jun 11.
Article in English | MEDLINE | ID: covidwho-1266223

ABSTRACT

ABSTRACT: The aim of the present work was to evaluate the tolerance of physiotherapy treatment implemented for patients with coronavirus disease (COVID-19) and undergoing hip surgeryCase-control study. During the period between March and May 2020, 9 patients were enrolled in the study with diagnosis of COVID-19 and hip fracture. In order to evaluate the tolerability of physiotherapy treatment a comparison group, involving 27 patients with a hip fracture but in the absence of suspicion of COVID-19 positivity, were put together. Blood saturation and heart rate, number of physiotherapy sessions, start of physiotherapy from surgery, number of healthcare providers, recovery of ambulation, execution of walking training and dyspnea measured by Borg scale were collected before and after each single physiotherapy session to describe the exercise tolerance of the patients.There are no significant differences between the two groups regarding basic characteristics. Average of Borg scale post treatment for COVID patients was 1.3 (DS = 1.3) compared to 0.6 (DS = 0.7) of non-COVID patients (P < .0005) but the breathing difficulty was light during the treatment, only 9% of COVID patients had a worsening superior of two points with Borg scale compared to 3% of non-COVID patients (P = .138). The incidence of walking recovery was 63% in the non-COVID patients group compared to 44.4% in the COVID group (P = .329).Physiotherapy treatment of patients with COVID-19 infection and undergoing surgery for hip fracture is well tolerated and should be encouraged and well monitored.


Subject(s)
COVID-19/complications , Exercise Therapy/statistics & numerical data , Fracture Fixation/rehabilitation , Hip Fractures/rehabilitation , Aged , Aged, 80 and over , Female , Hip Fractures/complications , Hip Fractures/surgery , Humans , Male , Retrospective Studies
9.
Orthopedics ; 44(3): 180-186, 2021.
Article in English | MEDLINE | ID: covidwho-1239042

ABSTRACT

In an attempt to preserve essential equipment and health care system capacity and slow the spread of coronavirus disease 2019 (COVID-19) infection, Governor Murphy suspended all elective surgeries performed in New Jersey from March 27, 2020, through May 25, 2020. The objective of this study was to determine the incidence of postoperative COVID-19 infection following nonelective hip and knee surgery during the peak of the COVID-19 pandemic in New Jersey during this time. A retrospective cohort of 149 patients who underwent nonelective hip and knee surgery from March 27, 2020, through May 25, 2020, at 2 institutions was identified. The cohort was divided into hip fracture and non-fracture patients to compare the postoperative experience of these patient populations. The primary outcome was the incidence of postoperative COVID-19 infection diagnosed via severe acute respiratory syndrome coronavirus 2 nasopharyngeal real-time reverse transcription polymerase chain reaction. Secondary outcomes included length of stay, discharge disposition, postoperative complications, and mortality rate. A total of 149 patients underwent nonelective hip and knee surgeries, including 76 hip fracture cases and 73 nonelective hip and knee arthroplasty cases. A postoperative diagnosis of COVID-19 was made for 5 (6.6%) of 76 hip fracture patients, and 2 of the 5 died secondary to COVID-19. There were no infections in the arthroplasty cohort. This study describes a low incidence of COVID-19 infection after nonelective hip and knee surgery during the surge of the COVID-19 pandemic in New Jersey. Patients who underwent hip fracture surgery had an increased incidence of postoperative COVID-19 infection. [Orthopedics. 2021;44(3):180-186.].


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , COVID-19/etiology , Fracture Fixation , Postoperative Complications/etiology , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Case-Control Studies , Comorbidity , Female , Hip Fractures/surgery , Humans , Incidence , Male , Middle Aged , New Jersey/epidemiology , Pandemics , Postoperative Complications/epidemiology , Retrospective Studies , Risk Factors
10.
Int J Environ Res Public Health ; 18(10)2021 May 13.
Article in English | MEDLINE | ID: covidwho-1227031

ABSTRACT

The mortality of hip fracture (HF) patients is increased by concomitant COVID-19; however, evidence is limited to only short follow-up. A retrospective matched case-control study was designed with the aim to report the 90-day mortality and determine the hazard ratio (HR) of concomitant HF and COVID-19 infection. Cases were patients hospitalized for HF and diagnosed with COVID-19. Controls were patients hospitalized for HF not meeting the criteria for COVID-19 diagnosis and were individually matched with each case through a case-control (1:3) matching algorithm. A total of 89 HF patients were treated during the study period, and 14 of them were diagnosed as COVID-19 positive (overall 15.7%). Patients' demographic, clinical, and surgical characteristics were similar between case and control groups. At 90 days after surgery, 5 deaths were registered among the 14 COVID-19 cases (35.7%) and 4 among the 42 HF controls (9.5%). COVID-19-positive cases had a higher risk of mortality at 30 days (HR = 4.51; p = 0.0490) and 90 days (HR = 4.50; p = 0.025) with respect to controls. Patients with concomitant HF and COVID-19 exhibit high perioperative mortality, which reaches a plateau of nearly 30-35% after 30 to 45 days and is stable up to 90 days. The mortality risk is more than four-fold higher in patients with COVID-19.


Subject(s)
COVID-19 , Hip Fractures , COVID-19 Testing , Case-Control Studies , Hip Fractures/surgery , Humans , Italy/epidemiology , Retrospective Studies , SARS-CoV-2
11.
Br J Anaesth ; 127(1): 15-22, 2021 07.
Article in English | MEDLINE | ID: covidwho-1184858

ABSTRACT

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.


Subject(s)
COVID-19/epidemiology , Databases, Factual/trends , Hip Fractures/epidemiology , Hip Fractures/surgery , Aged , Aged, 80 and over , COVID-19/prevention & control , Cohort Studies , Female , Humans , Length of Stay/trends , Male , Patient Discharge/trends , Retrospective Studies , Treatment Outcome , United States/epidemiology
12.
J Orthop Surg Res ; 16(1): 237, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1166922

ABSTRACT

BACKGROUND: Concerns of contracting the highly contagious disease COVID-19 have led to a reluctance in seeking medical attention, which may contribute to delayed hospital arrival among traumatic patients. The study objective was to describe differences in time from injury to arrival for patients with traumatic hip fractures admitted during the pandemic to pre-pandemic patients. MATERIALS AND METHODS: This retrospective cohort study at six level I trauma centers included patients with traumatic hip fractures. Patients with a non-fall mechanism and those who were transferred in were excluded. Patients admitted 16 March 2019-30 June 2019 were in the "pre-pandemic" group, patients were admitted 16 March 2020-30 June 2020 were in the "pandemic" group. The primary outcome was time from injury to arrival. Secondary outcomes were time from arrival to surgical intervention, hospital length of stay (HLOS), and mortality. RESULTS: There were 703 patients, 352 (50.1%) pre-pandemic and 351 (49.9%) during the pandemic. Overall, 66.5% were female and the median age was 82 years old. Patients were similar in age, race, gender, and injury severity score. The median time from injury to hospital arrival was statistically shorter for pre-pandemic patients when compared to pandemic patients, 79.5 (56, 194.5) min vs. 91 (59, 420), p = 0.04. The time from arrival to surgical intervention (p = 0.64) was statistically similar between groups. For both groups, the median HLOS was 5 days, p = 0.45. In-hospital mortality was significantly higher during the pandemic, 1.1% vs 3.4%, p = 0.04. CONCLUSIONS: While time from injury to hospital arrival was statistically longer during the pandemic, the difference may not be clinically important. Time from arrival to surgical intervention remained similar, despite changes made to prevent COVID-19 transmission.


Subject(s)
COVID-19/epidemiology , Hip Fractures/epidemiology , Patient Admission , Time-to-Treatment , Aged , Aged, 80 and over , Cohort Studies , Female , Hip Fractures/surgery , Hospital Mortality , Humans , Length of Stay/statistics & numerical data , Long-Term Care , Male , Pandemics , Patient Discharge , Retrospective Studies , Skilled Nursing Facilities , Trauma Centers , United States/epidemiology
13.
Acta Orthop ; 92(4): 376-380, 2021 08.
Article in English | MEDLINE | ID: covidwho-1147908

ABSTRACT

Background and purpose - Many countries implemented strict lockdown policies to control the COVID-19 pandemic during March 2020. The impacts of lockdown policies on joint surgeries are unknown. Therefore, we assessed the effects of COVID-19 pandemic lockdown restrictions on the number of emergency and elective hip joint surgeries, and explored whether these procedures are more/less affected by lockdown restrictions than other hospital care.Patients and methods - In 1,344,355 persons aged ≥ 35 years in the Norwegian emergency preparedness (BEREDT C19) register, we studied the daily number of persons having (1) emergency surgeries due to hip fractures, and (2) electively planned surgeries due to hip osteoarthritis before and after COVID-19 lockdown restrictions were implemented nationally on March 13, 2020, for different age and sex groups. Incidence rate ratios (IRR) reflect the after-lockdown number of surgeries divided by the before-lockdown number of surgeries.Results - After-lockdown elective hip surgeries comprised one-third the number of before-lockdown (IRR ∼0.3), which is a greater drop than that seen in all-cause elective hospital care (IRR ∼0.6). Men aged 35-69 had half the number of emergency hip fracture surgeries (IRR ∼0.6), whereas women aged ≥ 70 had the same number of emergency hip fracture surgeries after lockdown (IRR ∼1). Only women aged 35-69 and men aged ≥ 70 had emergency hip fracture surgery rates after lockdown comparable to what may be expected based on analyses of all-cause acute care (IRR ∼0.80)Interpretation - It is important to note for future pandemics management that lockdown restrictions may impact more on scheduled joint surgery than other scheduled hospital care. Lockdown may also impact the number of emergency joint surgeries for men aged ≥ 35 but not those for women aged ≥ 70.


Subject(s)
COVID-19 , Communicable Disease Control , Elective Surgical Procedures , Emergency Medical Services , Hip Fractures , Osteoarthritis, Hip , Age Factors , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Civil Defense/statistics & numerical data , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Emergency Medical Services/methods , Emergency Medical Services/statistics & numerical data , Female , Hip Fractures/epidemiology , Hip Fractures/surgery , Hospitalization/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Norway/epidemiology , Osteoarthritis, Hip/epidemiology , Osteoarthritis, Hip/surgery , Registries/statistics & numerical data , SARS-CoV-2 , Sex Factors
14.
Ann R Coll Surg Engl ; 103(5): 337-344, 2021 May.
Article in English | MEDLINE | ID: covidwho-1133654

ABSTRACT

INTRODUCTION: The COVID-19 pandemic presented extraordinary challenges to the UK healthcare system. This study aimed to assess the impact of the COVID-19 lockdown on the epidemiology, treatment pathways and 30-day mortality rates of hip fractures. Outcomes of COVID-19 positive patients were compared against those who tested negative. METHODS: An observational, retrospective, multicentre study was conducted across six hospitals in the South East of England. Data were retrieved from the National Hip Fracture Database and electronic medical records. Data was collected for the strictest UK lockdown period (period B=23 March 2020-11 May 2020), and the corresponding period in 2019 (period A). RESULTS: A total of 386 patients were admitted during period A, whereas 381 were admitted during period B. Despite the suspension of the 'Best Practice Tariff' during period B, time to surgery, time to orthogeriatric assessment, and 30-day mortality were similar between period A and B. The length of inpatient stay was significantly shorter during period B (11.5 days vs 17.0 days, p<0.001). Comparison of COVID-19 positive and negative patients during period B demonstrated that a positive test was associated with a significantly higher rate of 30-day mortality (53.6% vs 6.7%), surgical delay >36h (46.4% vs 30.8%, p=0.049), and increased length of inpatient stay (15.8 vs 11.7 days, p=0.015). CONCLUSIONS: The COVID-19 lockdown did not alter the epidemiology of hip fractures. A substantially higher mortality rate was observed among patients with a COVID-19 positive test. These findings should be taken into consideration by the healthcare policymakers while formulating contingency plans for a potential 'second wave'.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Hip Fractures/epidemiology , Length of Stay/statistics & numerical data , Mortality , Public Policy , Time-to-Treatment/statistics & numerical data , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip , Bone Screws , COVID-19/complications , Cohort Studies , England/epidemiology , Female , Fracture Fixation, Internal , Fracture Fixation, Intramedullary , Hemiarthroplasty , Hip Fractures/complications , Hip Fractures/surgery , Humans , Male , Reoperation , SARS-CoV-2
15.
Eur J Trauma Emerg Surg ; 47(3): 659-664, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1126523

ABSTRACT

BACKGROUND AND PURPOSE: The outbreak of the COVID-19 pandemic has resulted in an overall decline in fractures. However, the amount of hip fractures has remained relatively stable throughout the period. The objective of this study is to investigate the impact of perioperative COVID-19 infections on mortality among hip fracture patients. METHODS: A meta-analysis was performed by collecting current data available through a systematic literature search in the PubMed database. The search was performed Oct 18 2020. RESULTS: The meta-analysis was conducted on a trial population consisting of 1.272 hip fracture patients with a pooled prevalence of COVID-19 of 18%. Mortality among hip fracture patients without a perioperative COVID-19 infection was 7.49%. Mortality among hip fracture patients infected with COVID-19 perioperatively was associated with an odds ratio of 6.70 [(95% CI 4.64-9.68), p < 0.00001, I2 = 41%]. A sensitivity analysis showed no major impact of assumptions regarding varying definitions of COVID-19 statuses among the included studies. CONCLUSION: Perioperative infections with COVID-19 in hip fracture patients are correlated with a significantly increased mortality. The meta-analysis showed a pooled odds ratio of 6.70 [(95% CI 4.64-9.68), p < 0.00001, I2 = 41%].


Subject(s)
COVID-19 , Hip Fractures , Perioperative Period/mortality , SARS-CoV-2/isolation & purification , COVID-19/diagnosis , COVID-19/epidemiology , Comorbidity , Hip Fractures/epidemiology , Hip Fractures/surgery , Humans , Mortality , Risk Assessment
16.
Surgeon ; 19(5): e318-e324, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1101517

ABSTRACT

BACKGROUND AND PURPOSE OF THE STUDY: This study reviewed whether the response to the Coronavirus (COVID-19) pandemic affected the care for hip fracture patients at a major trauma centre in Scotland during the first-wave lock-down period. METHODS: All patients referred to Orthopaedics with a hip fracture in a major trauma centre in Scotland were captured between 14 th March and 28 th May (11 weeks) in 2020 and 2019. Patients were identified using electronic patient records. The primary outcomes are time to theatre, length of admission and 30-day mortality. Secondary outcomes are COVID-19 prevalence, duration of surgery, proportion of patients to theatre within 36 hours and COVID-19 positive 30-day mortality from time of surgery. 225 patients were included: 108 from 2019 and 117 from 2020. THE MAIN FINDINGS: 30-day mortality was 3.7% (n=4) in 2019 and 8.5% (n=10) in 2020 (p=0.142). There was no statistical difference with time to theatre (p=0.150) nor duration of theatre (p=0.450). Duration of admission was reduced from 12 days to 6.5 days (p=<0.005). 4 patients tested positive for COVID-19 during admission, one 5 days after discharge, all underwent surgical management. 30-day mortality for COVID-19 positive patients during admission was 40%. COVID-19 prevalence of patients that were tested (n=89) was 5.62%. CONCLUSIONS: This study has shown the care of hip fracture patients has been maintained during the COVID-19 pandemic. There is no statistically significant change in mortality, time to theatre, and duration of surgery, however, the patient's admission duration was significantly less than the 2019 cohort.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control , Fracture Fixation/statistics & numerical data , Hip Fractures/surgery , Trauma Centers , Aged , Aged, 80 and over , COVID-19/prevention & control , COVID-19/transmission , Cross-Sectional Studies , Female , Hip Fractures/diagnosis , Hip Fractures/epidemiology , Hospitalization , Humans , Male , Middle Aged , Retrospective Studies , Scotland , Treatment Outcome
17.
J Orthop Surg Res ; 16(1): 155, 2021 Feb 24.
Article in English | MEDLINE | ID: covidwho-1102343

ABSTRACT

BACKGROUND: On the 11th March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. Multiple new guidelines were proposed and existing models of social, domestic and hospital care altered. Most healthcare systems were largely unprepared for this, and the pandemic has tested their adaptability. This study aimed to assess the impact of COVID-19 on the demographics, presentation, clinical management and outcomes of patients with proximal femoral (hip) fractures comparing them to a similar cohort of patients admitted a year earlier. METHODS: This retrospective multi-centre cohort study compared all patients admitted with hip fractures between 1st March and 30th May 2019 (group PC: pre-COVID-19) with hip fracture patients admitted over the same time period during the pandemic in 2020 (group C: COVID-19). The data was obtained from the hospitals' local and National Hip Fracture Databases. Mortality data was checked with the Office for National Statistics (ONS). Primary outcomes were time to theatre, in-patient length of stay and 30-day mortality. RESULTS: A total of 580 patients were included (304 group PC, 276 group C). Patient demographics including Charlson Comorbidity Index and Nottingham Hip Fracture Scores were broadly similar across the two cohorts. There was a significant reduction in the percentage of total hip replacements (11 to 5%, p = 0.006) in group C. There was an increase in conservative management (1 to 5%, p = 0.002) in group C. Time to theatre was significantly delayed in group C (43.7 h) vs group PC (34.6 h) (p ≤ 0.001). The overall length of hospital stay was significantly longer in group PC (16.6 days) vs group C (15 days) (p = 0.025). The 30-day mortality rate in group C was 9.8% compared to 8.2% in group PC (p = 0.746), but for COVID-19 (+) patients, it was significantly higher at 38.2% vs 5.8% in COVID-19 (-) patients (p < 0.001). CONCLUSION: This is one of the largest multi-centre comparative cohort study in the literature to date examining the impact of the COVID-19 pandemic on the management of hip fracture patients. Whilst mortality rates were similar in both groups, COVID-19-positive patients were almost seven times more likely to die, reflecting the seriousness of the COVID-19 infection and its sequelae in such elderly, vulnerable patients.


Subject(s)
Arthroplasty, Replacement, Hip/statistics & numerical data , COVID-19 , Hemiarthroplasty/statistics & numerical data , Hip Fractures/surgery , Pandemics , Aged , Aged, 80 and over , Female , Humans , Male , Retrospective Studies
19.
Surgeon ; 19(6): e440-e445, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1083221

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 is a pandemic that forced a transformation in the services provided by the National Health Service in the United Kingdom. Fragility hip fractures account for over 65,000 cases per year in the elderly population. The study aims to assess the impact of the pandemic on fragility hip fractures. METHODS: A retrospective data gather was performed to identify fragility hip fractures from the 23rd of March 2020 to the 13th of May 2020, and from the 23rd of March 2019 to the 13th of May 19. Two groups were formed and compared over their 30 day follow up. RESULTS: The control group comprised of 97 patients, with a mean age of 82.1 years old (62-102 years) and M:F ratio of 38:59. The case group comprised of 102 patients, with a mean age of 82.3 years old (60-100 years) and a M:F ratio of 16:86. Significant differences between groups were identified for gender (p < 0.001), time to theatre (p = 0.002), length of stay (p < 0.001) and COVID-19 status (p = 0.001). In the Case group, association with mortality was found for male gender (p = 0.041), right side (p = 0.031) and COVID-19 positive test results (p = 0.011). CONCLUSION: Early surgical intervention is advocated wherever possible, and sufficient optimisation, prior to surgery whenever a COVID-19 positive patient is identified. A safe rehabilitation environment is paramount for recovery in this group of patients. Further studies are required to understand the effect of this pandemic on the fragility hip fractures. LEVEL OF EVIDENCE: Level III: Retrospective case-control study.


Subject(s)
COVID-19 , Hip Fractures , Aged , Aged, 80 and over , Case-Control Studies , Hip Fractures/epidemiology , Hip Fractures/surgery , Humans , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , State Medicine , Trauma Centers , United Kingdom/epidemiology
20.
Eur Geriatr Med ; 12(4): 749-757, 2021 08.
Article in English | MEDLINE | ID: covidwho-1064670

ABSTRACT

INTRODUCTION: To analyze the effect of the COVID-19 pandemic on the provision of fragility hip fracture care, comparing patients treated before cohorting and in separate COVID-19 and non-COVID-19 circuits with the corresponding months in 2018 and 2019. MATERIALS AND METHODS: Retrospective single-center cohort study including 64 patients with fragility hip fractures treated during the COVID-19 pandemic (March 1st-May 1st, 2020), compared to 172 patients treated in 2018 and 2019. Dedicated COVID-19 and non-COVID-19 circuits were established on March 14th. Patients treated before cohorting (17 patients), in COVID-19 (14 patients) and non-COVID-19 circuits (33 patients) were included. RESULTS: Baseline characteristics were similar for 2018-19 and 2020. Patients in 2020 had a lower median surgical delay (50.5 vs. 91.3 h) and length of stay (9.0 vs. 14.0 days), while those with COVID-19, had longer surgical delays and length of stay (87.7 h and 15.0 days, respectively). Thirty-days mortality was higher among patients before cohorting, but similar in Covid-19 and non-Covid-19 pathways compared to 2018-19 (7.1% and 3.0% vs 5.2%, respectively). 23.5% of patients treated before circuiting suffered coronavirus infectious disease-19 disease after discharge. Following separation, no secondary cases of coronavirus infectious disease-19 were observed. CONCLUSIONS: Separate circuits for patients with and without coronavirus infectious disease-19 provided adequate hip fracture care. We did not observe increased mortality rates among hip fracture patients with preoperatively confirmed or suspected coronavirus infectious disease-19, compared to negative cases and 2018-19. Delaying surgery among patients with severe respiratory illness until a favourable trend could be observed did not lead to increased mortality.


Subject(s)
COVID-19 , Hip Fractures , Aged , Aged, 80 and over , COVID-19/prevention & control , Cohort Studies , Female , Hip Fractures/mortality , Hip Fractures/surgery , Humans , Male , Pandemics , Retrospective Studies , SARS-CoV-2
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