The Effects of COVID-19 on Geriatric Hip Fracture Management and 1-Year Mortality in Beijing.

ABSTRACT

OBJECTIVES: Concerns about the coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented challenges to the management of geriatric hip fractures. We aimed to evaluate the effects of the COVID-19 surge on the time to surgery and 1 year mortality in geriatric patients with hip fracture at a large, urban Level 1 trauma center in Beijing, and to guide the management of geriatric hip fracture patients throughout the COVID-19 pandemic. METHODS: This single-center retrospective study included consecutive patients aged ≥65 years and injured 3 weeks prior to admission. Demographic and surgical data were collected between January 20 and May 31, 2020, and from the same period in 2019. Mortality data and functional status were collected at follow-up of 1-year after surgery. The primary outcomes were time to surgery and 1 year mortality. RESULTS: There were no significant differences in sex, fracture type, and surgical pattern between the 2020 (n = 261) and 2019 time-matched (n = 307) cohorts. The time from admission to surgery was significantly delayed in the 2020 cohort compared with that in the 2019 cohort (48.9 h vs 20.5 h, p < 0.001). Fewer patients underwent surgery within 48 h in the 2020 cohort (65.5% vs 87.6%, p < 0.001). Surgical delay was also associated with an increased risk of inpatient complications (30.2% vs 20.8%, p = 0.010), however there was no significant difference in the 1-year mortality rate, nor between pre-injury and 1 year follow-up mobility as assessed by Parker score. Only approximately half of the patients in both groups completely returned to their pre-injury mobility levels. CONCLUSIONS: The COVID-19 pandemic has significantly increased the surgery waiting time for geriatric patients with hip fractures, which resulted in increased inpatient complications without a higher mortality rate within 1 year. This reinforces the importance of maintaining timely and protocolized care for geriatric hip fractures throughout any subsequent waves of the pandemic.