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Variations of the quality of care during the COVID-19 pandemic affected the mortality rate of non-COVID patients with hip fracture
Davide Golinelli; Francesco Sanmarchi; Angelo Capodici; Giuorgia Gribaudo; Mattia Altini; Simona Rosa; Francesco Esposito; Maria Pia Fantini; Jacopo Lenzi.
  • Davide Golinelli; University of Bologna
  • Francesco Sanmarchi; University of Bologna
  • Angelo Capodici; University of Bologna
  • Giuorgia Gribaudo; University of Bologna
  • Mattia Altini; Healthcare Administration, AUSL Romagna, Ravenna, Italy
  • Simona Rosa; University of Bologna
  • Francesco Esposito; University of Bologna
  • Maria Pia Fantini; University of Bologna
  • Jacopo Lenzi; University of Bologna
Preprint in English | medRxiv | ID: ppmedrxiv-21266927
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ABSTRACT
IntroductionAs COVID-19 roared through the world, governments worldwide enforced containment measures that affected various treatment pathways, including those for hip fracture (HF). This study aimed to measure process and outcome indicators related to the quality of care provided to non-COVID-19 elderly patients affected by HF in Emilia-Romagna, a region of Italy severely hit by the pandemic. MethodsWe collected the hospital discharge records of all patients admitted to the hospitals of Emilia-Romagna with a diagnosis of HF from January to May in the years 2019/2020. We analyzed surgery rate, surgery timeliness, length of hospital stay, timely rehabilitation, and 30-day mortality for each HF patient. We evaluated monthly data (2020 vs. 2019) with the chi-square and t-test, where appropriate. Logistic regression was used to investigate the differences in 30-day mortality. ResultsOur study included 5379 patients with HF. In April and May 2020, there was a significant increase in the proportion of HF patients that did not undergo timely surgery. In March 2020, we found a significant increase in mortality (OR = 2.22). Female sex (OR = 0.52), age [≥]90 years (OR = 4.33), surgery after 48 hours (OR = 3.08) and not receiving surgery (OR = 6.19) were significantly associated with increased mortality. After adjusting for the aforementioned factors, patients hospitalized in March 2020 still suffered higher mortality (OR = 2.21). ConclusionsOur results show a reduction in the overall quality of care provided to non-COVID-19 elderly patients affected by HF. The mortality rate of patients with HF increased significantly in March 2020. Patients characteristics and variations in processes of care partially explained this increase. Our analysis reveals the importance of including process and outcomes indicators, for both acute and post-acute care management issues, in emergency preparedness plans, to monitor healthcare systems capacities and capabilities.
Full text: Available Collection: Preprints Database: medRxiv Language: English Year: 2021 Document Type: Preprint
Full text: Available Collection: Preprints Database: medRxiv Language: English Year: 2021 Document Type: Preprint