Impact of COVID-19 on clinical outcomes for patients with fractured hip: a multicentre observational cohort study
Author
Rasidovic, DamirAhmed, Imran
Thomas, Christopher
Kimani, Peter
Wall, Peter
Mangat, Karanjit
NOF-COV19 Study Collaborative Group
Affiliation
South Warwickshire University NHS Foundation Trust; University Hospital Coventry and Warwickshire NHS Trust; University of WarwickPublication date
2020-11
Metadata
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Aims: There are reports of a marked increase in perioperative mortality in patients admitted to hospital with a fractured hip during the COVID-19 pandemic in the UK, USA, Spain, and Italy. Our study aims to describe the risk of mortality among patients with a fractured neck of femur in England during the early stages of the COVID-19 pandemic. Methods: We completed a multicentre cohort study across ten hospitals in England. Data were collected from 1 March 2020 to 6 April 2020, during which period the World Health Organization (WHO) declared COVID-19 to be a pandemic. Patients ≥ 60 years of age admitted with hip fracture and a minimum follow-up of 30 days were included for analysis. Primary outcome of interest was mortality at 30 days post-surgery or postadmission in nonoperative patients. Secondary outcomes included length of hospital stay and discharge destination. Results: In total, 404 patients were included for final analysis with a COVID-19 diagnosis being made in 114 (28.2%) patients. Overall, 30-day mortality stood at 14.4% (n = 58). The COVID-19 cohort experienced a mortality rate of 32.5% (37/114) compared to 7.2% (21/290) in the non-COVID cohort (p < 0.001). In adjusted analysis, 30-day mortality was greatest in patients who were confirmed to have COVID-19 (odds ratio (OR) 5.64, 95% confidence interval (CI) 2.95 to 10.80; p < 0.001) with an adjusted excess risk of 20%, male sex (OR 2.69, 95% CI 1.37 to 5.29; p = 0.004) and in patients with ≥ two comorbidities (OR 4.68, CI 1.5 to 14.61; p = 0.008). Length of stay was also extended in the COVID-19 cohort, on average spending 17.6 days as an inpatient versus 12.04 days in the non-COVID-19 group (p < 0.001). Conclusion: This study demonstrates that patients who sustain a neck of femur fracture in combination with COVID-19 diagnosis have a significantly higher risk of mortality than would be normally expected.Cite this article: Bone Joint Open 2020;1-11:697-705. Keywords: COVID-19; Coronavirus; Hip fracture; NOF; Neck of femur fracture.Citation
Rasidovic D, Ahmed I, Thomas C, Kimani PK, Wall P, Mangat K; NOF-COV19 Study Collaborative Group. Impact of COVID-19 on clinical outcomes for patients with fractured hip: a multicentre observational cohort study. Bone Jt Open. 2020 Nov 4;1(11):697-705. doi: 10.1302/2633-1462.111.BJO-2020-0132.R1.Type
ArticleAdditional Links
http://www.ncbi.nlm.nih.gov/pmc/articles/pmc7690757/PMID
33263109Journal
Bone & Joint Openae974a485f413a2113503eed53cd6c53
10.1302/2633-1462.111.BJO-2020-0132.R1