The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients
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...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-02-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-021-02301-z |
| _version_ | 1828367957700378624 |
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| author | Alice Wignall Vasileios Giannoudis Chiranjit De Andrea Jimenez Simon Sturdee Sohail Nisar Hemant Pandit Aashish Gulati Jeya Palan |
| author_facet | Alice Wignall Vasileios Giannoudis Chiranjit De Andrea Jimenez Simon Sturdee Sohail Nisar Hemant Pandit Aashish Gulati Jeya Palan |
| author_sort | Alice Wignall |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-14T06:04:24Z |
| format | Article |
| id | doaj.art-1a2121b60ca44d96baa0ba3cd62f6c6f |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-14T06:04:24Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-1a2121b60ca44d96baa0ba3cd62f6c6f2022-12-22T02:08:34ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2021-02-011611710.1186/s13018-021-02301-zThe impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patientsAlice Wignall0Vasileios Giannoudis1Chiranjit De2Andrea Jimenez3Simon Sturdee4Sohail Nisar5Hemant Pandit6Aashish Gulati7Jeya Palan8Leeds Teaching Hospitals NHS TrustHuddersfield Royal InfirmarySandwell & West Birmingham Hospitals NHS TrustHuddersfield Royal InfirmaryHuddersfield Royal InfirmaryLeeds Teaching Hospitals NHS TrustLeeds Teaching Hospitals NHS TrustSandwell & West Birmingham Hospitals NHS TrustLeeds Teaching Hospitals NHS TrustAbstract 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.https://doi.org/10.1186/s13018-021-02301-zProximal femoral (hip) fractureCOVID-19Intracapsular hip fractureExtracapsular hip fracture30-day mortalityTime to theatre |
| spellingShingle | Alice Wignall Vasileios Giannoudis Chiranjit De Andrea Jimenez Simon Sturdee Sohail Nisar Hemant Pandit Aashish Gulati Jeya Palan The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients Journal of Orthopaedic Surgery and Research Proximal femoral (hip) fracture COVID-19 Intracapsular hip fracture Extracapsular hip fracture 30-day mortality Time to theatre |
| title | The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients |
| title_full | The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients |
| title_fullStr | The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients |
| title_full_unstemmed | The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients |
| title_short | The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients |
| title_sort | impact of covid 19 on the management and outcomes of patients with proximal femoral fractures a multi centre study of 580 patients |
| topic | Proximal femoral (hip) fracture COVID-19 Intracapsular hip fracture Extracapsular hip fracture 30-day mortality Time to theatre |
| url | https://doi.org/10.1186/s13018-021-02301-z |
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