The Prevalence and Mortality in COVID-19 Positive Patients with Hip Fracture: a Case-Series and Literature Review
,
Abstract
Background: The novel coronavirus has spread rapidly worldwide, with exceptionally high mortality in the elderly. Patients with hip fracture have an average age of 80 years, with an estimated 2.8 comorbidities per patient. This study aims to assess the impact of the COVID-19 pandemic on hip fracture care services and the associated mortality rate.
Methods: PubMed, Medline, and Google Scholar databases were searched for relevant studies linked to mortality in COVID-19 patients who have undergone hip surgeries using the keywords “COVID-19” OR “SARS-cov-2” OR “Coronavirus Infections”; AND “Surgery” OR “Hip” OR “Fracture” OR “Orthopedics.” We included all patients with hip fractures but excluded pathological fractures and other non-traumatic hip pathologies 30 studies for the final review were selected according to the inclusion and exclusion criteria.
Results: 30 studies were included in the review. The overall mortality was 10.52%. There was a significant difference in the mortality rate between patients with positive and negative tests and between the operative patients who tested positive and the operative patients who tested negative.
Conclusions: COVID-19-infected elderly patients with hip fractures have a higher mortality rate than non-COVID-19 infected cases. Further studies are warranted to examine the morbidity and mortality rates in COVID-19-positive patients with hip fractures and investigate how these outcomes can be improved.
[1] Ahmadinejad B, Shabani A, Jalali A. Implementation of Clean Hospital Strategy and Prioritizing Covid-19 Prevention Factors Using Best-Worst Method. HOSP TOP. 2021:1-11.
[2] Dupley L, Oputa TJ, Bourne JT. 30-day mortality for fractured neck of femur patients with concurrent COVID-19 infection. Eur J Orthop Surg Traumatol. 2021; 31(2):341-7.
[3] Narang A, Chan G, Aframian A, Ali Z, Carr A, Goodier H, et al. Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study. Int Orthop. 2021;45(1):23-31.
[4] Rabie H, Sharafi MH, Zanjani LO, Nabian MH. Novel coronavirus infection in orthopedic patients; report of seven cases. Arch Bone Jt Surg. 2020; 8(Suppl 1):302.
[5] Malik-Tabassum K, Crooks M, Robertson A, To C, Maling L, Selmon G. Management of hip fractures during the COVID-19 pandemic at a high-volume hip fracture unit in the United Kingdom. Int J Orthop. 2020; 20:332-7.
[6] Sobti A, Memon K, Bhaskar RRP, Unnithan A, Khaleel A. Outcome of trauma and orthopaedic surgery at a UK District General Hospital during the Covid-19 pandemic. J Clin Orthop Trauma. 2020; 11:S442-S5.
[7] Segarra B, Heras NB, Ortiz MV, Ribes-Iborra J, Martinez-Macias O, Cuesta-Peredo D. Are hospitals safe? A prospective study on SARS-CoV-2 prevalence and outcome on surgical fracture patients: a closer look at hip fracture patients. J Orthop Trauma. 2020;34(10):371-6.
[8] Thakrar A, Chui K, Kapoor A, Hambidge J. Thirty-day mortality rate of patients with hip fractures during the COVID-19 pandemic: a single centre prospective study in the United Kingdom. J Orthop Trauma. 2020;34(9):325-9.
[9] Kayani B, Onochie E, Patil V, Begum F, Cuthbert R, Ferguson D, et al. The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures: a multicentre cohort study. Bone Joint J. 2020;102(9):1136-45.
[10] Hall AJ, Clement ND, Farrow L, Group I-SS, MacLullich AM, Dall GF, et al. IMPACT-Scot report on COVID-19 and hip fractures: a multicentre study assessing mortality, predictors of early SARS-CoV-2 infection, and the effects of social lockdown on epidemiology. Bone Joint J. 2020;102(9):1219-28.
[11] Mi B, Chen L, Tong D, Panayi AC, Ji F, Guo J, et al. Delayed surgery versus nonoperative treatment for hip fractures in post-COVID-19 arena: a retrospective study of 145 patients. Acta Orthop. 2020;91(6):639-43.
[12] Mamarelis G, Oduoza U, Chekuri R, Estfan R, Greer T. Mortality in patients with proximal femoral fracture during the COVID-19 pandemic: A UK hospital’s experience. JBJS Open Access. 2020;5(4):20.
[13] Catellani F, Coscione A, D’Ambrosi R, Usai L, Roscitano C, Fiorentino G. Treatment of proximal femoral fragility fractures in patients with COVID-19 during the SARS-CoV-2 outbreak in Northern Italy. J Bone Joint Surg Am. 2020;102(12):58.
[14] Egol KA, Konda SR, Bird ML, Dedhia N, Landes EK, Ranson RA, et al. Increased mortality and major complications in hip fracture care during the COVID-19 pandemic: a New York City perspective. Orthop Trauma. 2020;34(8):395-402.
[15] Maniscalco P, Poggiali E, Quattrini F, Ciatti C, Magnacavallo A, Vercelli A, et al. Proximal femur fractures in COVID-19 emergency: the experience of two Orthopedics and Traumatology Departments in the first eight weeks of the Italian epidemic. Acta Biomed. 2020;91(2):89.
[16] Cheung ZB, Forsh DA. Early outcomes after hip fracture surgery in COVID-19 patients in New York City. J Orthop. 2020; 21:291-6.
[17] Vives JMM, Jornet-Gibert M, Cámara-Cabrera J, Esteban PL, Brunet L, Delgado-Flores L, et al. Mortality rates of patients with proximal femoral fracture in a worldwide pandemic: preliminary results of the Spanish HIP-COVID observational study. J Bone Joint Surg Am. 2020.
[18] LeBrun DG, Konnaris MA, Ghahramani GC, Premkumar A, DeFrancesco CJ, Gruskay JA, et al. Hip fracture outcomes during the COVID-19 pandemic: early results from New York. Orthop Trauma. 2020;34(8):403-10.
[19] Arafa M, Nesar S, Abu-Jabeh H, Jayme MOR, Kalairajah Y. COVID-19 pandemic and hip fractures: impact and lessons learned. Bone Jt Open. 2020;1(9):530-40.
[20] Chui K, Thakrar A, Shankar S. Evaluating the efficacy of a two-site (‘COVID-19’and ‘COVID-19-free’) trauma and orthopaedic service for the management of hip fractures during the COVID-19 pandemic in the UK. Bone Jt Open. 2020;1(6):190-7.
[21] Clement ND, Hall AJ, Makaram NS, Robinson PG, Patton RF, Moran M, et al. IMPACT-Restart: the influence of COVID-19 on postoperative mortality and risk factors associated with SARS-CoV-2 infection after orthopaedic and trauma surgery. Bone Joint J. 2020;102(12):1774-81.
[22] Clough TM, Shah N, Divecha H, Talwalkar S. COVID-19 consent and return to elective orthopaedic surgery: allowing a true patient choice? Bone Jt Open. 2020;1(9):556-61.
[23] De C, Wignall A, Giannoudis V, Jimenez A, Sturdee S, Aderinto J, et al. Peri-operative outcomes and predictors of mortality in COVID-19 positive patients with hip fractures: a multicentre study in the UK. Indian J Orthop. 2020;54(2):386-96.
[24] Fadulelmola A, Gregory R, Gordon G, Smith F, Jennings A. The impact of COVID-19 infection on hip fractures 30-day mortality. Trauma. 2021;23(4):295-300.
[25] Karayiannis PN, Roberts V, Cassidy R, Mayne AI, McAuley D, Milligan DJ, et al. 30-day mortality following trauma and orthopaedic surgery during the peak of the COVID-19 pandemic: a multicentre regional analysis of 484 patients. Bone Jt Open. 2020;1(7):392-7.
[26] Lazizi M, Marusza CJ, Sexton SA, Middleton RG. Orthopaedic surgery in a time of COVID-19: using a low prevalence COVID-19 trauma surgery model to guide a safe return to elective surgery. Bone Jt Open. 2020;1(6):229-35.
[27] Macey AR, Butler J, Martin SC, Tan TY, Leach WJ, Jamal B. 30-day outcomes in hip fracture patients during the COVID-19 pandemic compared to the preceding year. Bone Jt Open. 2020;1(7):415-9.
[28] Morelli I, Luceri F, Giorgino R, Accetta R, Perazzo P, Mangiavini L, et al. COVID-19: not a contraindication for surgery in patients with proximal femur fragility fractures. BioMed Central; 2020. p. 1-5.
[29] Muse IO, Montilla E, Gruson KI, Berger J. Perioperative management of patients with hip fractures and COVID-19: A single institution's early experiences. J Clin Anesth. 2020; 67:110017.
[30] Stoneham AC, Apostolides M, Bennett PM, Hillier-Smith R, Witek AJ, Goodier H, et al. Early outcomes of patients undergoing total hip arthroplasty for trauma during COVID-19. Bone Jt Open. 2020;1(7):438-42.
[31] Saleem JS, Fazal MA. Fragility hip fractures in the COVID-19 pandemic: a local experience in the United Kingdom. Int J Orthop Trauma Nurs. 2021; 41:100817.
[2] Dupley L, Oputa TJ, Bourne JT. 30-day mortality for fractured neck of femur patients with concurrent COVID-19 infection. Eur J Orthop Surg Traumatol. 2021; 31(2):341-7.
[3] Narang A, Chan G, Aframian A, Ali Z, Carr A, Goodier H, et al. Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study. Int Orthop. 2021;45(1):23-31.
[4] Rabie H, Sharafi MH, Zanjani LO, Nabian MH. Novel coronavirus infection in orthopedic patients; report of seven cases. Arch Bone Jt Surg. 2020; 8(Suppl 1):302.
[5] Malik-Tabassum K, Crooks M, Robertson A, To C, Maling L, Selmon G. Management of hip fractures during the COVID-19 pandemic at a high-volume hip fracture unit in the United Kingdom. Int J Orthop. 2020; 20:332-7.
[6] Sobti A, Memon K, Bhaskar RRP, Unnithan A, Khaleel A. Outcome of trauma and orthopaedic surgery at a UK District General Hospital during the Covid-19 pandemic. J Clin Orthop Trauma. 2020; 11:S442-S5.
[7] Segarra B, Heras NB, Ortiz MV, Ribes-Iborra J, Martinez-Macias O, Cuesta-Peredo D. Are hospitals safe? A prospective study on SARS-CoV-2 prevalence and outcome on surgical fracture patients: a closer look at hip fracture patients. J Orthop Trauma. 2020;34(10):371-6.
[8] Thakrar A, Chui K, Kapoor A, Hambidge J. Thirty-day mortality rate of patients with hip fractures during the COVID-19 pandemic: a single centre prospective study in the United Kingdom. J Orthop Trauma. 2020;34(9):325-9.
[9] Kayani B, Onochie E, Patil V, Begum F, Cuthbert R, Ferguson D, et al. The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures: a multicentre cohort study. Bone Joint J. 2020;102(9):1136-45.
[10] Hall AJ, Clement ND, Farrow L, Group I-SS, MacLullich AM, Dall GF, et al. IMPACT-Scot report on COVID-19 and hip fractures: a multicentre study assessing mortality, predictors of early SARS-CoV-2 infection, and the effects of social lockdown on epidemiology. Bone Joint J. 2020;102(9):1219-28.
[11] Mi B, Chen L, Tong D, Panayi AC, Ji F, Guo J, et al. Delayed surgery versus nonoperative treatment for hip fractures in post-COVID-19 arena: a retrospective study of 145 patients. Acta Orthop. 2020;91(6):639-43.
[12] Mamarelis G, Oduoza U, Chekuri R, Estfan R, Greer T. Mortality in patients with proximal femoral fracture during the COVID-19 pandemic: A UK hospital’s experience. JBJS Open Access. 2020;5(4):20.
[13] Catellani F, Coscione A, D’Ambrosi R, Usai L, Roscitano C, Fiorentino G. Treatment of proximal femoral fragility fractures in patients with COVID-19 during the SARS-CoV-2 outbreak in Northern Italy. J Bone Joint Surg Am. 2020;102(12):58.
[14] Egol KA, Konda SR, Bird ML, Dedhia N, Landes EK, Ranson RA, et al. Increased mortality and major complications in hip fracture care during the COVID-19 pandemic: a New York City perspective. Orthop Trauma. 2020;34(8):395-402.
[15] Maniscalco P, Poggiali E, Quattrini F, Ciatti C, Magnacavallo A, Vercelli A, et al. Proximal femur fractures in COVID-19 emergency: the experience of two Orthopedics and Traumatology Departments in the first eight weeks of the Italian epidemic. Acta Biomed. 2020;91(2):89.
[16] Cheung ZB, Forsh DA. Early outcomes after hip fracture surgery in COVID-19 patients in New York City. J Orthop. 2020; 21:291-6.
[17] Vives JMM, Jornet-Gibert M, Cámara-Cabrera J, Esteban PL, Brunet L, Delgado-Flores L, et al. Mortality rates of patients with proximal femoral fracture in a worldwide pandemic: preliminary results of the Spanish HIP-COVID observational study. J Bone Joint Surg Am. 2020.
[18] LeBrun DG, Konnaris MA, Ghahramani GC, Premkumar A, DeFrancesco CJ, Gruskay JA, et al. Hip fracture outcomes during the COVID-19 pandemic: early results from New York. Orthop Trauma. 2020;34(8):403-10.
[19] Arafa M, Nesar S, Abu-Jabeh H, Jayme MOR, Kalairajah Y. COVID-19 pandemic and hip fractures: impact and lessons learned. Bone Jt Open. 2020;1(9):530-40.
[20] Chui K, Thakrar A, Shankar S. Evaluating the efficacy of a two-site (‘COVID-19’and ‘COVID-19-free’) trauma and orthopaedic service for the management of hip fractures during the COVID-19 pandemic in the UK. Bone Jt Open. 2020;1(6):190-7.
[21] Clement ND, Hall AJ, Makaram NS, Robinson PG, Patton RF, Moran M, et al. IMPACT-Restart: the influence of COVID-19 on postoperative mortality and risk factors associated with SARS-CoV-2 infection after orthopaedic and trauma surgery. Bone Joint J. 2020;102(12):1774-81.
[22] Clough TM, Shah N, Divecha H, Talwalkar S. COVID-19 consent and return to elective orthopaedic surgery: allowing a true patient choice? Bone Jt Open. 2020;1(9):556-61.
[23] De C, Wignall A, Giannoudis V, Jimenez A, Sturdee S, Aderinto J, et al. Peri-operative outcomes and predictors of mortality in COVID-19 positive patients with hip fractures: a multicentre study in the UK. Indian J Orthop. 2020;54(2):386-96.
[24] Fadulelmola A, Gregory R, Gordon G, Smith F, Jennings A. The impact of COVID-19 infection on hip fractures 30-day mortality. Trauma. 2021;23(4):295-300.
[25] Karayiannis PN, Roberts V, Cassidy R, Mayne AI, McAuley D, Milligan DJ, et al. 30-day mortality following trauma and orthopaedic surgery during the peak of the COVID-19 pandemic: a multicentre regional analysis of 484 patients. Bone Jt Open. 2020;1(7):392-7.
[26] Lazizi M, Marusza CJ, Sexton SA, Middleton RG. Orthopaedic surgery in a time of COVID-19: using a low prevalence COVID-19 trauma surgery model to guide a safe return to elective surgery. Bone Jt Open. 2020;1(6):229-35.
[27] Macey AR, Butler J, Martin SC, Tan TY, Leach WJ, Jamal B. 30-day outcomes in hip fracture patients during the COVID-19 pandemic compared to the preceding year. Bone Jt Open. 2020;1(7):415-9.
[28] Morelli I, Luceri F, Giorgino R, Accetta R, Perazzo P, Mangiavini L, et al. COVID-19: not a contraindication for surgery in patients with proximal femur fragility fractures. BioMed Central; 2020. p. 1-5.
[29] Muse IO, Montilla E, Gruson KI, Berger J. Perioperative management of patients with hip fractures and COVID-19: A single institution's early experiences. J Clin Anesth. 2020; 67:110017.
[30] Stoneham AC, Apostolides M, Bennett PM, Hillier-Smith R, Witek AJ, Goodier H, et al. Early outcomes of patients undergoing total hip arthroplasty for trauma during COVID-19. Bone Jt Open. 2020;1(7):438-42.
[31] Saleem JS, Fazal MA. Fragility hip fractures in the COVID-19 pandemic: a local experience in the United Kingdom. Int J Orthop Trauma Nurs. 2021; 41:100817.
| Files | ||
| Issue | Vol 9 No 3 (2023): Summer |
|
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i3.13123 | |
| Keywords | ||
| orthopedics COVID-19 orthopedic procedures hip fractures surgery | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mirzaee F, Ahmadinejad B, Jalali A, Farahanchi Baradaran A. The Prevalence and Mortality in COVID-19 Positive Patients with Hip Fracture: a Case-Series and Literature Review. Arch Anesth & Crit Care. 2023;9(3):259-264.
