101
|
Kiyatkin ME, Levine SP, Kimura A, Linzer RW, Labins JR, Kim JI, Gurvich A, Gong MN. Increased incidence of post-operative respiratory failure in patients with pre-operative SARS-CoV-2 infection. J Clin Anesth 2021; 74:110409. [PMID: 34225188 PMCID: PMC8216857 DOI: 10.1016/j.jclinane.2021.110409] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 01/10/2023]
Abstract
Objective While studies have reported increased post-operative pulmonary complications with SARS-CoV-2 infection, many are limited by use of historical controls or focus on less severe respiratory complications. We characterized the association between pre-operative SARS-CoV-2 infection and post-operative respiratory failure (PORF). Design and setting This was a single center retrospective cohort study in New York City between March 14–June 14, 2020. Patients Exclusion criteria were age < 18-years, obstetric procedures, absence of SARS-CoV-2 PCR testing, and pre-operative respiratory failure. A total of 778 patients met criteria, of which 87 had SARS-CoV-2. Measurements The primary outcome, PORF, included inability to extubate for ≥24 h or unplanned re-intubation within 5 days. Multiple exposures were measured including SARS-CoV-2 infection 4 weeks before or 5 days after surgery. Multivariable logistic regression was performed to adjust for pre-operative hypoxemia, oxygen use, and pneumonia as well as tachycardia, gender, Charlson Comorbidity Index (CCI), Surgical Mortality Probability Model (S-MPM) index, and peri-operative blood transfusion. Main results SARS-CoV patients had higher CCI (P = 0.007) and S-MPM scores (P = 0.02). The incidence of PORF was 16% versus 7% in uninfected comparators (P = 0.001). Amongst infected individuals, 39% exhibited symptoms of COVID-19 and PORF was more common in these patients compared to asymptomatic individuals (26% vs. 9%, P = 0.04). Adjusted analysis revealed increased odds of PORF with infection (OR 2.8, 95% CI 1.2–6.2). This persisted even when adjusting for probable mediators such as pre-operative hypoxemia. Infected patients also demonstrated increased adjusted odds of 30-day mortality (OR 3.5, 95% CI 1.4–9.1). Conclusions Detection of SARS-CoV-2 infection within 4 weeks before or 5 days after surgery is associated with increased odds of 5-day PORF and 30-day mortality. This supports delaying elective surgery, but questions remain regarding the applicability of this recommendation for asymptomatic patients needing urgent or semi-urgent procedures such as oncologic surgery.
Collapse
Affiliation(s)
- Michael E Kiyatkin
- Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, USA; Department of Medicine, Montefiore Medical Center, Bronx, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | | | | | | | - Joseph I Kim
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
102
|
Cuthbert R, Ferguson D, Kayani B, Haque S, Ali A, Parkar A, Bates P, Vemulapalli K. Evidence-based approach to providing informed consent for hip fracture surgery during the COVID-19 era. World J Orthop 2021; 12:386-394. [PMID: 34189076 PMCID: PMC8223721 DOI: 10.5312/wjo.v12.i6.386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/15/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hip fractures are the most common reason for inpatient orthopaedic trauma admission. Urgent surgical intervention for hip fractures has remained a clinical priority throughout the coronavirus disease 2019 (COVID-19) pandemic. Despite this, there is a paucity of clinical guidance addressing the informed consent process for hip fracture surgery in COVID-19 positive patients. This is of paramount medicolegal importance in a high-risk patient population.
AIM To quantify the additional perioperative risks for COVID-19 positive patients undergoing hip fracture surgery and provide clinicians with an evidence-based framework to establish an informed consent process.
METHODS Two hundred and fifty nine consecutive patients undergoing surgical intervention for hip fractures in four hospitals in the United Kingdom were recruited. 51 patients were confirmed positive for COVID-19. Predefined outcomes were analyzed over a 30-d postoperative period. COVID-19 positive and COVID-19 negative patients were compared after adjustment for confounding factors.
RESULTS COVID-19 positive patients had more intensive care admissions (27% vs 5%, P < 0.001), longer inpatient stays (median 23 d vs 9 d, P < 0.001) and a higher 30-d mortality (29% vs 10%, P = 0.001) than COVID-19 negative patients. Postoperative complications were evident in 74.5% of COVID-19 positive patients. 35.3% of COVID-19 positive patients suffered postoperative lower respiratory tract infections with 13.7% developing acute respiratory distress syndrome (ARDS) and 9.8% experiencing symptomatic thromboembolic events.
CONCLUSION The COVID-19 pandemic has created uncertainty in the medical community worldwide and poses unique challenges in providing informed consent for surgery. COVID-19 positive patients undergoing hip fracture surgery should be consented for the additional risk of postoperative complications (including lower respiratory tract infection, ARDS, deep vein thrombosis and pulmonary embolism), increased requirement for intensive care admission, longer inpatient stay and higher risk of mortality. Further, clinicians must be transparent about the potential for unknown risks as research into the long-term surgical outcomes of COVID-19 positive patients continues to evolve.
Collapse
Affiliation(s)
- Rory Cuthbert
- Department of Trauma & Orthopaedic Surgery, Queen's Hospital-Romford, London RM7 0AG, United Kingdom
| | - David Ferguson
- Department of Trauma & Orthopaedic Surgery, Queen's Hospital-Romford, London RM7 0AG, United Kingdom
| | - Babar Kayani
- Department of Trauma & Orthopaedic Surgery, Royal London Hospital, London E1 1FR, United Kingdom
| | - Saeef Haque
- Department of Trauma & Orthopaedic Surgery, Queen's Hospital-Romford, London RM7 0AG, United Kingdom
| | - Aoun Ali
- Department of Trauma & Orthopaedic Surgery, Queen's Hospital-Romford, London RM7 0AG, United Kingdom
| | - Asif Parkar
- Department of Trauma & Orthopaedic Surgery, Queen's Hospital-Romford, London RM7 0AG, United Kingdom
| | - Peter Bates
- Department of Trauma & Orthopaedic Surgery, Royal London Hospital, London E1 1FR, United Kingdom
| | - Krishna Vemulapalli
- Department of Trauma & Orthopaedic Surgery, Queen's Hospital-Romford, London RM7 0AG, United Kingdom
| |
Collapse
|
103
|
Gao SS, Wang YJ, Zhang GX, Zhang WT. Rehabilitation guidance for hip fracture patients during the COVID-19 pandemic using chat software: A new model. J Back Musculoskelet Rehabil 2021; 34:337-342. [PMID: 33896813 DOI: 10.3233/bmr-200324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hip fractures are serious fractures for the elderly. The rehabilitation of patients with hip fractures has been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE We have piloted a new model for tracking patients and providing rehabilitation guidance that uses WeChat. The purpose of this study is to explore the role of chat software in rehabilitation guidance for hip fracture patients during COVID-19. METHODS Patients treated for hip fractures from February 1 to April 30, 2020 were randomly divided into a control group and an observation group. The control group was given conventional discharge guidance, while the observation group also followed up the patients using WeChat to guide the exercise. Satisfaction, the Harris Hip Score, complications and the mortality of the two groups after discharge were compared. RESULTS The incidence of complications and mortality in the observation group were significantly lower than in the control group: p= 0.022 and p= 0.048, respectively. The Harris Hip Score and satisfaction were significantly better than the control group's: p= 0.000 and p= 0.007, respectively. CONCLUSION During the COVID-19 pandemic, it is very helpful to use WeChat software or other social software with similar functions (such as WhatsApp and Facebook) to guide the rehabilitation of hip fractures.
Collapse
Affiliation(s)
- Shuai-Shuai Gao
- Department of Traumatology and Orthopedic Surgery, Xi'an Daxing Hospital, Shaanxi, China.,International Doctoral School, University of Seville, Seville, Spain
| | - Yan-Jun Wang
- Department of Traumatology and Orthopedic Surgery, Xi'an Daxing Hospital, Shaanxi, China
| | - Guo-Xun Zhang
- International Doctoral School, University of Seville, Seville, Spain
| | - Wen-Ting Zhang
- International Doctoral School, University of Seville, Seville, Spain
| |
Collapse
|
104
|
Colosimo C, Bhuller S, Cornett B, Dziadkowiec O, Yon JR, Weaver J, Stahel PF. Perioperative mortality in SARS-CoV-2-positive surgical patients during the first wave of the novel coronavirus pandemic. Br J Surg 2021; 108:e201-e202. [PMID: 33769457 PMCID: PMC8083642 DOI: 10.1093/bjs/znab058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 11/13/2022]
Affiliation(s)
- C Colosimo
- Department of Surgery, Sky Ridge Medical Center, Lone Tree, Colorado, USA
| | - S Bhuller
- Department of Surgery, Sky Ridge Medical Center, Lone Tree, Colorado, USA
| | - B Cornett
- Graduate Medical Education, HCA Healthcare Continental Division, Denver, Colorado, USA
| | - O Dziadkowiec
- Graduate Medical Education, HCA Healthcare Continental Division, Denver, Colorado, USA
| | - J R Yon
- Division of Acute Care Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - J Weaver
- Department of Surgery, Sky Ridge Medical Center, Lone Tree, Colorado, USA
| | - P F Stahel
- Department of Specialty Medicine, Rocky Vista University, College of Osteopathic Medicine, Parker, Colorado, USA
| |
Collapse
|
105
|
AKTI S, ÇANKAYA D. The Effect of the COVID-19 Pandemic on the Epidemiology of Hip Fractures. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.866332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
106
|
Skibicki HE, Post ZD, Brustein JA, Ong AC, Orozco FR, Ponzio DY. Incidence of COVID-19 After Nonelective Hip and Knee Surgery During the Peak of the Pandemic: The New Jersey Experience. Orthopedics 2021; 44:180-186. [PMID: 34039215 DOI: 10.3928/01477447-20210416-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In an attempt to preserve essential equipment and health care system capacity and slow the spread of coronavirus disease 2019 (COVID-19) infection, Governor Murphy suspended all elective surgeries performed in New Jersey from March 27, 2020, through May 25, 2020. The objective of this study was to determine the incidence of postoperative COVID-19 infection following nonelective hip and knee surgery during the peak of the COVID-19 pandemic in New Jersey during this time. A retrospective cohort of 149 patients who underwent nonelective hip and knee surgery from March 27, 2020, through May 25, 2020, at 2 institutions was identified. The cohort was divided into hip fracture and non-fracture patients to compare the postoperative experience of these patient populations. The primary outcome was the incidence of postoperative COVID-19 infection diagnosed via severe acute respiratory syndrome coronavirus 2 nasopharyngeal real-time reverse transcription polymerase chain reaction. Secondary outcomes included length of stay, discharge disposition, postoperative complications, and mortality rate. A total of 149 patients underwent nonelective hip and knee surgeries, including 76 hip fracture cases and 73 nonelective hip and knee arthroplasty cases. A postoperative diagnosis of COVID-19 was made for 5 (6.6%) of 76 hip fracture patients, and 2 of the 5 died secondary to COVID-19. There were no infections in the arthroplasty cohort. This study describes a low incidence of COVID-19 infection after nonelective hip and knee surgery during the surge of the COVID-19 pandemic in New Jersey. Patients who underwent hip fracture surgery had an increased incidence of postoperative COVID-19 infection. [Orthopedics. 2021;44(3):180-186.].
Collapse
|
107
|
Kumar P, Jindal K, Aggarwal S, Kumar V, Rajnish RK. 30-Day Mortality Rate in Hip Fractures Among the Elderly with Coexistent COVID-19 Infection: A Systematic Review. Indian J Orthop 2021; 55:571-581. [PMID: 33678822 PMCID: PMC7926082 DOI: 10.1007/s43465-021-00386-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/13/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Hip fractures in the elderly require a multi-disciplinary approach and are associated with increased morbidity and mortality. The current COVID-19 pandemic has affected substantially this high-risk population group. This present review was done to ascertain whether or not the pandemic has affected the 30-day mortality and outcomes of hip fracture in the elderly. RESEARCH QUESTION Does the coexistence of COVID-19 infection and hip fractures in the elderly increase the mortality rates? METHODOLOGY A systematic review and meta-analysis were conducted using three databases (PubMed, EMBASE and SCOPUS) to compare the mortality rates between COVID-19 positive/suspect and COVID-19 negative patients. The secondary outcomes included comparison of in-hospital mortality, complication rate and length of hospital stay. Risk of bias assessment was done using the MINORS tool. RESULTS The present review included 20 studies. Primary outcome: A significantly higher 30 day mortality rate was seen in COVID-19 positive/suspect patients with an Odds ratio of 6.09 (95% CI 4.75-8.59, p < 0.00001). Secondary outcome: We observed significantly higher rates of inpatient mortality [OR 18.22, (95% CI 7.10-46.75], complication rate (OR 9.28, 95% CI 4.46-19.30), and length of hospital stay (MD: 4.96, 95% CI 2.86-7.05) in COVID-19 positive/suspect patients as compared to COVID-19 negative patients. CONCLUSION COVID-19 has deteriorated the outcomes in elderly patients with hip fractures and associated with higher rates of mortality in the short term. A multidisciplinary approach is needed to contain this "pandemic within a pandemic" and improve the overall outcome to survival.
Collapse
Affiliation(s)
- Prasoon Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, India
| | - Karan Jindal
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, India
| | - Sameer Aggarwal
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, India
| | - Vishal Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, India
| | - Rajesh Kumar Rajnish
- Department of Orthopaedics, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh India
| |
Collapse
|
108
|
Tripathy SK, Varghese P, Panigrahi S, Panda BB, Srinivasan A, Sen RK. Perioperative mortality and morbidity of hip fractures among COVID-19 infected and non-infected patients: A systematic review and meta-analysis. Chin J Traumatol 2021:S1008-1275(21)00088-2. [PMID: 34154865 PMCID: PMC8135192 DOI: 10.1016/j.cjtee.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Hip fractures among elderly patients are surgical emergencies. During COVID-19 pandemic time, many such patients could not be operated at early time because of the limitation of the medical resources, the risk of infection and redirection of medical attention to a severe infective health problem. METHODS A search of electronic databases (PubMed, Medline, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials) with the keywords "COVID", "COVID-19″, "SARS-COV-2", "Corona", "pandemic", "hip fracture", "trochanteric fracture" and "neck femur fracture" revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time. The 30-day mortality rate, inpatient mortality rate, critical care/special care need, readmission rate and complications rate in both groups were evaluated. Data were analyzed using Review Manager (RevMan) V.5.3. RESULTS After screening, 7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected (COVID-19 +) and non-infected (COVID-19 -) patients. There were significantly increased risks of 30-day mortality (32.23% COVID-19 + death vs. 8.85% COVID-19 - death) and inpatient mortality (29.33% vs. 2.62%) among COVID-19 + patients with odds ratio (OR) of 4.84 (95% CI: 3.13-7.47, p < 0.00001) and 15.12 (95% CI: 6.12-37.37, p < 0.00001), respectively. The COVID-19 + patients needed more critical care admission (OR = 5.08, 95% CI: 1.49-17.30, p < 0.009) and they remain admitted for a longer time in hospital (MD = 3.6, 95% CI: 1.74-5.45, p = 0.0001); but there was no difference in readmission rate between these 2 groups. The risks of overall complications (OR = 17.22), development of pneumonia (OR = 22.25), and acute respiratory distress syndrome/acute respiratory failure (OR = 32.96) were significantly high among COVID-19 + patients compared to COVID-19 - patients. CONCLUSIONS There are increased risks of the 30-day mortality, inpatient mortality and critical care admission among hip fracture patients who are COVID-19 +. The chances of developing pneumonia and acute respiratory failure are more in COVID-19 + patients than in COVID-19 ‒ patients.
Collapse
Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
| | - Paulson Varghese
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Sibasish Panigrahi
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Bijnya Birajita Panda
- Department of Ophthalmology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, 753007, India
| | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | | |
Collapse
|
109
|
Raheman FJ, Rojoa DM, Nayan Parekh J, Berber R, Ashford R. Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic. Sci Rep 2021; 11:10157. [PMID: 33980936 PMCID: PMC8115062 DOI: 10.1038/s41598-021-89617-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
Incidence of hip fractures has remained unchanged during the pandemic with overlapping vulnerabilities observed in patients with hip fractures and those infected with COVID-19. We aimed to investigate the independent impact of COVID-19 infection on the mortality of these patients. Healthcare databases were systematically searched over 2-weeks from 1st-14th November 2020 to identify eligible studies assessing the impact of COVID-19 on hip fracture patients. Meta-analysis of proportion was performed to obtain pooled values of prevalence, incidence and case fatality rate of hip fracture patients with COVID-19 infection. 30-day mortality, excess mortality and all-cause mortality were analysed using a mixed-effects model. 22 studies reporting 4015 patients were identified out of which 2651 (66%) were assessed during the pandemic. An excess mortality of 10% was seen for hip fractures treated during the pandemic (OR 2.00, p = 0.007), in comparison to the pre-pandemic controls (5%). Estimated mortality of COVID-19 positive hip fracture patients was four-fold (RR 4.59, p < 0.0001) and 30-day mortality was 38.0% (HR 4.73, p < 0.0001). The case fatality rate for COVID-19 positive patients was 34.74%. Between-study heterogeneity for the pooled analysis was minimal (I2 = 0.00) whereas, random effects metaregression identified subgroup heterogeneity for male gender (p < 0.001), diabetes (p = 0.002), dementia (p = 0.001) and extracapsular fractures (p = 0.01) increased risk of mortality in COVID-19 positive patients.
Collapse
Affiliation(s)
- Firas J Raheman
- The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK.
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, Balmoral Building, Infirmary Square, Leicester, LE1 5WW, UK.
| | - Djamila M Rojoa
- The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | | | - Reshid Berber
- Nottingham University Hospitals, NHS Trust, Nottingham, UK
| | - Robert Ashford
- The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| |
Collapse
|
110
|
Heaps BM, Ladnier K, Haselman WT, Limpisvasti O, Banffy MB. Epidemiologic impact of COVID-19 on a multi-subspecialty orthopaedic practice. J Orthop 2021; 25:151-154. [PMID: 33972818 PMCID: PMC8099547 DOI: 10.1016/j.jor.2021.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/02/2021] [Indexed: 12/20/2022] Open
Abstract
The purpose of this study is to report the change in surgical case volume and composition encountered by a multi-subspecialty orthopaedic practice due to COVID-19. We reviewed electronic medical records for patients who had surgery at our institution and collected multiple variables including age and the joint that was operated on. In the post-COVID-19 period, we found a significant increase in the percentage of hip procedures, and a significant decrease in the percentage of hand/wrist procedures. Overall, the total surgical volume of our multi-subspecialty orthopaedic practice decreased due to the COVID-19 pandemic, and the composition of surgical cases changed.
Collapse
Affiliation(s)
| | - Karen Ladnier
- The Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA, USA
| | | | | | | |
Collapse
|
111
|
Batko BD, Hreha J, Potter JS, Guinand L, Reilly MC, Sirkin MS, Vosbikian MM, Adams MR. Orthopaedic trauma during COVID-19: Is patient care compromised during a pandemic? J Clin Orthop Trauma 2021; 18:181-186. [PMID: 33967549 PMCID: PMC8088543 DOI: 10.1016/j.jcot.2021.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Coronavirus disease-2019 (COVID-19) placed unprecedented pressure on the healthcare system. Many institutions implemented a government-mandated restructured set of safety and administrative protocols to treat urgent orthopaedic trauma patients. The objective of this study was to compare two cohorts of patients, a COVID group and non-COVID control group, and to evaluate the effectiveness of safety measures outlined in the Rutgers Orthopaedic Trauma Patient Safety Protocol (ROTPSP). Secondary outcomes were to elucidate risk factors for complications associated with fractures and COVID-19. METHODS Patients treated for orthopaedic traumatic injuries were retrospectively identified between March and May 2020, and compared to a series of patients from the same time period in 2018. Main outcome measures included surgical site infections (SSI), length of stay (LOS), post-operative LOS (poLOS), presentation to OR time (PORT), and length of surgery. RESULTS After review, 349 patients (201 non-COVID, 148 COVID) undergoing 426 surgeries were included. Average LOS (11.91 days vs. 9.27 days, p = 0.04), poLOS (9.68 days vs. 7.39 days, p = 0.03), and PORT (30.56 vs. 25.59 h, p < 0.01) was significantly shorter in the COVID cohort. There were less SSI in the COVID group (5) compared to the non-COVID group (14) (p = 0.03). Overall complications were significantly lower in the COVID group. Patients receiving Cepheid tests had significantly shorter LOS and poLOS compared to patients receiving the RNA and DiaSorin tests (p < 0.01 and p < 0.01, respectively). The Cepheid test carried the best benefit-to-cost ratio, 0.10, p < 0.05. CONCLUSION The restructuring of care protocols caused by COVID-19 did not negatively impact perioperative complication rates, PORT or LOS. Cepheid COVID test type administered upon admission plays an integral role in a patient's hospital course by reducing both length of stay and hospital costs. This information demonstrates we can continue to treat orthopaedic trauma patients safely during the COVID-19 pandemic by utilizing strict safety protocols.
Collapse
Affiliation(s)
- Brian D. Batko
- Corresponding author. Rutgers New Jersey Medical School, 140 Bergen St., Suite D-1610, Newark, NJ, 07103, USA.
| | | | | | | | | | | | | | | |
Collapse
|
112
|
Alcock H, Moppett EA, Moppett IK. Early mortality outcomes of patients with fragility hip fracture and concurrent SARS-CoV-2 infection : a systematic review and meta-analysis. Bone Jt Open 2021; 2:314-322. [PMID: 34003031 PMCID: PMC8168550 DOI: 10.1302/2633-1462.25.bjo-2020-0183.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aims Hip fracture is a common condition of the older, frailer person. This population is also at risk from SARS-CoV-2 infection. It is important to understand the impact of coexistent hip fracture and SARS-CoV-2 for informed decision-making at patient and service levels. Methods We undertook a systematic review and meta-analysis of observational studies of older (> 60 years) people with fragility hip fractures and outcomes with and without SARS-CoV-2 infection during the first wave of the COVID-19 pandemic. The primary outcome was early (30-day or in-hospital) mortality. Secondary outcomes included length of hospital stay and key clinical characteristics known to be associated with outcomes after hip fracture. Results A total of 14 cohort and five case series studies were included (692 SARS-CoV-2 positive, 2,585 SARS-CoV-2 negative). SARS-CoV-2 infection was associated with an overall risk ratio (RR) for early mortality of 4.42 (95% confidence interval (CI) 3.42 to 5.82). Early mortality was 34% (95% CI 30% to 38%) and 9% (95% CI 8% to 10%) in the infected and noninfected groups respectively. Length of stay was increased in SARS-CoV-2 infected patients (mean difference (MD) 5.2 days (3.2 to 7.2)). Age (MD 1.6 years (0.3 to 2.9)); female sex (RR 0.83 (95% CI 0.65 to 1.05)); admission from home (RR 0.51 (95% CI 0.26 to 1.00)); presence of dementia (RR 1.13 (95% CI 0.94 to 1.43)); and intracapsular fracture (RR 0.89 (95% CI 0.71 to 1.11)) were not associated with SARS-CoV-2 infection. There were statistically, but not clinically, significantly greater Nottingham Hip Fracture Scores in infected compared with non-infected patients (MD 0.7 (0.4 to 0.9)). Conclusion SARS-CoV-2 infection is associated with worse outcomes after hip fracture. This is not explained by differences in patient characteristics. These data can be used to support informed decision-making and may help track the impact of widespread adoption of system-level and therapeutic changes in management of the COVID-19 pandemic. Cite this article: Bone Jt Open 2021;2(5):314–322.
Collapse
Affiliation(s)
- Harry Alcock
- Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Anaesthesia and Critical Care, Academic Unit of Injury, Inflammation and Recovery Science, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Iain Keith Moppett
- Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Anaesthesia and Critical Care, Academic Unit of Injury, Inflammation and Recovery Science, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
113
|
Temple HT. CORR Insights®: What Proportion of Patients with Bone and Soft Tissue Tumors Contracted Coronavirus-19 and Died From Surgical Procedures During the Initial Period of the COVID-19 Pandemic? Results From the Multicenter British Orthopaedic Oncology Society Observational Study. Clin Orthop Relat Res 2021; 479:1167-1169. [PMID: 33704095 PMCID: PMC8051861 DOI: 10.1097/corr.0000000000001682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/26/2021] [Indexed: 01/31/2023]
Affiliation(s)
- H Thomas Temple
- H. T. Temple, Medical Director, Orthopaedic Innovations, Mercy Hospital, HCA East Florida Division, Miami, FL, USA
| |
Collapse
|
114
|
Pak YS, Ro YS, Kim SH, Han SH, Ko SK, Kim T, Kwak YH, Heo T, Moon S. Effects of Emergency Care-related Health Policies during the COVID-19 Pandemic in Korea: a Quasi-Experimental Study. J Korean Med Sci 2021; 36:e121. [PMID: 33904264 PMCID: PMC8076843 DOI: 10.3346/jkms.2021.36.e121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/06/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The purpose of this study was to review the nationwide emergency care-related health policies during the coronavirus disease 2019 (COVID-19) pandemic disaster in Korea and to analyze the effects of the policies on the safety of patients who visit emergency departments (EDs) during this period. METHODS This study is a quasi-experiment study. The study population was patients who visited all 402 EDs in Korea between December 31, 2019 and May 13, 2020, using the National Emergency Department Information System (NEDIS) database. The study period was classified into 5 phases according to the level of national crisis warning of infectious disease and the implementation of emergency care-related health policies, and all study phases were 27 days. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay (LOS) in the ED during the COVID-19 outbreak. RESULTS The number of ED visits during the study period was 2,636,341, and the in-hospital mortality rate was 1.4%. The number of ED visits decreased from 803,160 in phase 1 to 496,619 in phase 5 during the study period. For in-hospital mortality, the adjusted odds ratio (OR) (95% confidence interval) was 0.77 (0.74-0.79) in phase 5 compared to phase 3. Additionally, by subgroup, the ORs were 0.69 (0.57-0.83) for the patients with acute myocardial infarction and 0.76 (0.67-0.87) for severe trauma in phase 5 compared to phase 3. The ED LOS increased while the number of ED visits decreased as the COVID-19 pandemic progressed, and the ED LOS declined after policy implementation (beta coefficient: -5.3 [-6.5 to -4.2] minutes in phase 5 compared to phase 3). CONCLUSION Implementing appropriate emergency care policies in the COVID-19 pandemic would have contributed to improving the safety of all emergency patients and reducing in-hospital mortality by preventing excessive deaths.
Collapse
Affiliation(s)
- Yun Suk Pak
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Young Sun Ro
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Se Hyung Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - So Hyun Han
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Sung Keun Ko
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Taehui Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tag Heo
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.
| | - Sungwoo Moon
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| |
Collapse
|
115
|
Motta Filho GDR, Leal AC, Amaral MVGD, Maia PAV, Duarte MEL, Bähr GL. Impact of the Strategies Adopted to Face the COVID-19 Pandemic in a Brazilian Reference Institute for High Complexity Surgery in Orthopedics and Traumatology. Rev Bras Ortop 2021; 56:161-167. [PMID: 33935311 PMCID: PMC8075648 DOI: 10.1055/s-0041-1728703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/11/2021] [Indexed: 11/17/2022] Open
Abstract
COVID-19 pandemics required substantial reorganization and adaptation of healthcare services all over the world. This study aims to analyze the effect of operational strategies implemented in Brazil to manage the extra strain placed on healthcare services by the COVID-19 pandemic of 2020. In particular, this investigation examines the strategy to convert an institute specialized in elective orthopedic procedures of high complexity into a trauma unit for all musculoskeletal trauma patients of an entire federative unit. A retrospective study was conducted comparing hospital variables at the peak period of the pandemic (from March 16, 2020 to June 30, 2020) with the same period in 2019 as a comparative baseline. The variables analyzed included number of professionals away from work, surgeries performed, outpatient care, transfers, length of stay, number of patients diagnosed with COVID-19 and patient mortality. During the COVID-19 peak period, there was a 48.5% reduction in surgical productivity and 72.4% reduction in outpatient care compared with the same period in 2019. The number of transfers increased substantially (124.5%), while 94 confirmed cases and 77 suspected cases of COVID-19 were reported. The mortality rate increased by 245%. The present study highlighted the effect of COVID-19 on a tertiary orthopedic hospital. Despite the dramatic changes in hospital operations, due to the implementation of protocols to manage the pandemic, the results demonstrated the feasibility and efficiency of such protocols in prioritizing quality and safety for patients and the healthcare workforce.
Collapse
Affiliation(s)
| | - Ana Carolina Leal
- Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | | | | | - Maria Eugênia Leite Duarte
- Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Germana Lyra Bähr
- Programas Especiais, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
116
|
Akalın Y, Ulusaloglu AC, Avci O, Cevik N, Guler BO, Ozturk A. A COMPARISON OF ORTHOPAEDIC TRAUMA CASES OPERATED ON DURING THE COVID-19 PANDEMIC WITH DIFFERENT PERIODS: A SINGLE CENTRE STUDY. SANAMED 2021. [DOI: 10.24125/sanamed.v16i1.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
117
|
De C, Kainth N, Harbham PK, Brooks M, Agarwal S. Review of orthopaedic trauma surgery during the peak of COVID-19 pandemic - An observational cohort study in the UK. J Clin Orthop Trauma 2021; 20:101422. [PMID: 33903787 PMCID: PMC8059261 DOI: 10.1016/j.jcot.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/23/2021] [Accepted: 04/16/2021] [Indexed: 01/26/2023] Open
Abstract
AIM This study aims to estimate the risk of acquiring medical complication or death from COVID-19 infection in patients who were admitted for orthopaedic trauma surgery during the peak and plateau of pandemic. Unlike other recently published studies, where patient-cohort included a more morbid group and cancer surgeries, we report on a group of patients who had limb surgery and were more akin to elective orthopaedic surgery. METHODS The study included 214 patients who underwent orthopaedic trauma surgeries in the hospital between 12th March and 12th May-2020 when the pandemic was on the rise in the United Kingdom. Data was collected on demographic profile including comorbidities, ASA grade, COVID-19 testing, type of procedures and any readmissions, complications or mortality due to COVID-19. RESULTS There were 7.9% readmissions and 52.9% of it was for respiratory complications. Only one patient had positive COVID-19 test during readmission. 30-day mortality for trauma surgeries was 0% if hip fractures were excluded and 2.8% in all patients. All the mortalities were for proximal femur fracture surgeries and between ASA Grade 3 and 4 or in patients above the age of 70 years. CONCLUSION This study suggests that presence of COVID-19 virus in the community and hospital did not adversely affect the outcome of orthopaedic trauma surgeries or lead to excess mortality or readmissions in patients undergoing limb trauma surgery. The findings also support resumption of elective orthopaedic surgeries with appropriate risk stratification, patient optimization and with adequate infrastructural support amidst the recovery phase of the pandemic.
Collapse
|
118
|
Zhong H, Poeran J, Liu J, Wilson LA, Memtsoudis SG. Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review. Br J Anaesth 2021; 127:15-22. [PMID: 33965205 PMCID: PMC8049451 DOI: 10.1016/j.bja.2021.04.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background The COVID-19 pandemic has impacted healthcare in various vulnerable patient subpopulations. However, data are lacking on the impact of COVID-19 on hip fractures, seen mainly in older patients. Using national claims data, we aimed to describe the epidemiology during the first COVID-19 wave in the USA. Methods We compared patients admitted for hip fractures during March and April of 2020 with those admitted in 2019 in terms of patient and healthcare characteristics, COVID-19 diagnosis, and outcomes. An additional comparison was made between COVID-19-positive and -negative patients. Outcomes included length of hospital stay (LOS), admission to an ICU, ICU LOS, use of mechanical ventilation, 30-day readmission, discharge disposition, and a composite variable of postoperative complications. Results Overall, 16 068 hip fractures were observed in 2019 compared with 7498 in 2020. Patients with hip fractures in 2020 (compared with 2019) experienced earlier hospital discharge and were less likely to be admitted to ICU, but more likely to be admitted to home. Amongst 83 patients with hip fractures with concomitant COVID-19 diagnosis, we specifically observed more non-surgical treatments, almost doubled LOS, a more than 10-fold increased mortality rate, and higher complication rates compared with COVID-19-negative patients. Conclusions The COVID-19 pandemic significantly impacted not only volume of hip fractures, but also patterns in care and outcomes. These results may inform policymakers in future outbreaks and how this may affect vulnerable patient populations, such as those experiencing a hip fracture.
Collapse
Affiliation(s)
- Haoyan Zhong
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Lauren A Wilson
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria; Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA.
| |
Collapse
|
119
|
Dallari D, Zagra L, Cimatti P, Guindani N, D'Apolito R, Bove F, Casiraghi A, Catani F, D'Angelo F, Franceschini M, Massè A, Momoli A, Mosconi M, Ravasi F, Rivera F, Zatti G, Castelli CC. Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study. J Orthop Traumatol 2021; 22:15. [PMID: 33818650 PMCID: PMC8020826 DOI: 10.1186/s10195-021-00577-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. MATERIALS AND METHODS For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C- group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. RESULTS Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C- group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. CONCLUSIONS Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. LEVEL OF EVIDENCE Therapeutic study, level 4.
Collapse
Affiliation(s)
- Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Pietro Cimatti
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Nicola Guindani
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Rocco D'Apolito
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy
| | - Federico Bove
- Department of Orthopaedic Surgery, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Alessandro Casiraghi
- Department of Orthopaedic Surgery, ASST Degli Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Policlinico Universitario di Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Fabio D'Angelo
- Division of Orthopaedics and Traumatology, ASST Dei Sette Laghi, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Viale L. Borri 57, 21100, Varese, Italy
| | | | - Alessandro Massè
- Department of Orthopaedic Surgery Ospedale Città Della Salute e Della Scienza, Università di Torino, Via G. Zuretti 29, 10126, Turin, Italy
| | - Alberto Momoli
- Department of Orthopaedic Surgery Ospedale San Bortolo, Viale F. Rodolfi 37, 36100, Vicenza, Italy
| | - Mario Mosconi
- Department of Orthopaedic Surgery, IRCCS Policlinico San Matteo di Pavia, Viale C. Golgi 19, 27100, Pavia, Italy
| | - Flavio Ravasi
- Department of Orthopaedic Surgery, ASST Melegnano Martesana-Ospedale di Vizzolo Predabissi, Via Pandina 1, 20077, Vizzolo Predabissi, Italy
| | - Fabrizio Rivera
- Department of Orthopaedic Surgery Ospedale SS Annunziata, Via Ospedali 14, 12038, Savigliano, Italy
| | - Giovanni Zatti
- Department of Orthopaedic Surgery ASST di Monza, Università Milano Bicocca, Via Pergolesi 33, 20900, Monza, Italy
| | - Claudio Carlo Castelli
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| |
Collapse
|
120
|
Fitzgerald MJ, Goodman HJ, Kenan S, Kenan S. Did COVID-19 related delays in surgical management lead to patient morbidity in the orthopaedic oncological population? Bone Jt Open 2021; 2:236-242. [PMID: 33870729 PMCID: PMC8085619 DOI: 10.1302/2633-1462.24.bjo-2021-0005.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS The aim of this study was to assess orthopaedic oncologic patient morbidity resulting from COVID-19 related institutional delays and surgical shutdowns during the first wave of the pandemic in New York, USA. METHODS A single-centre retrospective observational study was conducted of all orthopaedic oncologic patients undergoing surgical evaluation from March to June 2020. Patients were prioritized as level 0-IV, 0 being elective and IV being emergent. Only priority levels 0 to III were included. Delay duration was measured in days and resulting morbidities were categorized into seven groups: prolonged pain/disability; unplanned preoperative radiation and/or chemotherapy; local tumour progression; increased systemic disease; missed opportunity for surgery due to progression of disease/lost to follow up; delay in diagnosis; and no morbidity. RESULTS Overall, 25 patients met inclusion criteria. There were eight benign tumours, seven metastatic, seven primary sarcomas, one multiple myeloma, and two patients without a biopsy proven diagnosis. There was no priority level 0, two priority level I, six priority level II, and 17 priority level III cases. The mean duration of delay for priority level I was 114 days (84 to 143), priority level II was 88 days (63 to 133), and priority level III was 77 days (35 to 269). Prolonged pain/disability and delay in diagnosis, affecting 52% and 40%,respectively, represented the two most frequent morbidities. Local tumour progression and increased systemic disease affected 32% and 24% respectively. No patients tested positive for COVID-19. CONCLUSION COVID-19 related delays in surgical management led to major morbidity in this studied orthopaedic oncologic patient population. By understanding these morbidities through clearer hindsight, a thoughtful approach can be developed to balance the risk of COVID-19 exposure versus delay in treatment, ensuring optimal care for orthopedic oncologic patients as the pandemic continues with intermittent calls for halting surgery. Cite this article: Bone Jt Open 2021;2(4):236-242.
Collapse
Affiliation(s)
- Michael J. Fitzgerald
- Department of Orthopaedics, North Shore-Long Island Jewish Hospital, Northwell Health Medical Center, New Hyde Park, New York, USA
| | - Howard J. Goodman
- Department of Orthopaedics, North Shore-Long Island Jewish Hospital, Northwell Health Medical Center, New Hyde Park, New York, USA
| | - Samuel Kenan
- Department of Orthopaedics, North Shore-Long Island Jewish Hospital, Northwell Health Medical Center, New Hyde Park, New York, USA
| | - Shachar Kenan
- Department of Orthopaedics, North Shore-Long Island Jewish Hospital, Northwell Health Medical Center, New Hyde Park, New York, USA
| |
Collapse
|
121
|
Jarvis S, Salottolo K, Madayag R, Pekarek J, Nwafo N, Wessel A, Duane T, Roberts Z, Lieser M, Corrigan C, Bar-Or D. Delayed hospital admission for traumatic hip fractures during the COVID-19 pandemic. J Orthop Surg Res 2021; 16:237. [PMID: 33794939 PMCID: PMC8012515 DOI: 10.1186/s13018-021-02382-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Concerns of contracting the highly contagious disease COVID-19 have led to a reluctance in seeking medical attention, which may contribute to delayed hospital arrival among traumatic patients. The study objective was to describe differences in time from injury to arrival for patients with traumatic hip fractures admitted during the pandemic to pre-pandemic patients. MATERIALS AND METHODS This retrospective cohort study at six level I trauma centers included patients with traumatic hip fractures. Patients with a non-fall mechanism and those who were transferred in were excluded. Patients admitted 16 March 2019-30 June 2019 were in the "pre-pandemic" group, patients were admitted 16 March 2020-30 June 2020 were in the "pandemic" group. The primary outcome was time from injury to arrival. Secondary outcomes were time from arrival to surgical intervention, hospital length of stay (HLOS), and mortality. RESULTS There were 703 patients, 352 (50.1%) pre-pandemic and 351 (49.9%) during the pandemic. Overall, 66.5% were female and the median age was 82 years old. Patients were similar in age, race, gender, and injury severity score. The median time from injury to hospital arrival was statistically shorter for pre-pandemic patients when compared to pandemic patients, 79.5 (56, 194.5) min vs. 91 (59, 420), p = 0.04. The time from arrival to surgical intervention (p = 0.64) was statistically similar between groups. For both groups, the median HLOS was 5 days, p = 0.45. In-hospital mortality was significantly higher during the pandemic, 1.1% vs 3.4%, p = 0.04. CONCLUSIONS While time from injury to hospital arrival was statistically longer during the pandemic, the difference may not be clinically important. Time from arrival to surgical intervention remained similar, despite changes made to prevent COVID-19 transmission.
Collapse
Affiliation(s)
- Stephanie Jarvis
- ION Research, 501 East Hampden Avenue, Englewood, Colorado 80113 USA
| | - Kristin Salottolo
- ION Research, 501 East Hampden Avenue, Englewood, Colorado 80113 USA
| | | | - Jennifer Pekarek
- ION Research, 501 East Hampden Avenue, Englewood, Colorado 80113 USA
- St. Anthony Hospital, Lakewood, CO USA
| | | | | | | | | | - Mark Lieser
- Research Medical Center, Kansas City, MO USA
| | | | - David Bar-Or
- ION Research, 501 East Hampden Avenue, Englewood, Colorado 80113 USA
| |
Collapse
|
122
|
Onizuka N, Topor LN, Schroder LK, Switzer JA. Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic. Geriatr Orthop Surg Rehabil 2021; 12:21514593211006692. [PMID: 33868768 PMCID: PMC8012779 DOI: 10.1177/21514593211006692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures. Design: Retrospective cohort study. Setting: A community hospital. Participants: Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125). Measurements: We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed. Results: The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period. Conclusion: This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.
Collapse
Affiliation(s)
- Naoko Onizuka
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Orthopaedic Surgery, Methodist Hospital, Saint Louis Park, MN, USA
| | - Lauren N Topor
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lisa K Schroder
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA
| | - Julie A Switzer
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Orthopaedic Surgery, Methodist Hospital, Saint Louis Park, MN, USA
| |
Collapse
|
123
|
Barker T, Thompson J, Corbett J, Johal S, McNamara I. Increased 30-day mortality rate in patients admitted with hip fractures during the COVID-19 pandemic in the UK. Eur J Trauma Emerg Surg 2021; 47:1327-1334. [PMID: 33783567 PMCID: PMC8008328 DOI: 10.1007/s00068-021-01649-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
Introduction Hip fractures are the most common traumatic injury in the UK’s elderly population. Patients are often extremely frail with multiple comorbidities and so are at high risk of death should they contract COVID-19. This study aims to quantify the effects of COVID-19 on patients presenting with hip fractures to the Norfolk and Norwich University Hospital (NNUH). Methods This is a single centre, prospective, observational cohort study of patients over the age of sixty admitted with a hip fracture to NNUH between March 24th and April 22nd, 2020 and comparing them retrospectively with controls in April 2019. Patients were followed up for 30 days; data collected includes demographics, COVID-19 PCR results, date/cause of death and other prognostic indicators. Results 66 consecutive patients managed for hip fractures were included in the study. 30-day mortality increased from 8.5% in April 2019 to 18.2% in April 2020. The 30-day mortality rate was 80% for those patients who test positive for COVID-19 as an inpatient, and was 13.8% for patients COVID-19 negative and for those who were untested. Those admitted from a healthcare institution were more likely to test positive for COVID-19 and had a higher 30-day mortality (p = 0.04 & p = 0.006, respectively). Suspected COVID-19-positive patients at time of admission had a delayed time to theatre, 46.7 h versus 27.1 h (p = 0.007), however this had no significant effect on mortality (p = 0.7). Conclusions The combination of fragility hip fracture and COVID-19 is associated with poor outcomes. COVID-19 has also indirectly increased mortality in this patient group.
Collapse
Affiliation(s)
- Thomas Barker
- Trauma and Orthopaedics Department, Norfolk and Norwich University Hospital, Norwich, UK.
| | - Joshua Thompson
- Trauma and Orthopaedics Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - James Corbett
- Trauma and Orthopaedics Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - Sim Johal
- Trauma and Orthopaedics Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - Iain McNamara
- Trauma and Orthopaedics Department, Norfolk and Norwich University Hospital, Norwich, UK
| |
Collapse
|
124
|
Impact of the 1st and 2nd Wave of the COVID-19 Pandemic on Primary or Revision Total Hip and Knee Arthroplasty-A Cross-Sectional Single Center Study. J Clin Med 2021; 10:jcm10061260. [PMID: 33803721 PMCID: PMC8003209 DOI: 10.3390/jcm10061260] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to evaluate the number of primary and revision total joint arthroplasties (TJA/rTJA) in 2020 compared to 2019. Specifically, the first and the second waves of the COVID-19 pandemic were evaluated as well as the pre-operative COVID-19 test. A cross-sectional single-center study of our prospectively maintained institutional arthroplasty registry was performed. The first COVID-19 wave and the second COVID-19 wave led to a socioeconomic lockdown in 2020. Performed surgeries, cause of revision, age, gender, and American Society of Anesthesiologists-level were analyzed. Preoperative COVID-19 testing was evaluated and nationwide COVID-19 data were compared to other countries. In 2020, there was a decrease by 16.2% in primary and revision TJAs of the hip and knee compared to 2019. We observed a reduction of 15.8% in primary TJAs and a reduction of 18.6% on rTJAs in 2020 compared to 2019. There is an incline in total hip arthroplasties (THAs) and a decline in total knee arthroplasties (TKAs) comparing 2019 to 2020. During the first wave, there was a reduction in performed primary TJAs of 86%. During the second wave, no changes were observed. This is the first study quantifying the impact of the COVID-19 pandemic on primary and revision TJAs regarding the first and second wave.
Collapse
|
125
|
Fessler J, Jacobsen T, Lauritzen JB, Jørgensen HL. Mortality among hip fracture patients infected with COVID-19 perioperatively. Eur J Trauma Emerg Surg 2021; 47:659-664. [PMID: 33704515 PMCID: PMC7947941 DOI: 10.1007/s00068-021-01634-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/03/2021] [Indexed: 12/23/2022]
Abstract
Background and purpose The outbreak of the COVID-19 pandemic has resulted in an overall decline in fractures. However, the amount of hip fractures has remained relatively stable throughout the period. The objective of this study is to investigate the impact of perioperative COVID-19 infections on mortality among hip fracture patients. Methods A meta-analysis was performed by collecting current data available through a systematic literature search in the PubMed database. The search was performed Oct 18 2020. Results The meta-analysis was conducted on a trial population consisting of 1.272 hip fracture patients with a pooled prevalence of COVID-19 of 18%. Mortality among hip fracture patients without a perioperative COVID-19 infection was 7.49%. Mortality among hip fracture patients infected with COVID-19 perioperatively was associated with an odds ratio of 6.70 [(95% CI 4.64–9.68), p < 0.00001, I2 = 41%]. A sensitivity analysis showed no major impact of assumptions regarding varying definitions of COVID-19 statuses among the included studies. Conclusion Perioperative infections with COVID-19 in hip fracture patients are correlated with a significantly increased mortality. The meta-analysis showed a pooled odds ratio of 6.70 [(95% CI 4.64–9.68), p < 0.00001, I2 = 41%].
Collapse
Affiliation(s)
- Johannes Fessler
- Department of Orthopedic Surgery, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 KBH NV, Copenhagen, Denmark
| | - Thomas Jacobsen
- Department of Orthopedic Surgery, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 KBH NV, Copenhagen, Denmark
| | - Jes Bruun Lauritzen
- Department of Orthopedic Surgery, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 KBH NV, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 KBH N, Copenhagen, Denmark
| | - Henrik Løvendahl Jørgensen
- Department of Clinical Biochemistry, Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 KBH N, Copenhagen, Denmark.
| |
Collapse
|
126
|
Malik-Tabassum K, Robertson A, Tadros BJ, Chan G, Crooks M, Buckle C, Rogers B, Selmon G, Arealis G. The effect of the COVID-19 lockdown on the epidemiology of hip fractures in the elderly: a multicentre cohort study. Ann R Coll Surg Engl 2021; 103:337-344. [PMID: 33715420 DOI: 10.1308/rcsann.2020.7071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic presented extraordinary challenges to the UK healthcare system. This study aimed to assess the impact of the COVID-19 lockdown on the epidemiology, treatment pathways and 30-day mortality rates of hip fractures. Outcomes of COVID-19 positive patients were compared against those who tested negative. METHODS An observational, retrospective, multicentre study was conducted across six hospitals in the South East of England. Data were retrieved from the National Hip Fracture Database and electronic medical records. Data was collected for the strictest UK lockdown period (period B=23 March 2020-11 May 2020), and the corresponding period in 2019 (period A). RESULTS A total of 386 patients were admitted during period A, whereas 381 were admitted during period B. Despite the suspension of the 'Best Practice Tariff' during period B, time to surgery, time to orthogeriatric assessment, and 30-day mortality were similar between period A and B. The length of inpatient stay was significantly shorter during period B (11.5 days vs 17.0 days, p<0.001). Comparison of COVID-19 positive and negative patients during period B demonstrated that a positive test was associated with a significantly higher rate of 30-day mortality (53.6% vs 6.7%), surgical delay >36h (46.4% vs 30.8%, p=0.049), and increased length of inpatient stay (15.8 vs 11.7 days, p=0.015). CONCLUSIONS The COVID-19 lockdown did not alter the epidemiology of hip fractures. A substantially higher mortality rate was observed among patients with a COVID-19 positive test. These findings should be taken into consideration by the healthcare policymakers while formulating contingency plans for a potential 'second wave'.
Collapse
Affiliation(s)
| | | | - B J Tadros
- East Kent Hospitals University NHS Foundation Trust, UK
| | - G Chan
- Western Sussex Hospitals NHS Trust, UK.,Brighton and Sussex Medical School, UK
| | - M Crooks
- East Sussex Healthcare NHS Trust, UK
| | - C Buckle
- Brighton and Sussex University Hospitals NHS Trust, UK
| | - B Rogers
- Brighton and Sussex University Hospitals NHS Trust, UK
| | - G Selmon
- East Sussex Healthcare NHS Trust, UK
| | - G Arealis
- East Kent Hospitals University NHS Foundation Trust, UK
| |
Collapse
|
127
|
Greensmith TSW, Faulkner AC, Davies PSE, Sinnerton RJH, Cherry JV, Supparamaniam S, MacInnes A, Dalgleish S. Hip fracture care during the 2020 COVID-19 first-wave: a review of the outcomes of hip fracture patients at a Scottish Major Trauma Centre. Surgeon 2021; 19:e318-e324. [PMID: 33692003 PMCID: PMC7904444 DOI: 10.1016/j.surge.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE OF THE STUDY This study reviewed whether the response to the Coronavirus (COVID-19) pandemic affected the care for hip fracture patients at a major trauma centre in Scotland during the first-wave lock-down period. METHODS All patients referred to Orthopaedics with a hip fracture in a major trauma centre in Scotland were captured between 14 th March and 28 th May (11 weeks) in 2020 and 2019. Patients were identified using electronic patient records. The primary outcomes are time to theatre, length of admission and 30-day mortality. Secondary outcomes are COVID-19 prevalence, duration of surgery, proportion of patients to theatre within 36 hours and COVID-19 positive 30-day mortality from time of surgery. 225 patients were included: 108 from 2019 and 117 from 2020. THE MAIN FINDINGS 30-day mortality was 3.7% (n=4) in 2019 and 8.5% (n=10) in 2020 (p=0.142). There was no statistical difference with time to theatre (p=0.150) nor duration of theatre (p=0.450). Duration of admission was reduced from 12 days to 6.5 days (p=<0.005). 4 patients tested positive for COVID-19 during admission, one 5 days after discharge, all underwent surgical management. 30-day mortality for COVID-19 positive patients during admission was 40%. COVID-19 prevalence of patients that were tested (n=89) was 5.62%. CONCLUSIONS This study has shown the care of hip fracture patients has been maintained during the COVID-19 pandemic. There is no statistically significant change in mortality, time to theatre, and duration of surgery, however, the patient's admission duration was significantly less than the 2019 cohort.
Collapse
Affiliation(s)
- Thomas S W Greensmith
- Department of Trauma and Orthopaedics, Ninewells Hospital, NHS Tayside, Dundee, DD1 9SY, UK.
| | - Alastair C Faulkner
- Department of Trauma and Orthopaedics, Ninewells Hospital, NHS Tayside, Dundee, DD1 9SY, UK
| | - Peter S E Davies
- Department of Trauma and Orthopaedics, Ninewells Hospital, NHS Tayside, Dundee, DD1 9SY, UK
| | - Robert J H Sinnerton
- Department of Trauma and Orthopaedics, Ninewells Hospital, NHS Tayside, Dundee, DD1 9SY, UK
| | - Jennifer V Cherry
- Department of Trauma and Orthopaedics, Ninewells Hospital, NHS Tayside, Dundee, DD1 9SY, UK
| | - Shreyas Supparamaniam
- Department of Trauma and Orthopaedics, Ninewells Hospital, NHS Tayside, Dundee, DD1 9SY, UK
| | - Alasdair MacInnes
- Department of Trauma and Orthopaedics, Ninewells Hospital, NHS Tayside, Dundee, DD1 9SY, UK
| | - Stephen Dalgleish
- Department of Trauma and Orthopaedics, Ninewells Hospital, NHS Tayside, Dundee, DD1 9SY, UK
| |
Collapse
|
128
|
Delayed Presentation of Patients with Hip Fractures during the COVID-19 "Stay-at-Home" Order in the Southmost Region of the United States. Adv Orthop 2021; 2021:8822004. [PMID: 33643668 PMCID: PMC7902137 DOI: 10.1155/2021/8822004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 12/12/2022] Open
Abstract
To evaluate the effects of COVID-19 and stay-at-home orders in traumatic hip fractures presentation, we conducted a retrospective chart review cohort study from March 13 to June 13 in 2020 compared to 2019 from a single-hospital Trauma Level 2 Center. Males and females, 18 years of age and older presenting with a diagnosis of displaced or nondisplaced, intracapsular, or extracapsular hip fracture, underwent standard of care—comparative analysis of the patient's characteristics and clinical outcomes. The primary study outcomes included age, sex, ethnicity, and body mass index, the onset of injury, date of arrival, payer, the primary type of injury and comorbidities, mechanism of injury, treatment received, postoperative complications, days in an intensive care unit (ICU), discharge disposition, pre- and postinjury functional status, and COVID-19 test. Age, sex, ethnicity, and body mass index were similar in the patients in 2019 compared to 2020. The patients' average age was 76 years old, 80% reported Hispanic ethnicity, and 63% of the patients were females. Most injuries (90%) occurred due to falls. On average, patients in 2020 presented 4.8 days after the injury onset as compared to 0.7 days in 2019 (p < 0.05). There was an increase in displaced fractures in 2019 compared to 2020 and an increase in patients' disposition into rehabilitation facilities compared to skilled nursing facilities. Despite the delay in presentation, length of stay, days in the ICU, or functional outcomes of the patients were not affected. Although the patients showed a delayed presentation after hip fracture, this does not appear to significantly interfere with the short-term or the 6-month mortality outcomes of the patients, suggesting the possibility of guided delayed care during times of national emergency and increased strain in hospital resources.
Collapse
|
129
|
Giorgi PD, Gallazzi E, Capitani P, Biancardi E, Bove F, Mezzadri U, Capitani D, Schirò GR. Mortality and morbidity in COVID-19 orthopedic trauma patients: is early surgery the keystone? Pan Afr Med J 2021; 38:163. [PMID: 33995770 PMCID: PMC8077645 DOI: 10.11604/pamj.2021.38.163.27125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/05/2021] [Indexed: 12/23/2022] Open
Abstract
In the pandemic disease caused by SARS-CoV-2 virus, trauma surgery continued the management of patients with fractures. The purpose of the study is to evaluate mortality and morbidity in orthopedic trauma patients surgically treated with a diagnosis of COVID-19 infection, comparing them to a control group of COVID-19 negative. We retrospectively identified patients admitted to our Emergency Room from March 8th to May 4th 2020 (time frame corresponding to the first wave of the pandemic peak, one of the most severe in the world at that time) with a diagnosis of fracture that were subsequently surgically treated. We applied a dedicated pathway for the management of COVID-19 trauma patients allowed to perform an early surgery and short hospitalization. For each patient included demographics, clinical, laboratory, radiological data and type of treatment for COVID-19 infection were collected. Sixty-five (65) patients were identified. Of those, 17 (6 women and 11 men, mean age 63.41 years old, mean ASA grade 2.35) were COVID-19 positive (study group), while the others were control group (mean age 56.58 years old, mean ASA grade 2.21). In the study group, the preoperative laboratory tests showed leukocytosis in six and lymphopenia in 15 cases. Fourteen patients had a high level of C-reactive protein. Fifteen patients had an abnormal level of D-dimer. The mortality recorded was 5.8% and 4.1% in the study and control group respectively. Perioperative adverse events were registered in 5 cases (29.4%) in the study group and in 8 (16.6%) in the control group (p>0.05). Dedicated COVID-19 trauma pathway with the aim of an early surgery could be key for a better result in terms of mortality and morbidity. Age and ASA grade could represent independent risk factors for perioperative complications.
Collapse
Affiliation(s)
| | - Enrico Gallazzi
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy
| | - Paolo Capitani
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy
| | - Elena Biancardi
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy
| | - Federico Bove
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy
| | - Umberto Mezzadri
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy
| | - Dario Capitani
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy
| | | |
Collapse
|
130
|
Hip fracture care and mortality among patients treated in dedicated COVID-19 and non-COVID-19 circuits. Eur Geriatr Med 2021; 12:749-757. [PMID: 33550563 PMCID: PMC7867866 DOI: 10.1007/s41999-021-00455-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Aim What were the effects of the COVID-19 pandemic and patient cohorting on the mortality and care provided for patients with hip fractures? Findings Mortality due to COVID-19 infection was higher before patient cohorting, and no nosocomial infections were detected after cohorting. Survival of patients treated in the COVID-19 circuit was similar to non-COVID-19 controls, in spite of longer surgical delay and length of stay. Message Separate circuits for COVID-19 and non-COVID-19 patients allows adequate hip fracture care, without observing increased mortality when delaying surgery until stabilization among patients with severe respiratory illness. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00455-x. Introduction To analyze the effect of the COVID-19 pandemic on the provision of fragility hip fracture care, comparing patients treated before cohorting and in separate COVID-19 and non-COVID-19 circuits with the corresponding months in 2018 and 2019. Materials and methods Retrospective single-center cohort study including 64 patients with fragility hip fractures treated during the COVID-19 pandemic (March 1st–May 1st, 2020), compared to 172 patients treated in 2018 and 2019. Dedicated COVID-19 and non-COVID-19 circuits were established on March 14th. Patients treated before cohorting (17 patients), in COVID-19 (14 patients) and non-COVID-19 circuits (33 patients) were included. Results Baseline characteristics were similar for 2018–19 and 2020. Patients in 2020 had a lower median surgical delay (50.5 vs. 91.3 h) and length of stay (9.0 vs. 14.0 days), while those with COVID-19, had longer surgical delays and length of stay (87.7 h and 15.0 days, respectively). Thirty-days mortality was higher among patients before cohorting, but similar in Covid-19 and non-Covid-19 pathways compared to 2018–19 (7.1% and 3.0% vs 5.2%, respectively). 23.5% of patients treated before circuiting suffered coronavirus infectious disease-19 disease after discharge. Following separation, no secondary cases of coronavirus infectious disease-19 were observed. Conclusions Separate circuits for patients with and without coronavirus infectious disease-19 provided adequate hip fracture care. We did not observe increased mortality rates among hip fracture patients with preoperatively confirmed or suspected coronavirus infectious disease-19, compared to negative cases and 2018–19. Delaying surgery among patients with severe respiratory illness until a favourable trend could be observed did not lead to increased mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00455-x.
Collapse
|
131
|
Ojeda-Thies C, Cuarental-García J, Ramos-Pascua LR. Decreased volume of hip fractures observed during COVID-19 lockdown. Eur Geriatr Med 2021; 12:759-766. [PMID: 33481186 PMCID: PMC7820835 DOI: 10.1007/s41999-020-00447-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/28/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The aim was to study the incidence and characteristics of fragility hip fractures admitted during COVID-19 lockdown. MATERIALS AND METHODS We analysed socio-demographic and baseline characteristics of patients suffering fragility hip fractures between March 1st and May 1st 2020, period most affected by COVID-19 confinement measures. Cases (n = 64) were compared with controls (n = 172) from corresponding periods in 2018 and 2019. Poisson Generalised Linear Model regression analysis was performed to compare daily case counts, and LOESS curves compared time series. RESULTS No differences were found regarding age or gender distributions, pre-fracture living, ambulatory, functional or cognitive status. More patients in 2020 had a high-risk ASA score. Fewer cases [Reduction = 26% (95% CI 1-44%)] were admitted in 2020. The reduction seemed to correspond with confinement. CONCLUSIONS Approximately, one quarter less fragility hip fractures were admitted to our hospital during lockdown. Patients' baseline status and socio-demographic characteristics were similar.
Collapse
Affiliation(s)
- Cristina Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda Córdoba s/n, 28041, Madrid, Spain.
| | - Javier Cuarental-García
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda Córdoba s/n, 28041, Madrid, Spain
| | - Luis Rafael Ramos-Pascua
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda Córdoba s/n, 28041, Madrid, Spain.,Department of Surgery, School of Medicine, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
132
|
Tripathy SK, Varghese P, Panigrahi S, Panda BB, Velagada S, Sahoo SS, Naik MA, Rao SK. Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: A systematic review and meta-analysis. World J Orthop 2021; 12:35-50. [PMID: 33520680 PMCID: PMC7814308 DOI: 10.5312/wjo.v12.i1.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/05/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality. However, limitations of the resources, risk of disease transmission and redirection of medical attention to a more severe infective health problem during coronavirus disease 2019 (COVID-19) pandemic period have affected the quality of care even in a surgical emergency.
AIM To compare the 30-d mortality rate and complications of hip fracture patients treated during COVID-19 pandemic and pre-pandemic times.
METHODS The search of electronic databases on 1st August 2020 revealed 45 studies related to mortality of hip fracture during the COVID-19 pandemic and pre-pandemic times. After careful screening, eight studies were eligible for quantitative and qualitative analysis of data.
RESULTS The pooled data of eight studies (n = 1586) revealed no significant difference in 30-d mortality rate between the hip fracture patients treated during the pandemic and pre-pandemic periods [9.63% vs 6.33%; odds ratio (OR), 0.62; 95%CI, 0.33, 1.17; P = 0.14]. Even the 30-d mortality rate was not different between COVID-19 non-infected patients who were treated during the pandemic time, and all hip fracture patients treated during the pre-pandemic period (OR, 1.03; 95%CI, 0.61, 1.75; P = 0.91). A significant difference in mortality rate was observed between COVID-19 positive and COVID-19 negative patients (OR, 6.99; 95%CI, 3.45, 14.16; P < 0.00001). There was no difference in the duration of hospital stay (OR, -1.52, 95%CI, -3.85, 0.81; P = 0.20), overall complications (OR, 1.62; P = 0.15) and incidence of pulmonary complications (OR, 1.46; P = 0.38) in these two-time frames. Nevertheless, the preoperative morbidity was more severe, and there was less use of general anesthesia during the pandemic time.
CONCLUSION There was no difference in 30-d mortality rate between hip fracture patients treated during the pandemic and pre-pandemic periods. However, the mortality risk was higher in COVID-19 positive patients compared to COVID-19 negative patients. There was no difference in time to surgery, complications and hospitalization time between these two time periods.
Collapse
Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Paulson Varghese
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, India
| | - Sibasish Panigrahi
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, India
| | | | - Sandeep Velagada
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, India
| | | | - Monappa A Naik
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576104, India
| | - Sharath K Rao
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, Manipal 576104, India
| |
Collapse
|
133
|
Holmes N, Virani S, Relwani J. Hospital transmission rates of the SARS-CoV 2 disease amongst orthopaedic in-patients in a secondary care centre: A quantitative review. J Clin Orthop Trauma 2021; 16:43-48. [PMID: 33519136 PMCID: PMC7834768 DOI: 10.1016/j.jcot.2020.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Orthopaedic practice changed during COVID-19 with elective work ceasing, trauma reducing and work forces redistributed to medical areas. During the United Kingdom lockdown, hospitals were stretched thinly with admissions of SARS-CoV-2 positive patients. AIM Evaluate orthopaedic admissions to a district general hospital during lockdown and the volume of those who subsequently were found to be COVID-19 positive. METHOD Retrospective study of patients admitted under trauma and orthopaedics between March 23, 2020-June 18, 2020. Data includes; diagnosis, COVID-19 swab dates, results and mortality using orthopaedic admission sheets, patient and pathology electronic recording system. RESULTS 3/4 of admitted patients tested negative for SARS-CoV-2 initially. Of these 240 patients, 12.5% subsequently tested positive during their stay, often within one week of their admission. 17.8% of patients were never tested. 7.8% mortality rate of which 48% were neck of femur fracture (NOF#) patients. 28 NOF# were confirmed COVID-19 positive; mortality rate of 21.4%. 87 NOF# were COVID-19 negative; mortality rate 6.9%. Mortality relative risk (RR) for NOF# and COVID-19 positive was 2.6. COVID-19 positive mortality 27% as compared to 4% in COVID-19 negative patients. Patients who acquired COVID-19 whilst in hospital had a mortality relative risk 6.4. CONCLUSION 12.5% orthopaedic in-hospital viral transmission rate amongst orthopaedic patients despite the segregation measures taken, possibly due to asymptomatic health care workers or inpatients awaiting swab results. We emphasize the importance of testing all inpatients and regular testing of healthcare workers.
Collapse
|
134
|
Cannada LK, Mears SC, Quatman C. Clinical Faceoff: When Should Patients 65 Years of Age and Older Have Surgery for Hip Fractures, and When is it a Bad Idea? Clin Orthop Relat Res 2021; 479:24-27. [PMID: 33315622 PMCID: PMC7899710 DOI: 10.1097/corr.0000000000001596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/05/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Lisa K Cannada
- L. K. Cannada, Orthopaedic Trauma Surgeon, Novant Health Orthopedics, Charlotte, NC, USA
- S. C. Mears, Professor, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- C. Quatman, Associate Professor, Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
| | - Simon C Mears
- L. K. Cannada, Orthopaedic Trauma Surgeon, Novant Health Orthopedics, Charlotte, NC, USA
- S. C. Mears, Professor, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- C. Quatman, Associate Professor, Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
| | - Carmen Quatman
- L. K. Cannada, Orthopaedic Trauma Surgeon, Novant Health Orthopedics, Charlotte, NC, USA
- S. C. Mears, Professor, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- C. Quatman, Associate Professor, Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
135
|
Clement ND. Letter to the editor: Coronavirus disease 2019 (COVID-19) markedly increased mortality in patients with hip fracture: A systematic review and meta-analysis. J Clin Orthop Trauma 2021; 12:43. [PMID: 33239854 PMCID: PMC7673211 DOI: 10.1016/j.jcot.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
136
|
Lim MA, Pranata R. Coronavirus disease 2019 (COVID-19) markedly increased mortality in patients with hip fracture - A systematic review and meta-analysis. J Clin Orthop Trauma 2021; 12:187-193. [PMID: 32958988 PMCID: PMC7495188 DOI: 10.1016/j.jcot.2020.09.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION This systematic review and meta-analysis aimed to evaluate the prevalence of coronavirus disease 2019 (COVID-19) and its impact on mortality in patients with hip fracture. METHODS We performed a systematic literature search in PubMed, Cochrane Central Database, and medRvix from inception up to July 13, 2020 on research articles that enrolled hip fracture patients who had information on COVID-19 and clinically validated definition of death. RESULTS A total of 984 participants from 6 studies were included in our study. The pooled prevalence of COVID-19 was 9% [95% CI: 7-11%]. The mortality rate in patients with concomitant hip fracture and COVID-19 was found to be 36% (95% CI: 26-47%), whereas the mortality rate in hip fracture without COVID-19 is 2% (95% CI: 1-3%). Meta-analysis showed that COVID-19 was associated with a seven-fold increase in risk (RR 7.45 [95% CI: 2.72, 20.43], p < 0.001; I2: 68.6%) of mortality in patients with hip fracture. Regression-based Harbord's test showed no indication of small-study effects (p = 0.06). CONCLUSION The present meta-analysis showed that COVID-19 increased the risk of mortality in patients with hip fracture. TRIAL REGISTRATION This study is registered with PROSPERO, July 21, 2020, number CRD42020199618. Available from https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020199618.
Collapse
Affiliation(s)
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| |
Collapse
|
137
|
Brown WA, Moore EM, Watters DA. Mortality of patients with
COVID
‐19 who undergo an elective or emergency surgical procedure: a systematic review and meta‐analysis. ANZ J Surg 2020; 91:33-41. [DOI: 10.1111/ans.16500] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/12/2020] [Accepted: 11/21/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Wendy A. Brown
- Department of Surgery Monash University, Alfred Health Melbourne Victoria Australia
| | - Eileen M. Moore
- Department of Surgery Deakin University, Barwon Health Geelong Victoria Australia
| | - David A. Watters
- Department of Surgery Deakin University, Barwon Health Geelong Victoria Australia
| |
Collapse
|
138
|
Clement ND, Ng N, Simpson CJ, Patton RFL, Hall AJ, Simpson AHRW, Duckworth AD. The prevalence, mortality, and associated risk factors for developing COVID-19 in hip fracture patients: a systematic review and meta-analysis. Bone Joint Res 2020; 9:873-883. [PMID: 33350316 PMCID: PMC9021904 DOI: 10.1302/2046-3758.912.bjr-2020-0473.r1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS The aims of this meta-analysis were to assess: 1) the prevalence of coronavirus disease 2019 (COVID-19) in hip fracture patients; 2) the associated mortality rate and risk associated with COVID-19; 3) the patient demographics associated with COVID-19; 4) time of diagnosis; and 5) length of follow-up after diagnosis of COVID-19. METHODS Searches of PubMed, Medline, and Google Scholar were performed in October 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Search terms included "hip", "fracture", and "COVID-19". The criteria for inclusion were published clinical articles reporting the mortality rate associated with COVID-19 in hip fracture patients. In total, 53 articles were identified and following full text screening 28 articles satisfied the inclusion criteria. RESULTS A total of 28 studies reported the mortality of COVID-19-positive patients, of which 21 studies reported the prevalence of COVID-19-positive patients and compared the mortality rate to COVID-19-negative patients. The prevalence of COVID-19 was 13% (95% confidence interval (CI) 11% to 16%) and was associated with a crude mortality rate of 35% (95% CI 32% to 39%), which was a significantly increased risk compared to those patients without COVID-19 (odds ratio (OR) 7.11, 95% CI 5.04 to 10.04; p < 0.001). COVID-19-positive patients were more likely to be male (OR 1.51, 95% CI 1.16 to 1.96; p = 0.002). The duration of follow-up was reported in 20 (71.4%) studies. A total of 17 studies reported whether a patient presented with COVID-19 (n = 108 patients, 35.1%) or developed COVID-19 following admission (n = 200, 64.9%), of which six studies reported a mean time to diagnosis of post-admission COVID-19 at 15 days (2 to 25). CONCLUSION The prevalence of COVID-19 was 13%, of which approximately one-third of patients were diagnosed on admission, and was associated with male sex. COVID-19-positive patients had a crude mortality rate of 35%, being seven times greater than those without COVID-19. Due to the heterogenicity of the reported data minimum reporting standards of outcomes associated with COVID-19 are suggested. Cite this article: Bone Joint Res 2020;9(12):873-883.
Collapse
Affiliation(s)
- Nicholas D Clement
- Orthopaedics and Trauma, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Nathan Ng
- Orthopaedics and Trauma, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Cameron J Simpson
- Orthopaedics and Trauma, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Robyn F L Patton
- Medical School, Biomedical Sciences, Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Andrew James Hall
- Orthopaedics and Trauma, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.,The Department of Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Hamish R W Simpson
- The Department of Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew D Duckworth
- Orthopaedics and Trauma, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.,The Department of Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
139
|
Craig J, Maguire M, Shevlin SP, Black ND. The effects of COVID-19 on hip fracture management and mortality in a regional trauma centre. Anaesthesia 2020; 76:710-711. [PMID: 33263184 PMCID: PMC7753778 DOI: 10.1111/anae.15323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/01/2022]
Affiliation(s)
- J Craig
- Royal Victoria Hospital, Belfast, UK
| | - M Maguire
- Royal Victoria Hospital, Belfast, UK
| | | | - N D Black
- Royal Victoria Hospital, Belfast, UK
| |
Collapse
|
140
|
Wang KC, Xiao R, Cheung ZB, Barbera JP, Forsh DA. Early mortality after hip fracture surgery in COVID-19 patients: A systematic review and meta-analysis. J Orthop 2020; 22:584-591. [PMID: 33223732 PMCID: PMC7670234 DOI: 10.1016/j.jor.2020.11.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023] Open
Abstract
Objective The aim of this systematic review and meta-analysis was to assess the risk of early mortality in hip fracture patients with COVID-19 infection who undergo surgical intervention. Data sources MEDLINE (PubMed) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Study selection Studies were included in the systematic review if they reported postoperative mortality in patients with COVID-19 infection who underwent operative intervention for hip fracture. From this selection of studies, only investigations that reported postoperative mortality in a COVID-positive and a non-COVID group were included in the meta-analysis. Data extraction Data regarding patient demographics, age, and sex were recorded. Additional data that was extracted included study location, data collection period, length of follow-up, COVID testing methodology, COVID testing results, and number of patients who underwent operative versus nonoperative management. The primary outcome of interest was postoperative mortality. Data synthesis Random effects meta-analyses were performed to assess the pooled relative risk of postoperative mortality according to COVID status. Odds ratios and 95% confidence intervals (CI) were calculated. Conclusions The overall pooled mortality rate in the early postoperative period for hip fracture patients with concomitant COVID-19 infection was 32.6%. The relative risk for postoperative mortality in COVID-positive patients compared to non-COVID patients was 5.66 (95% CI 4.01–7.98; p < 0.001). The currently available literature demonstrates that COVID-19 infection represents a substantial risk factor for early postoperative mortality in the already susceptible hip fracture population. Further investigations will be needed to assess longer-term morbidity and mortality in this patient population. Level of evidence Therapeutic Level IV.
Collapse
Affiliation(s)
- Kevin C Wang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ryan Xiao
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Zoe B Cheung
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Joseph P Barbera
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - David A Forsh
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| |
Collapse
|
141
|
Rasidovic D, Ahmed I, Thomas C, Kimani PKU, Wall P, Mangat K. Impact of COVID-19 on clinical outcomes for patients with fractured hip: a multicentre observational cohort study. Bone Jt Open 2020; 1:697-705. [PMID: 33263109 PMCID: PMC7690757 DOI: 10.1302/2633-1462.111.bjo-2020-0132.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Imran Ahmed
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | - Peter Wall
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | |
Collapse
|
142
|
Raj S, Chouksey P, Mishra R, Shrivastava A, Agrawal A. Letter to the Editor Regarding: "Case Volumes and Perioperative COVID-19 Incidence in Neurosurgical Patients During a Pandemic: Experiences at Two Tertiary Care Centers in Washington, DC". World Neurosurg 2020; 143:632. [PMID: 33167155 PMCID: PMC7608007 DOI: 10.1016/j.wneu.2020.08.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Sumit Raj
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, India
| | - Pradeep Chouksey
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, India
| | - Rakesh Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, India
| | - Adesh Shrivastava
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, India.
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, India
| |
Collapse
|
143
|
Adesunkanmi AO, Ubom AE, Olasehinde O, Wuraola FO, Ijarotimi OA, Okon NE, Ikimalo JI, Fasubaa OB, Adesunkanmi ARK. Impact of the COVID-19 Pandemic on Surgical Residency Training: Perspective from a Low-Middle Income Country. World J Surg 2020; 45:10-17. [PMID: 33118075 PMCID: PMC7594960 DOI: 10.1007/s00268-020-05826-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic has drastically impacted postgraduate training programmes worldwide. This study aims to evaluate the Nigerian situation with respect to surgical training, with a view to identifying gaps and proffering solutions. METHODS A cross-sectional survey of surgical residents in Nigeria was conducted between 27 July 2020 and 14 August 2020. A structured questionnaire designed using the free software Google Forms® was utilised for the study. The questionnaire was electronically distributed randomly to 250 surgical residents via emails and social media platforms including WhatsApp and Telegram. The data obtained was analysed by Google Forms®. Ethical approval for the study was obtained from the ethics and research unit of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria. RESULTS At the end of the study period, 207 surgical residents completed and submitted the questionnaire, giving a response rate of 82.8%. The majority of respondents reported a reduction (164, 79.2%) or cancellation (11, 5.3%) of postgraduate programmes in their institutions. Of those who had academic programmes, meetings were done using virtual technology in all instances. The majority of respondents reported seeing fewer patients in the outpatient clinics (173, 83.6%), as well as a reduction in the number of emergency and elective operations (58.5% and 90.8%, respectively). About a third of the respondents (70, 33.8%) were contemplating emigrating from the country. CONCLUSION The COVID-19 pandemic has significantly affected the clinical, research and teaching components of surgical training in Nigeria. It has, however, led to increased adoption of digital technology which should be further explored in the face of current realities.
Collapse
Affiliation(s)
| | - Akaninyene Eseme Ubom
- Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Funmilola Olanike Wuraola
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Omotade Adebimpe Ijarotimi
- Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Obstetrics, Gynaecology, and Perinatology, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | | | - John Igemo Ikimalo
- Department of Obstetrics and Gynaecology, University of Port Harcourt/University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Olusola Benjamin Fasubaa
- Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Obstetrics, Gynaecology, and Perinatology, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Abdul Rashid Kayode Adesunkanmi
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| |
Collapse
|
144
|
Abate SM, Mantefardo B, Basu B. Postoperative mortality among surgical patients with COVID-19: a systematic review and meta-analysis. Patient Saf Surg 2020; 14:37. [PMID: 33062056 PMCID: PMC7549731 DOI: 10.1186/s13037-020-00262-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic puts perioperative providers and staff at risk of viral exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during aerosol-generating procedures, particularly in asymptomatic carriers.However, the perioperative risk for adverse outcomes in SARS-CoV-2 infected patients remain uncertain and the topic of debate. The current study was designed to determine the postoperative mortality in COVID-19 patients based on a systematic review and meta-analysis of the global published peer-reviewed literature. METHODS A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019, to August15, 2020, without language restriction. All observational studies reporting the prevalence of mortality were included while case reports and reviews were excluded. The data from each study were extracted with two independent authors with a customized format excel sheet and the disagreements were resolved by the third author. The methodological quality of included studies was evaluated using a standardized critical appraisal Tool adapted from the Joanna Briggs Institute. RESULTS A total of 715 articles were identified from different databases and 45 articles were selected for evaluation after the successive screening. Twenty-three articles with 2947 participants were included. The meta-analysis revealed a very high global rate of postoperative mortality among COVID-19 patients of 20% (95% CI: 15 to 26) and a postoperative ICU admission rate of 15% (95% confidence interval (CI):10 to 21). CONCLUSION The unexpected high postoperative mortality rate in SARS-CoV-2 infected patients of 20% in the global literature mandates further scrutiny in assuring appropriate surgical indications and perioperative surgical safety measures in this vulnerable cohort of patients. REGISTRATION This systematic review and meta-analysis was registered in Prospero's international prospective register of systematic reviews (CRD42020203362) on August 10, 2020.
Collapse
Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, PO.BOX:419, Dilla, Ethiopia
| | - Bahiru Mantefardo
- Department of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences, University of Calcutta, Kolkata, India
| |
Collapse
|
145
|
De C, Wignall A, Giannoudis V, Jimenez A, Sturdee S, Aderinto J, Pandit H, Palan J, Gulati A. 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; 54:386-396. [PMID: 33052147 PMCID: PMC7545153 DOI: 10.1007/s43465-020-00272-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
AIM This UK based multi-centre study reports clinical characteristics, early outcomes and predictors of mortality in 34 consecutive COVID-19-positive hip fractures so that the lessons learnt could be utilised in other parts of World who are at a different phase of the pandemic. METHODS This study analysed patient admitted with hip fractures with COVID positive swabs, between March and May'2020 in three large hospitals covering a population of nearly two million. Data was collected on demographic profile, peri-operative variables, post-operative complications and mortality. The specific aim was to identify any variables, which could predict high 30-day mortality. RESULTS Overall, 12% of hip fractures were COVID positive with the mortality rate of 41.2%. The higher age (p = 0.036) and male gender (p = 0.025) was significantly associated with mortality and most of the deaths were between American Society of Anaesthesiologists (ASA) grade 3 and 4 patients. The patients having intramedullary (IM) nailing were more likely to die (p = 0.02). There was no difference in laboratory parameters but there was significant difference in findings on chest radiographs (p < 0.001), post-operative oxygen requirements (p = 0.006) and early respiratory complications (p = 0.006). CONCLUSION This study suggests that the mortality following surgery for a hip fracture in COVID-positive patients is strikingly high and is associated with higher age and male gender. Higher mortality has been observed for extracapsular fracture operated with intramedullary nailing. In the immediate post-operative period, rapid deterioration of chest imaging, higher oxygen requirement and early pulmonary complications can serve as warning signs and predicting factors for higher mortality.
Collapse
Affiliation(s)
- Chiranjit De
- Sandwell and West Birmingham Hospitals HNS Trust, West Bromwich, UK
| | - Alice Wignall
- grid.418161.b0000 0001 0097 2705Leeds General Infirmary, Leeds, UK
| | | | - Andrea Jimenez
- grid.487190.3Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Simon Sturdee
- grid.487190.3Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Joseph Aderinto
- grid.418161.b0000 0001 0097 2705Leeds General Infirmary, Leeds, UK
| | - Hemant Pandit
- grid.418161.b0000 0001 0097 2705Leeds General Infirmary, Leeds, UK
| | - Jeya Palan
- grid.418161.b0000 0001 0097 2705Leeds General Infirmary, Leeds, UK
| | - Aashish Gulati
- Sandwell and West Birmingham Hospitals HNS Trust, West Bromwich, UK
| |
Collapse
|
146
|
Konda SR, Ranson RA, Solasz SJ, Dedhia N, Lott A, Bird ML, Landes EK, Aggarwal VK, Bosco JA, Furgiuele DL, Gould J, Lyon TR, McLaurin TM, Tejwani NC, Zuckerman JD, Leucht P, Ganta A, Egol KA. Modification of a Validated Risk Stratification Tool to Characterize Geriatric Hip Fracture Outcomes and Optimize Care in a Post-COVID-19 World. J Orthop Trauma 2020; 34:e317-e324. [PMID: 32815845 PMCID: PMC7446996 DOI: 10.1097/bot.0000000000001895] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES (1) To demonstrate how a risk assessment tool modified to account for the COVID-19 virus during the current global pandemic is able to provide risk assessment for low-energy geriatric hip fracture patients. (2) To provide a treatment algorithm for care of COVID-19 positive/suspected hip fractures patients that accounts for their increased risk of morbidity and mortality. SETTING One academic medical center including 4 Level 1 trauma centers, 1 university-based tertiary care referral hospital, and 1 orthopaedic specialty hospital. PATIENTS/PARTICIPANTS One thousand two hundred seventy-eight patients treated for hip fractures between October 2014 and April 2020, including 136 patients treated during the COVID-19 pandemic between February 1, 2020 and April 15, 2020. INTERVENTION The Score for Trauma Triage in the Geriatric and Middle-Aged ORIGINAL (STTGMAORIGINAL) score was modified by adding COVID-19 virus as a risk factor for mortality to create the STTGMACOVID score. Patients were stratified into quartiles to demonstrate differences in risk distribution between the scores. MAIN OUTCOME MEASUREMENTS Inpatient and 30-day mortality, major, and minor complications. RESULTS Both STTGMA score and COVID-19 positive/suspected status are independent predictors of inpatient mortality, confirming their use in risk assessment models for geriatric hip fracture patients. Compared with STTGMAORIGINAL, where COVID-19 patients are haphazardly distributed among the risk groups and COVID-19 inpatient and 30 days mortalities comprise 50% deaths in the minimal-risk and low-risk cohorts, the STTGMACOVID tool is able to triage 100% of COVID-19 patients and 100% of COVID-19 inpatient and 30 days mortalities into the highest risk quartile, where it was demonstrated that these patients have a 55% rate of pneumonia, a 35% rate of acute respiratory distress syndrome, a 22% rate of inpatient mortality, and a 35% rate of 30 days mortality. COVID-19 patients who are symptomatic on presentation to the emergency department and undergo surgical fixation have a 30% inpatient mortality rate compared with 12.5% for patients who are initially asymptomatic but later develop symptoms. CONCLUSION The STTGMA tool can be modified for specific disease processes, in this case to account for the COVID-19 virus and provide a robust risk stratification tool that accounts for a heretofore unknown risk factor. COVID-19 positive/suspected status portends a poor outcome in this susceptible trauma population and should be included in risk assessment models. These patients should be considered a high risk for perioperative morbidity and mortality. Patients with COVID-19 symptoms on presentation should have surgery deferred until symptoms improve or resolve and should be reassessed for surgical treatment versus definitive nonoperative treatment with palliative care and/or hospice care. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of Levels of Evidence.
Collapse
Affiliation(s)
- Sanjit R. Konda
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| | - Rachel A. Ranson
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
| | - Sara J. Solasz
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
| | - Nicket Dedhia
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
| | - Ariana Lott
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
| | - Mackenzie L. Bird
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
| | - Emma K. Landes
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| | - Vinay K. Aggarwal
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
- Department of Orthopaedic Surgery, Bellevue Hospital, New York, NY
| | - Joseph A. Bosco
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
| | - David L. Furgiuele
- Department of Orthopaedic Surgery, NYU Winthrop Hospital, Mineola, NY; and
| | - Jason Gould
- Department of Orthopaedic Surgery, NYU Winthrop Hospital, Mineola, NY; and
| | - Thomas R. Lyon
- Department of Orthopaedic Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY
| | - Toni M. McLaurin
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
- Department of Orthopaedic Surgery, Bellevue Hospital, New York, NY
| | - Nirmal C. Tejwani
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
- Department of Orthopaedic Surgery, Bellevue Hospital, New York, NY
| | - Joseph D. Zuckerman
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
| | - Philipp Leucht
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
- Department of Orthopaedic Surgery, Bellevue Hospital, New York, NY
| | - Abhishek Ganta
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| | - Kenneth A. Egol
- Division of Orthopaedic Trauma Surgery, Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, New York, NY
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| |
Collapse
|
147
|
MacDonald DRW, Neilly DW, Davies PSE, Crome CR, Jamal B, Gill SL, Jariwala AC, Stevenson IM, Ashcroft GP. Effects of the COVID-19 lockdown on orthopaedic trauma: a multicentre study across Scotland. Bone Jt Open 2020; 1:541-548. [PMID: 33215152 PMCID: PMC7659679 DOI: 10.1302/2633-1462.19.bjo-2020-0114.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIMS The UK government declared a national lockdown on 23 March 2020 to reduce transmission of COVID-19. This study aims to identify the effect of lockdown on the rates, types, mechanisms, and mortality of musculoskeletal trauma across Scotland. METHODS Data for all musculoskeletal trauma requiring operative treatment were collected prospectively from five key orthopaedic units across Scotland during lockdown (23 March 2020 to 28 May 2020). This was compared with data for the same timeframe in 2019 and 2018. Data collected included all cases requiring surgery, injury type, mechanism of injury, and inpatient mortality. RESULTS A total of 1,315 patients received operative treatment from 23 March 2020 to 28 May 2020 compared with 1,791 in 2019 and 1,719 in 2018. The numbers of all injury types decreased, but the relative frequency of hip fractures increased (36.3% in 2020 vs 30.2% in 2019, p < 0.0001 and 30.7% in 2018, p < 0.0001). Significant increases were seen in the proportion of DIY-related injuries (3.1% in 2020 vs 1.7% in 2019, p = 0.012 and 1.6% in 2018, p < 0.005) and injuries caused by falls (65.6% in 2020 vs 62.6% in 2019, p = 0.082 and 61.9% in 2018, p = 0.047). Significant decreases were seen in the proportion of road traffic collisions (2.6% in 2020 vs 5.4% in 2019, p < 0.0001 and 4.2% in 2018, p = 0.016), occupational injuries (1.8% in 2020 vs 3.0% in 2019, p = 0.025 and 2.3% in 2018, p = 0.012) and infections (6.8% in 2020 vs 7.8% in 2019, p = 0.268 and 10.3% in 2018, p < 0.012). Cycling injuries increased (78 in 2020 vs 64 in 2019 vs 42 in 2018). A significant increase in the proportion of self-harm injuries was seen (1.7% in 2020 vs 1.1% in 2019, p = 0.185 and 0.5% in 2018, p < 0.0001). Mortality of trauma patients was significantly higher in 2020 (5.0%) than in 2019 (2.8%, p = 0.002) and 2018 (1.8%, p < 0.0001). CONCLUSION The UK COVID-19 lockdown has resulted in a marked reduction in musculoskeletal trauma patients undergoing surgery in Scotland. There have been significant changes in types and mechanisms of injury and, concerningly, mortality of trauma patients has risen significantly.Cite this article: Bone Joint Open 2020;1-9:541-548.
Collapse
Affiliation(s)
| | - David W. Neilly
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Christopher R. Crome
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Bilal Jamal
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sarah L. Gill
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Arpit C. Jariwala
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, UK
| | - Iain M. Stevenson
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | | |
Collapse
|
148
|
Slullitel PA, Lucero CM, Soruco ML, Barla JD, Benchimol JA, Boietti BR, Zanotti G, Comba F, Taype-Zamboni DR, Carabelli GS, Piccaluga F, Sancineto CF, Diehl M, Buttaro MA. Prolonged social lockdown during COVID-19 pandemic and hip fracture epidemiology. INTERNATIONAL ORTHOPAEDICS 2020; 44:1887-1895. [PMID: 32772318 PMCID: PMC7414899 DOI: 10.1007/s00264-020-04769-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 01/14/2023]
Abstract
Purpose To analyse the impact of prolonged mandatory lockdown due to COVID-19 on hip fracture epidemiology. Methods Retrospective case-control study of 160 hip fractures operated upon between December 2019 and May 2020. Based on the date of declaration of national lockdown, the cohort was separated into two groups: ‘pre-COVID time’ (PCT), including 86 patients, and ‘COVID time’ (CT), consisting of 74 patients. All CT patients tested negative for SARS-CoV-2. Patients were stratified based on demographic characteristics. Outcome measures were 30-day complications, readmissions and mortality. A logistic regression model was run to evaluate factors associated with mortality. Results Age, female/male ratio, body mass index and American Society of Anaesthesia score were similar between both groups (p > 0.05). CT patients had a higher percentage of Charlson ≥ 5 and Rockwood Frailty Index ≥ 5 scores (p < 0.05) as well as lower UCLA and Instrumental Activities of Daily Living scores (p < 0.05). This translated into a higher hemiarthroplasty/total hip arthroplasty ratio during CT (p = 0.04). Thromboembolic disease was higher during CT (p = 0.02). Readmissions (all negative for SARS-CoV-2) were similar between both groups (p = 0.34). Eight (10.8%) casualties were detected in the CT group, whereas no deaths were seen in the control group. Logistic regression showed that frailer (p = 0.006, OR 10.46, 95%CI 8.95–16.1), less active (p = 0.018, OR 2.45, 95%CI 1.45–2.72) and those with a thromboembolic event (p = 0.005, OR 30, 95%CI 11–42) had a higher risk of mortality. Conclusion Despite testing negative for SARS-CoV-2, CT patients were less active and frailer than PCT patients, depicting an epidemiological shift that was associated with higher mortality rate.
Collapse
Affiliation(s)
- Pablo A Slullitel
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina.
| | - Carlos M Lucero
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Maria L Soruco
- Trauma Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Jorge D Barla
- Trauma Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Javier A Benchimol
- Department of Geriatric Medicine, Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Bruno R Boietti
- Department of Geriatric Medicine, Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina.,Department of Health Informatics, Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Gerardo Zanotti
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Fernando Comba
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Danilo R Taype-Zamboni
- Trauma Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Guido S Carabelli
- Trauma Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Francisco Piccaluga
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Carlos F Sancineto
- Trauma Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Maria Diehl
- Department of Endocrinology, Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Martin A Buttaro
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | | |
Collapse
|
149
|
Macey ARM, 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; 1:415-419. [PMID: 33215132 PMCID: PMC7659666 DOI: 10.1302/2633-1462.17.bjo-2020-0077.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS To establish if COVID-19 has worsened outcomes in patients with AO 31 A or B type hip fractures. METHODS Retrospective analysis of prospectively collected data was performed for a five-week period from 20 March 2020 and the same time period in 2019. The primary outcome was mortality at 30 days. Secondary outcomes were COVID-19 infection, perioperative pulmonary complications, time to theatre, type of anaesthesia, operation, grade of surgeon, fracture type, postoperative intensive care admission, venous thromboembolism, dislocation, infection rates, and length of stay. RESULTS In all, 76 patients with hip fractures were identified in each group. All patients had 30-day follow-up. There was no difference in age, sex, American Society of Anesthesiologists (ASA) classification or residence at time of injury. However, three in each group were not fit for surgery. No significant difference was found in 30-day mortality; ten patients (13%) in 2019 and 11 patients (14%) in 2020 (p = 0.341). In the 2020 cohort, ten patients tested positive for COVID-19, two (20%) of whom died. There was no significant increase in postoperative pulmonary complications. Median time to theatre was 20 hours (interquartile range (IQR) 16 to 25) in 2019 versus 23 hours (IQR 18 to 30) in 2020 (p = 0.130). Regional anaesthesia increased from 24 (33%) cases in 2019 to 46 (63%) cases in 2020, but ten (14%) required conversion to general anaesthesia. In both groups, 53 (70%) operations were done by trainees. Hemiarthroplasty for 31 B type fractures was the most common operation. No significant difference was found for intensive care admission or 30-day venous thromboembolism, dislocation or infection, or length of stay. CONCLUSION Little information exists on mortality and complications after hip fracture during the COVID-19 pandemic. At the time of writing, no other study of outcomes in the UK has been published.Cite this article: Bone Joint Open 2020;1-7:415-419.
Collapse
Affiliation(s)
- Alistair R. M. Macey
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Joanna Butler
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sean C. Martin
- Nuffield Department of Surgical Sciences, John Radcliff Hospital, Oxford, UK
| | - Ting Yang Tan
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - William J. Leach
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Bilal Jamal
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|