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Harvey LA, Payne NL, Tan A, Zhang J, Lai YC, Taylor ME, Armstrong E, McVeigh C, Mikolaizak AS, Hairu R, Scott TA, Bishop M, Close J. Variation in mortality following hip fracture across the Asia Pacific region: Systematic review and proportional meta-analysis. Arch Gerontol Geriatr 2024; 126:105519. [PMID: 38941947 DOI: 10.1016/j.archger.2024.105519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/24/2024] [Accepted: 06/02/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE To determine country/region-specific mortality (in-hospital, 30-day and 1-year) following hip fracture across the Asia Pacific region. METHODS Five databases MEDLINE, PUBMED, EMBASE, Web of Science and the Cochrane Library were searched to identify studies that reported mortality following hospitalisation for low-trauma hip fracture in adults aged ≥50 years with data from 2010 to 30 September 2021. There were no restrictions on study design or language. Pooled mortality estimates for countries/regions with ≥2 studies were calculated using random-effects models. RESULTS In total 244 studies were included in the meta-analysis. 123 studies (1,382,810 patients, 13 countries/regions) reported in-hospital mortality which ranged from 1.4 % in Japan [95 %CI 1.2-1.7], Singapore [95 %CI 1.0-1.6], China [95 %CI 0.8-2.3] and Hong Kong SAR [95 %CI 0.8-2.6] to 5.5 % [95 %CI 4.1-7.2] in New Zealand. 92 studies (628,450 patients, 13 countries/regions) reported 30-day mortality which ranged from 1.2 % in Japan [95 %CI 0.9-1.5] and Thailand [95 %CI 0.7-2.0] to 7.4 % [95 %CI 7.0-7.8] in Australia. 142 studies (1,139,752 patients, 14 countries/regions) reported 1-year mortality which ranged from 10.8 % [95 %CI 9.6-12.1] in Singapore to 23.3 % [95 %CI 22.3-24.5] in Australia and 23.8 % in New Zealand. CONCLUSION There is substantial variation in mortality across the Asia Pacific region. Short-term mortality rates in Asian countries, notably Japan and Singapore, are up to four-fold lower than for Australia and New Zealand. This difference, although less marked, is sustained at 1-year with a two-fold lower mortality rate in Asia. This meta-analysis is the first to delineate these differences, further studies are required to understand the reasons for this variation.
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Affiliation(s)
- L A Harvey
- Neuroscience Research Australia, Sydney, Australia; School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia.
| | - N L Payne
- Neuroscience Research Australia, Sydney, Australia
| | - A Tan
- Nepean Hospital, Sydney, Australia
| | - J Zhang
- School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia
| | - Y C Lai
- Khoo Teck Puat Hospital, Singapore
| | - M E Taylor
- Neuroscience Research Australia, Sydney, Australia; School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia; Ageing Futures Institute, UNSW Sydney, Sydney, Australia
| | - E Armstrong
- Neuroscience Research Australia, Sydney, Australia; School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia
| | - C McVeigh
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
| | | | - R Hairu
- Neuroscience Research Australia, Sydney, Australia; School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
| | - T A Scott
- Prince of Wales Hospital, Sydney, Australia
| | - M Bishop
- Concord Repatriation General Hospital, Sydney, Australia
| | - Jct Close
- Neuroscience Research Australia, Sydney, Australia; School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
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Warren M, Bretherton C, Parker M. Delay to surgery beyond 12 hours is associated with increased hip fracture mortality. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2973-2980. [PMID: 38844565 PMCID: PMC11377486 DOI: 10.1007/s00590-024-03997-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/09/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE Time to surgery from admission is one of the few variables known to influence outcome after a hip fracture. We reviewed our hip fracture database to determine correlation between delays to surgery and mortality in our elderly hip fracture population. METHODS Data on all hip fracture patients admitted to a large district hospital were prospectively collected between January 1989 and August 2021. Time of the injury, time of admission and time of surgery were recorded. Patients over 60 years old with a hip fracture requiring operative management were included. Patients with pathological fractures, those managed conservatively, and patients delayed for medical reasons were excluded. Surgical timing categories were divided into; under 12 h, 12-24 h, 24-72 h and over 72 h. RESULTS Time from admission to surgery was recorded for 10,659 patients, of these time of fall was available for 10,346 patients. Mean age was 82.2 years (sd 8.39) for the cohort and 30 day mortality was 6.20%. Odds of 30-day mortality was 1.43 (CI 1.057-1.988, p = 0.025) for delay to surgery from admission of over 12 h compared to under 12 h. Odds ratios for 30-day mortality were not significant at any other time threshold. The odds of 30-day mortality for delay to surgery from time of fall were 1.550 (CI 1.026-2.459, p = 0.048) at the 12 h threshold. CONCLUSION This is the largest prospective study to date in elderly patients with hip fractures demonstrating a statistically significant increase in 30-day mortality with a delay to surgery over 12 h.
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Affiliation(s)
- Madeline Warren
- NWAFT, Peterborough, UK.
- Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK.
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Huang YW, Chien CH, Chiang YH, Liu CY, Huang XY. Social participation, positive affect, and negative affect in postoperative patients with hip fractures: A cross-sectional study. J Health Psychol 2024; 29:303-316. [PMID: 37776243 DOI: 10.1177/13591053231200318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023] Open
Abstract
This study investigated the social participation, positive affect (PA), and negative affect (NA) of patients with hip fractures after surgery and determined their possible predictive factors. We used a cross-sectional study design to recruit 154 participants with hip fractures post-surgery. Assessment tools included the Barthel Index, the Automatic Thoughts Questionnaire, the Assessment of Life Habits, and the Positive and Negative Affect Schedule. Patients with better functioning in daily living activities experienced more social participation, higher PA, and lower NA. Patients with more positive automatic thoughts experienced more social participation and higher PA. Patients with more negative automatic thoughts experienced more social participation, lower PA, and higher NA. Early rehabilitation and psychosocial interventions should be provided for postoperative hip fracture patients to improve their activities of daily living and emotional well-being.
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Affiliation(s)
- Yi-Wen Huang
- National Taipei University of Nursing and Health Sciences
- National Yang Ming Chiao Tung University Hospital
| | | | | | - Chieh-Yu Liu
- National Taipei University of Nursing and Health Sciences
| | - Xuan-Yi Huang
- National Taipei University of Nursing and Health Sciences
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Sun Y, Liu Y, Zhu Y, Luo R, Luo Y, Wang S, Feng Z. Risk prediction models of mortality after hip fracture surgery in older individuals: a systematic review. Curr Med Res Opin 2024; 40:523-535. [PMID: 38323327 DOI: 10.1080/03007995.2024.2307346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE This study aimed to critically assess existing risk prediction models for postoperative mortality in older individuals with hip fractures, with the objective of offering substantive insights for their clinical application. DESIGN A comprehensive search was conducted across prominent databases, including PubMed, Embase, Cochrane Library, SinoMed, CNKI, VIP, and Wanfang, spanning original articles in both Chinese and English up until 1 December 2023. Two researchers independently extracted pertinent research characteristics, such as predictors, model performance metrics, and modeling methodologies. Additionally, the bias risk and applicability of the incorporated risk prediction models were systematically evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST). RESULTS Within the purview of this investigation, a total of 21 studies were identified, constituting 21 original risk prediction models. The discriminatory capacity of the included risk prediction models, as denoted by the minimum and maximum areas under the subject operating characteristic curve, ranged from 0.710 to 0.964. Noteworthy predictors, recurrent across various models, included age, sex, comorbidities, and nutritional status. However, among the models assessed through the PROBAST framework, only one was deemed to exhibit a low risk of bias. Beyond this assessment, the principal limitations observed in risk prediction models pertain to deficiencies in data analysis, encompassing insufficient sample size and suboptimal handling of missing data. CONCLUSION Subsequent research endeavors should adopt more stringent experimental designs and employ advanced statistical methodologies in the construction of risk prediction models. Moreover, large-scale external validation studies are warranted to rigorously assess the generalizability and clinical utility of existing models, thereby enhancing their relevance as valuable clinical references.
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Affiliation(s)
- Ying Sun
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Yanhui Liu
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Yaning Zhu
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Ruzhen Luo
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yiwei Luo
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zihang Feng
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
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Foster JA, Landy DC, Pectol RW, Annamalai RT, Aneja A. A multi-institutional study of short-term mortality in COVID-positive patients undergoing hip fracture surgery: is survival better than expected? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:285-291. [PMID: 37462783 DOI: 10.1007/s00590-023-03620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/11/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE Early reports of 30-day mortality in COVID-positive patients with hip fracture were often over 30% and were higher than historical rates of 10% in pre-COVID studies. We conducted a multi-institutional retrospective cohort study to determine whether the incidence of 30-day mortality and complications in COVID-positive patients undergoing hip fracture surgery is as high as initially reported. METHODS A retrospective chart review was performed at 11 level I trauma centers from January 1, 2020 to May 1, 2022. Patients 50 years or older undergoing hip fracture surgery with a positive COVID test at the time of surgery were included. The primary outcome measurements were the incidence of 30-day mortality and complications. Post-operative outcomes were reported using proportions with 95% confidence interval (C.I.). RESULTS Forty patients with a median age of 71.5 years (interquartile range, 50-87 years) met the criteria. Within 30-days, four patients (10%; 95% C.I. 3-24%) died, four developed pneumonia, three developed thromboembolism, and three remained intubated post-operatively. Increased age was a statistically significant predictor of 30-day mortality (p = 0.01), with all deaths occurring in patients over 80 years. CONCLUSION In this multi-institutional analysis of COVID-positive patients undergoing hip fracture surgery, 30-day mortality was 10%. The 95% C.I. did not include 30%, suggesting that survival may be better than initially reported. While COVID-positive patients with hip fractures have high short-term mortality, the clinical situation may not be as dire as initially described, which may reflect initial publication bias, selection bias introduced by testing, or other issues. LEVELS OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Jeffrey A Foster
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA.
| | - David C Landy
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Richard W Pectol
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Ramkumar T Annamalai
- Department of Biomedical Engineering, University of Kentucky College of Engineering, Lexington, KY, USA
| | - Arun Aneja
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
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Testa EJ, Albright AJ, Morrissey P, Orman S, Clippert D, Antoci V. Local anesthetic with monitored anesthesia care in cephalomedullary nailing of proximal femur fractures. Orthop Traumatol Surg Res 2023; 109:103619. [PMID: 37044244 DOI: 10.1016/j.otsr.2023.103619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Proximal femur fractures have high rates of morbidity, mortality, and perioperative complications. Limiting anesthesia, especially in the elderly population, is a priority from a medical perspective. The goal of the current study is to present a technique of using local anesthetic with monitored anesthesia care (MAC) for the fixation of intertrochanteric (IT) femur fractures with cephalomedullary nailing (CMN), provide early clinical results in a small series of patients, and evaluate the safety, efficiency, and anesthetic efficacy of our technique. HYPOTHESIS The use of only local anesthetic with MAC for the fixation of IT fractures is safe and leads to decreased operative times when compared to spinal and general anesthesia. MATERIALS AND METHODS Patients undergoing cephalomedullary nailing (CMN) with a long nail for IT femur fractures by a single surgeon from January 2020 to June 2021 were identified retrospectively from a prospectively-collected patient registry. Patient demographics, operative time, length of hospital stay, perioperative medication use, and complications were collected. Analysis of variance, Chi2, linear regression, and two-sampled T-tests were performed to analyze potential differences between the local anesthesia group and the general or spinal anesthesia group. RESULTS Thirty-seven patients were identified. Eleven patients underwent CMN using local anesthesia with MAC, 11 using spinal anesthesia, and 15 using general anesthesia. The local anesthesia group demonstrated significantly lower operating room times and anesthesia induction to incision time compared to other anesthesia techniques. The local anesthesia group also trended towards less need for vasopressors during surgery and less postoperative delirium. No differences were identified in intraoperative narcotic use, complications, patient mortality, or hospital readmissions. CONCLUSIONS Local anesthesia with MAC for the treatment of IT fractures with CMN was associated with decreased operating room times and had similar complication rates including blood transfusions, readmissions, and mortalities, when compared to spinal and general anesthesia. LEVEL OF EVIDENCE III, therapeutic.
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Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - Alex J Albright
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Patrick Morrissey
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Sebastian Orman
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | | | - Valentin Antoci
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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Tay HY, Wu WT, Peng CH, Liu KL, Yu TC, Chen IH, Yao TK, Chang CM, Chua JY, Wang JH, Yeh KT. COVID-19 Infection Was Associated with the Functional Outcomes of Hip Fracture among Older Adults during the COVID-19 Pandemic Apex. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1640. [PMID: 37763759 PMCID: PMC10534880 DOI: 10.3390/medicina59091640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Hip fractures are associated with mortality and poor functional outcomes. The COVID-19 pandemic has affected patterns of care and health outcomes among fracture patients. This study aimed to determine the influence of COVID-19 infection on hip fracture recovery. Materials and Methods: We prospectively collected data on patients with hip fractures who presented at Hualien Tzu Chi Hospital between 9 March 2022 and 9 September 2022. The data included demographic information and functional scores taken before, during, and after surgery. The patients were divided into two groups: COVID-19 (+) and COVID-19 (-). Results: This study recruited 85 patients, 12 of whom (14.12%) were COVID-19 (+). No significant differences in preoperative or perioperative parameters between the two groups were observed. The postoperative Barthel index score was significantly impacted by COVID-19 infection (p = 0.001). The incidence of postoperative complications was significantly correlated with general anesthesia (p = 0.026) and the length of stay (p = 0.004) in hospital. Poor postoperative functional scores were associated with lower preoperative Barthel index scores (p < 0.001). Male sex (p = 0.049), old age (p = 0.012), a high American Society of Anesthesiologists grade (p = 0.029), and a high Charlson comorbidity index score (p = 0.028) were associated with mortality. Conclusions: Hip fracture surgeries were not unduly delayed in our hospital during the COVID-19 pandemic, but the patients' postoperative Barthel index scores were significantly influenced by COVID-19 (+). The preoperative Barthel index score may be a good predictive tool for the postoperative functional recovery of these patients.
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Affiliation(s)
- Hua-Yong Tay
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
- Department of Medical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
| | - Wen-Tien Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Cheng-Huan Peng
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
| | - Kuan-Lin Liu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Tzai-Chiu Yu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
| | - Ing-Ho Chen
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Ting-Kuo Yao
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
| | - Chia-Ming Chang
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
| | - Jian-Yuan Chua
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan;
| | - Kuang-Ting Yeh
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
- Department of Medical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970374, Taiwan
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Muacevic A, Adler JR. COVID-19 Vaccination: Does It Alter Postoperative Mortality and Morbidity in Hip Fractures? Cureus 2022; 14:e32688. [PMID: 36545356 PMCID: PMC9762274 DOI: 10.7759/cureus.32688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction The primary aim of our study was to evaluate the impact of coronavirus disease 2019 (COVID-19) vaccination on mortality in patients with hip fractures by comparing it to those who are unvaccinated. Our secondary objective was to compare the impact on postoperative morbidity parameters like length of hospital stay and complications. Methods A total of 619 hip fractures were divided into the 'Vaccinated group' consisting of 300 patients who had COVID-19 vaccination and the 'Unvaccinated group' consisting of 319 patients who were not vaccinated. Patient demographic variables, Nottingham hip fracture score, American Society of Anesthesiologists (ASA) grade, type of anaesthesia used, and Charlson Comorbidity Index were collected. Our primary outcome measures were 30- and 90-day mortality. Secondary outcome measures included postoperative complications like thromboembolic complications, cardiac, and respiratory complications, etc. Mortality among the COVID-positive patients was also compared between the groups. Results Thirty-day postoperative mortality was higher in the unvaccinated group at 13.2% than in the vaccinated group at 5.3%. A similar increase in 90-day mortality was also observed in the unvaccinated group at 24.8% when compared to 14.7% in the vaccinated group(p<0.001). Despite having a higher baseline prevalence of cardiac comorbidities, the Vaccinated group had fewer post-operative cardiac, thromboembolic, and neurological complications (p>0.05). Moreover, electrolyte imbalance and AKI were also seen in fewer patients in the vaccinated group compared to the control group (p<0.05). Furthermore, it was found that among the vaccinated patients who did have perioperative COVID-19 infection, the 30-day mortality was significantly lower (10%) compared to the control group (31.2%) (p<0.001). Similarly, 90-day mortality was significantly lower (25%) compared to the control group (43.75%) (p<0.001). Conclusion Vaccination against COVID-19 independently reduced mortality and morbidity among patients with hip fractures when compared to those who are not vaccinated. Furthermore, it decreased the risk of acquiring COVID-19, and subsequent postoperative complications. Among those who are infected with COVID-19 despite vaccination, the mortality was significantly lesser.
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Holleyman RJ, Khan SK, Charlett A, Inman DS, Johansen A, Brown C, Barnard S, Fox S, Baker PN, Deehan D, Burton P, Gregson CL. The impact of COVID-19 on mortality after hip fracture : a population cohort study from England. Bone Joint J 2022; 104-B:1156-1167. [PMID: 36177635 DOI: 10.1302/0301-620x.104b10.bjj-2022-0082.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Hip fracture commonly affects the frailest patients, of whom many are care-dependent, with a disproportionate risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England. METHODS We conducted a cohort study of patients with hip fracture recorded in the National Hip Fracture Database between 1 February 2019 and 31 October 2020 in England. Data were linked to Hospital Episode Statistics to quantify patient characteristics and comorbidities, Office for National Statistics mortality data, and Public Health England's SARS-CoV-2 testing results. Multivariable Cox regression examined determinants of 90-day mortality. Excess mortality attributable to COVID-19 was quantified using Quasi-Poisson models. RESULTS Analysis of 102,900 hip fractures (42,630 occurring during the pandemic) revealed that among those with COVID-19 infection at presentation (n = 1,120) there was a doubling of 90-day mortality; hazard ratio (HR) 2.09 (95% confidence interval (CI) 1.89 to 2.31), while the HR for infections arising between eight and 30 days after presentation (n = 1,644) the figure was greater at 2.51 (95% CI 2.31 to 2.73). Malnutrition (1.45 (95% CI 1.19 to 1.77)) and nonoperative treatment (2.94 (95% CI 2.18 to 3.95)) were the only modifiable risk factors for death in COVID-19-positive patients. Patients who had tested positive for COVID-19 more than two weeks prior to hip fracture initially had better survival compared to those who contracted COVID-19 around the time of their hip fracture; however, survival rapidly declined and by 365 days the combination of hip fracture and COVID-19 infection was associated with a 50% mortality rate. Between 1 January and 30 June 2020, 1,273 (99.7% CI 1,077 to 1,465) excess deaths occurred within 90 days of hip fracture, representing an excess mortality of 23% (99.7% CI 20% to 26%), with most deaths occurring within 30 days. CONCLUSION COVID-19 infection more than doubles the rate of early hip fracture mortality. Those contracting infection between 8 and 30 days after initial presentation are at even higher mortality risk, signalling the potential for targeted interventions during this period to improve survival.Cite this article: Bone Joint J 2022;104-B(10):1156-1167.
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Affiliation(s)
- Richard J Holleyman
- Public Health England, London, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sameer K Khan
- Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | | | - Dominic S Inman
- Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | | | | | | | | | - Paul N Baker
- James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
- York Medical School, University of York, York, UK
- Teeside University, Middlesbrough, UK
| | | | - Paul Burton
- Public Health England, London, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Royal United Hospital NHS Foundation Trust, Bath, UK
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