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Elhadidy HSMA, Politano G, Onorati R, Catozzi D, Gianino MM. Impact of the COVID-19 pandemic on the complete rehabilitation journey of hip fracture patients in Italy: From surgical admission to rehabilitation facility discharge. PLoS One 2024; 19:e0305966. [PMID: 38990821 DOI: 10.1371/journal.pone.0305966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/08/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic led to a significant reorganization of health services, potentially affecting the quality of care for major public health concerns such as proximal femoral fractures. This study aimed to investigate potential changes in the timing of various steps in the patient journey after a hip fracture during the pandemic in Piedmont, a region in Northern Italy. METHODS A retrospective study was conducted on the discharge records of patients aged 65 or older who were admitted for hip surgery following a femur fracture in 2019 and 2020. The study examined four-time steps: duration from hospital admission to surgery, length of hospital stay, interval between hospital discharge and admission to the rehabilitation facility, and duration of stay at the rehabilitation facility. To mitigate biases linked to sex and age factors, groups well-balanced across 2019 and 2020 were created using propensity score estimation. RESULTS The dataset consisted of two cohorts of 583 patients each for the years 2019 and 2020. The average duration from admission to surgery was approximately 1.9 days in both years, with 75% of patients undergoing surgery within 2 days of hospital admission. The average hospital stay reduced from 13.49 days in 2019 to 11.34 days in 2020. The gap between hospital discharge and admission to rehabilitation was approximately 10-12 days, and the average duration of stay at the rehabilitation facility was about 31.6 days. DISCUSSION The study indicates that healthcare systems can exhibit resilience and adaptability, even during a global pandemic, to ensure high-quality and safe standards of care. However, further long-term studies are needed to fully understand the pandemic's impact on primary health outcomes following hip replacement surgery and subsequent rehabilitation. The potential role of telemedicine in reducing the time between steps also warrants further investigation.
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Affiliation(s)
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Torino, Italy
| | - Roberta Onorati
- Regional Public Health Observatory, Epidemiology Unit, Local Healthcare Authority ASL TO3, Grugliasco, Italy
| | - Dario Catozzi
- Department of Public Health Sciences and Pediatrics, Università di Torino, Torino, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università di Torino, Torino, Italy
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Prieto-Moreno R, Molina-García P, Ortiz-Piña M, Mora-Traverso M, Estévez-López F, Martín-Matillas M, Ariza-Vega P. Association of the @ctivehip tele-rehabilitation with the fear of falling of older adults with hip fracture and their family caregivers: Secondary analysis of a non-randomised controlled trial. J Telemed Telecare 2024:1357633X241257972. [PMID: 38836335 DOI: 10.1177/1357633x241257972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Osteoporotic hip fracture is a major health problem. Falls, the primary cause, might lead to a persistent fear of falling (FoF) among older adults, affecting their daily activities and rehabilitation. While in-person interventions exist, limited research is available on the effects of tele-rehabilitation on the FoF after a hip fracture. Thus, this study aims to test the association of the @ctivehip tele-rehabilitation programme on reducing the levels of FoF experienced by both older adults with hip fracture and their family caregivers. METHODS A non-randomised controlled trial (ClinicalTrials.gov; Identifier: NCT02968589) that compared a webpage-based tele-rehabilitation (@ctivehip) against usual care. Fear of falling was assessed using the Short Falls Efficacy Scale-International. Patients' functional status was evaluated using the Functional Independence Measure. Physical performance was assessed by the Timed Up and Go test and Short Physical Performance Battery. We conducted a per-protocol analysis as the primary outcome, and an intention-to-treat approach as secondary analysis. RESULTS A total of 71 patients with hip fracture (78.75 ± 6.12 years, 75% women) and their family caregivers participated. Participants in the intervention showed a higher decrease in FoF in comparison to those in the usual care (0.5 Cohen's d; p = 0.042). The reduction in FoF resulting from participation in the tele-rehabilitation programme was mediated by improvements in functional status by 79%. The @ctivehip programme did not decrease FoF of family caregivers. DISCUSSION @ctivehip is associated with a reduction of the FoF in older adults with hip fractures, but not in their family caregivers, with the reduction being mostly explained by improvements in the patients' functional status. Although the intervention seems promising, it should not be applied in clinical settings until confirmed by appropriate-designed randomised clinical trials.
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Affiliation(s)
- Rafael Prieto-Moreno
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | | | - Mariana Ortiz-Piña
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
| | - Marta Mora-Traverso
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Fernando Estévez-López
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Miguel Martín-Matillas
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
| | - Patrocinio Ariza-Vega
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Obidike P, Chang A, Calisi O, Lee JJ, Ssentongo P, Ssentongo AE, Oh JS. COVID-19 and Mortality in the Global Surgical Population: A Systematic Review and Meta-Analysis. J Surg Res 2024; 297:88-100. [PMID: 38460454 DOI: 10.1016/j.jss.2024.01.021] [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: 09/26/2023] [Revised: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION To date, no systematic review or meta-analysis has comprehensively estimated the risk of mortality by surgery type on an international scale. We aim to delineate the risk of mortality in patients with COVID-19 who undergo surgery. METHODS PubMed (MEDLINE), Scopus, OVID, the World Health Organization Global Literature on Coronavirus Disease, and Corona-Central databases were searched from December 2019 through January 2022. Studies providing data on mortality in patients undergoing surgery were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for abstracting data were followed and performed independently by two reviewers. The main outcome was mortality in patients with COVID-19. RESULTS Of a total of 4023 studies identified, 46 studies with 80,015 patients met our inclusion criteria. The mean age was 67 y; 57% were male. Surgery types included general (14.9%), orthopedic (23.4%), vascular (6.4%), thoracic (10.6%), and urologic (8.5%). Patients undergoing surgery with COVID-19 elicited a nine-fold increased risk of mortality (relative risk [RR] 8.99, 95% confidence interval [CI] 4.96-16.32) over those without COVID-19. In low-income and middle-income countries (RR: 16.04, 95% CI: 4.59-56.12), the mortality risk was twice as high compared to high-income countries (RR: 7.50, 95% CI: 4.30-13.09). CONCLUSIONS Mortality risk in surgical patients with COVID-19 compared to those without is increased almost 10-fold. The risk was highest in low-income and middle-income countries compared to high-income countries, suggesting a disproportionate effect of the pandemic on resource-constrained regions.
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Affiliation(s)
- Prisca Obidike
- Department of General Surgery, University of Virginia, Charlottesville, Virginia; Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Allison Chang
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Olivia Calisi
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jungeun J Lee
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Paddy Ssentongo
- Department of Medicine, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Anna E Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania; Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - John S Oh
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania.
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Ariza-Vega P, Prieto-Moreno R, Mora-Traverso M, Molina-García P, Ashe MC, Martín-Matillas M. Co-creation of mHealth intervention for older adults with hip fracture and family caregivers: a qualitative study. Disabil Rehabil Assist Technol 2024; 19:1009-1018. [PMID: 36308295 DOI: 10.1080/17483107.2022.2138999] [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: 04/06/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Hip fracture results in an older person's loss of independence. Limited healthcare resources make mobile Health (mHealth) an alternative. Engaging key stakeholders in health technology development is essential to overcome existing barriers. The aim of this study was to establish perspectives of older adults with hip fracture, family caregivers and health professionals (stakeholders) on the development of a mHealth system. MATERIALS AND METHODS Qualitative study guided by user-centered design principles with focus groups to engage stakeholders during the development. Seven focus groups were conducted [older adults with hip fracture (n = 2), caregivers (n = 3), and health providers (n = 2)] with 45 participants (14 older adults, 21 caregivers and 10 health providers). Inclusion criteria were older adults ≥ 65 years who sustained a hip fracture in the previous 3 months; family caregiver of a person with hip fracture; and health providers with 2+ years of clinical experience working older adults with hip fracture. We followed standard methods for focus groups, including recording sessions, transcription and conducting an inductive content analysis. The same moderator, with clinical and research experience, conducted all focus groups. RESULTS Three themes were generated to consider for a future mHealth intervention: (1) user-friendly design; (2) content to include recovery and prevention information; and (3) implementation factors. Our mHealth system was developed based on feedback from participants. CONCLUSIONS Co-creating mHealth technology with stakeholders is essential for uptake and adherence. We provide an overview of the development of ActiveHip+, an mHealth system for the clinical care of older adults with hip fracture.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rafael Prieto-Moreno
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Marta Mora-Traverso
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pablo Molina-García
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Maureen C Ashe
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
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Mora-Traverso M, Prieto-Moreno R, Molina-Garcia P, Salas-Fariña Z, Martín-Martín L, Martín-Matillas M, Ariza-Vega P. Effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients with hip fracture. J Telemed Telecare 2024; 30:549-558. [PMID: 35060784 DOI: 10.1177/1357633x211073256] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Telerehabilitation has emerged in the last decade as a promising alternative to conduct the rehabilitation process at home. However, there are no studies testing the effects of telerehabilitation interventions for patients with hip fracture on quality of life nor psychological factors, whereas the evidence on fitness level is scarce. Thus, the aim of this study is to test the effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients who had suffered a hip fracture. METHODS The present study is a non-randomized clinical trial that includes patients older than 65 years old with a hip fracture and their family caregivers (ClinicalTrials.gov; Identifier: NCT02968589). Per-protocol (64 participants) and intention-to-treat (71 participants) analyses were performed, the first being the main analysis. The intervention group received a home-based multidisciplinary telerehabilitation intervention, called @ctivehip, that lasted 12 weeks. The control group received the traditional care and rehabilitation provided by the Andalusian Public Health Care System. The outcomes measured were the patients' quality of life through the EuroQol Quality of Life Questionnaire (EQ-5D), physiological factors (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS) and the fitness level, assessed with the International Fitness Scale. RESULTS The quality of life of the telerehabilitation group increased, while the control group scored worsened at the 3-month follow-up (medium effect size: 0.66 SDs; p = 0.006). The telerehabilitation group demonstrated a greater decrease than the control group in the total HADS score (medium effect size: -0.50 SDs; p = 0.015). Lastly, the telerehabilitation group recovered a fitness level close to the pre-hip fracture in comparison with the control group (small effect size: 0.49 SDs; p = 0.022). DISCUSSION The @ctivehip telerehabilitation program seems to be a promising treatment to improve the quality of life and psychological factors (i.e. anxiety and depression) of older adults after a hip fracture, as well as to recover their previous fitness level.
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Affiliation(s)
- Marta Mora-Traverso
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
| | - Rafael Prieto-Moreno
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
| | - Pablo Molina-Garcia
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Zeus Salas-Fariña
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain
- Sport and Health University Research Institute (iMUDS), Universtity of Granada, Granada, Spain
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Patrocinio Ariza-Vega
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
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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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Levitt EB, Patch DA, Hess MC, Terrero A, Jaeger B, Haendel MA, Chute CG, Yeager MT, Ponce BA, Theiss SM, Spitler CA, Johnson JP. Outcomes of SARS-CoV-2 infection among patients with orthopaedic fracture surgery in the National COVID Cohort Collaborative (N3C). Injury 2023; 54:111092. [PMID: 37871347 DOI: 10.1016/j.injury.2023.111092] [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: 07/17/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND The objective of this study was to investigate the outcomes of COVID-19-positive patients undergoing orthopaedic fracture surgery using data from a national database of U.S. adults with a COVID-19 test for SARS-CoV-2. METHODS This is a retrospective cohort study using data from a national database to compare orthopaedic fracture surgery outcomes between COVID-19-positive and COVID-19-negative patients in the United States. Participants aged 18-99 with orthopaedic fracture surgery between March and December 2020 were included. The main exposure was COVID-19 status. Outcomes included perioperative complications, 30-day all-cause mortality, and overall all-cause mortality. Multivariable adjusted models were fitted to determine the association of COVID-positivity with all-cause mortality. RESULTS The total population of 6.5 million patient records was queried, identifying 76,697 participants with a fracture. There were 7,628 participants in the National COVID Cohort who had a fracture and operative management. The Charlson Comorbidity Index was higher in the COVID-19-positive group (n = 476, 6.2 %) than the COVID-19-negative group (n = 7,152, 93.8 %) (2.2 vs 1.4, p<0.001). The COVID-19-positive group had higher mortality (13.2 % vs 5.2 %, p<0.001) than the COVID-19-negative group with higher odds of death in the fully adjusted model (Odds Ratio=1.59; 95 % Confidence Interval: 1.16-2.18). CONCLUSION COVID-19-positive participants with a fracture requiring surgery had higher mortality and perioperative complications than COVID-19-negative patients in this national cohort of U.S. adults tested for COVID-19. The risks associated with COVID-19 can guide potential treatment options and counseling of patients and their families. Future studies can be conducted as data accumulates. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Eli B Levitt
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA; Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - David A Patch
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Matthew C Hess
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Alfredo Terrero
- Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA; Department of Translational Medicine, School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Byron Jaeger
- Department of Epidemiology, University of Alabama, Birmingham, AL, USA
| | - Melissa A Haendel
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew T Yeager
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | | | - Steven M Theiss
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Joey P Johnson
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA.
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Konda SR, Esper GW, Meltzer-Bruhn AT, Solasz SJ, Ganta A, Leucht P, Tejwani NC, Egol KA. One year later: How outcomes of hip fractures treated during the "first wave" of the COVID-19 pandemic were affected. Musculoskelet Surg 2023; 107:405-412. [PMID: 37020155 PMCID: PMC10075150 DOI: 10.1007/s12306-023-00784-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/26/2023] [Indexed: 04/07/2023]
Abstract
The purpose of this study was to assess the impact of COVID-19 on long-term outcomes in the geriatric hip fracture population. We hypothesize that COVID + geriatric hip fracture patients had worse outcomes at 1-year follow-up. Between February and June 2020, 224 patients > 55 years old treated for a hip fracture were analyzed for demographics, COVID status on admission, hospital quality measures, 30- and 90-day readmission rates, 1-year functional outcomes (as measured by the EuroQol- 5 Dimension [EQ5D-3L] questionnaire), and inpatient, 30-day, and 1-year mortality rates with time to death. Comparative analyses were conducted between COVID + and COVID- patients. Twenty-four patients (11%) were COVID + on admission. No demographic differences were seen between cohorts. COVID + patients experienced a longer length of stay (8.58 ± 6.51 vs. 5.33 ± 3.09, p < 0.01) and higher rates of inpatient (20.83% vs. 1.00%, p < 0.01), 30-day (25.00% vs. 5.00%, p < 0.01), and 1-year mortality (58.33% vs. 18.50%, p < 0.01). There were no differences seen in 30- or 90-day readmission rates, or 1-year functional outcomes. While not significant, COVID + patients had a shorter average time to death post-hospital discharge (56.14 ± 54.31 vs 100.68 ± 62.12, p = 0.171). Pre-vaccine, COVID + geriatric hip fracture patients experienced significantly higher rates of mortality within 1 year post-hospital discharge. However, COVID + patients who did not die experienced a similar return of function by 1-year as the COVID- cohort.
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Affiliation(s)
- Sanjit R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA.
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Richmond Hill, NY, 11418, USA.
| | - Garrett W Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
| | - Ariana T Meltzer-Bruhn
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
| | - Sara J Solasz
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
| | - Abhishek Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Richmond Hill, NY, 11418, USA
| | - Philipp Leucht
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Bellevue Hospital, 462 1st Ave, New York, NY, 10016, USA
| | - Nirmal C Tejwani
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Bellevue Hospital, 462 1st Ave, New York, NY, 10016, USA
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Richmond Hill, NY, 11418, USA
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Nath U, Alam B, Das A, Bakhiet A, Pillai A. The Impact of COVID-19 on the Neck of Femur Fracture Service in a Tertiary Care Hospital in the United Kingdom. Cureus 2023; 15:e47298. [PMID: 38021733 PMCID: PMC10656497 DOI: 10.7759/cureus.47298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The emergence of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in late 2019 ushered in a global crisis that profoundly impacted healthcare systems worldwide. In the United Kingdom, COVID-19 resulted in a significant toll on public health and the National Health Service (NHS). As the virus surged, the NHS faced unprecedented challenges, including surges in COVID-19 cases, a dire need for medical equipment, and a strain on intensive care units. Simultaneously, stringent nationwide lockdowns were imposed to curb the virus's spread, disrupting daily life and healthcare access. Amid this crisis, the interactions between COVID-19 and other prevalent health conditions came to the forefront of medical research, sparking interest in understanding their connections. This study delves into the intriguing interplay between COVID-19 and neck of femur (NoF) fractures, exploring shared risk factors, resource implications, and potential alterations in patient pathways. Given the severity of both conditions and their impact on the vulnerable elderly population, elucidating these connections is crucial for comprehensive patient care and resource allocation within the healthcare system. Methods This study used data from the National Hip Fracture Audit (NHFA) database, focusing on NoF fracture patients at Wythenshawe Hospital. We examined two cohorts: pre-pandemic (from March 2019 to March 2020) and pandemic (from March 2020 to March 2021). We compared key parameters and incorporated COVID-19 data. Graphs showed trends and cohort similarities. We also analyzed demographic data (age, gender, fracture type, times, COVID-19 status, and mortality), removing outliers for accuracy. Results The data revealed that while certain factors such as patient age and mobilization remained largely unaffected, there was a modest association between COVID-19 incidence and NoF fracture patients. Notably, regional lockdown measures had a substantial impact on patient care. The initial lockdown effectively reduced COVID-19-positive cases upon admission but led to prolonged intervals and surgical delays. However, the second lockdown showed improvements, attributed to lessons learned, increased resource allocation, and better familiarity with hospital-specific lockdown measures. This research sheds light on the intricate relationship between a global pandemic and orthopedic patient care, highlighting the importance of adapting healthcare systems to evolving challenges. Conclusion This study explores the impact of COVID-19 on neck of femur (NoF) fracture patients, highlighting key findings from Wythenshawe Hospital. It uncovers a dynamic relationship between the pandemic and patient care, with increased COVID-19 cases coinciding with reduced NoF fracture rates. Lockdowns influenced outcomes, with the first causing delays and higher post-discharge mortality, while the second improved efficiency and safety. These insights extend beyond Wythenshawe Hospital, offering implications for healthcare practices in the United Kingdom and beyond, especially in countries with limited vaccination resources. This research underscores the need for tailored strategies to optimize NoF fracture patient outcomes during pandemics and lockdowns.
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Affiliation(s)
- Upamanyu Nath
- Trauma and Orthopedics, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Benyamin Alam
- Trauma and Orthopedics, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Abhirun Das
- Trauma and Orthopedics, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Abdelwakeel Bakhiet
- Trauma and Orthopedics, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Anand Pillai
- Trauma and Orthopedics, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR
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Balziano S, Greenstein N, Apterman S, Fogel I, Baran I, Prat D. Subtype consideration in hip fracture research: patient variances in inter- and intra-classification levels highlight the need for future research deliberation. A 2-years follow-up prospective-historical cohort. Arch Osteoporos 2023; 18:123. [PMID: 37770694 DOI: 10.1007/s11657-023-01334-7] [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: 07/05/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023]
Abstract
Current research on elderly patients with hip fractures often neglects specific subtypes, either grouping all fracture types or overlooking them entirely. By categorizing elderly patients based on fracture subtypes, we observed diverse baseline characteristics but found no discrepancies in measured outcomes. This emphasizes the need for caution in future research dealing with different or broader measured outcomes that were not covered by the scope of this research. PURPOSE/INTRODUCTION Existing research in elderly patients with hip fractures often overlooks the distinct subtypes or lumps all fracture types together. We aim to examine the differences between hip fracture subtypes to assess if these differences are meaningful for clinical outcomes and should be considered in future research. METHODS Patients above 65 years who underwent hip fracture surgeries during a three-year period were retrospectively reviewed. Cases were grouped based on fracture subtype: non-displaced femoral neck (nDFN), displaced femoral neck (DFN), stable intertrochanteric (sIT), and unstable intertrochanteric (uIT). RESULTS Among the 1,285 included cases, the nDFN-group had lower ASA scores (p = 0.009) and younger patients (p < 0.001), followed by the DFN-group (p = 0.014). The uIT-group had a higher proportion of female patients (72.3%, p = 0.004). Differences in preoperative ambulation status were observed (p = 0.001). However, no significant associations were found between fracture type and postoperative outcomes, including ambulation, transfusions, complications, reoperations, or mortality. Gender and preoperative ambulation status were predictors of mortality across all time frames. ASA score predicted mortality only within the first year after surgery. Age and gender were predictors of postoperative blood transfusions, while age and preoperative ambulation status were predictors of postoperative complications. CONCLUSIONS Variations in baseline characteristics of hip fractures were observed, but no significant differences were found in measured outcomes. This indicates that the hip fracture group is not homogeneous, emphasizing the need for caution in research involving this population. While grouping all types of proximal femur fractures may be acceptable depending on the outcome being studied, it's essential not to extrapolate these results to outcomes beyond the study's scope. Therefore, we recommend consider hip fracture subtypes when researching different outcomes not covered by this study.
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Affiliation(s)
- Snir Balziano
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel.
| | - Nechemia Greenstein
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Sagy Apterman
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Itay Fogel
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Isaac Baran
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Dan Prat
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
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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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12
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Putera HD, Halim V, Panghiyangani R. The impact of COVID-19 on mortality in trauma patients undergoing orthopedic surgery: a systematic review and meta-analysis. Clin Exp Emerg Med 2023; 10:315-326. [PMID: 37188360 PMCID: PMC10579729 DOI: 10.15441/ceem.22.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/19/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE The global spread of the COVID-19 pandemic has affected all aspects of medicine, including orthopedic trauma surgery. This study aims to investigate whether COVID-19 patients who underwent orthopedic surgery trauma had a higher risk of postoperative mortality. METHODS ScienceDirect, the Cochrane COVID-19 Study Register, and MEDLINE were searched for original publications. This study adhered to the PPRISMA 2020 statement. The validity of the studies was evaluated using a checklist developed by the Joanna Briggs Institute. Study and participant characteristics, as well as the odds ratio, were extracted from selected publications. Data were analyzed using RevMan ver. 5.4.1. RESULTS After applying the inclusion and exclusion criteria, 16 articles among 717 total were deemed eligible for analysis. Lower-extremity injuries were the most common condition, and pelvic surgery was the most frequently performed intervention. There were 456 COVID-19 patients (6.12%) and 134 deaths among COVID-19 patients, revealing an increase in mortality (29.38% vs. 5.30%; odds ratio, 7.72; 95% confidence interval, 6.01-9.93; P<0.001). CONCLUSION Among COVID-19 patients who received orthopedic surgery due to trauma, the postoperative death rate increased by 7.72 times.
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Affiliation(s)
- Husna Dharma Putera
- Department of Orthopedic and Traumatology, Faculty of Medicine, Ulin General Hospital, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
| | - Valentina Halim
- Department of Emergency, Siloam Hospital, Banjarmasin, Indonesia
| | - Roselina Panghiyangani
- Biomedical Department, Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
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13
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Wong SC, Chau PH, So SYC, Chiu KHY, Yuen LLH, AuYeung CHY, Lam GKM, Chan VWM, Chen JHK, Chen H, Li X, Ho PL, Chan SSC, Yuen KY, Cheng VCC. Epidemiology of multidrug-resistant organisms before and during COVID-19 in Hong Kong. Infect Prev Pract 2023; 5:100286. [PMID: 37223243 PMCID: PMC10165868 DOI: 10.1016/j.infpip.2023.100286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) has influenced antimicrobial consumption and incidence of multidrug-resistant organisms (MDROs). We aimed to study the epidemiology of MDROs before and during the COVID-19 pandemic in Hong Kong. Methods With the maintenance of infection control measures, we described the trend of MDRO infections, including methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum-beta-lactamase-(ESBL)-producing Enterobacterales, in a healthcare region with 3100-bed before (1 January 2016 to 31 December 2019, period 1) and during COVID-19 (1 January 2020 to 30 September 2022, period 2), together with the antimicrobial consumption using piecewise Poisson regression. The epidemiological characteristics of newly diagnosed COVID-19 patients with or without MDRO infections were analyzed. Results Between period 1 and 2, we observed a significant increase in the trend of CRA infections (P<0.001), while there was no significant increase in the trend of MRSA (P=0.742) and ESBL-producing Enterobacterales (P=0.061) infections. Meanwhile, a significant increase in the trend of carbapenems (P<0.001), extended-spectrum beta-lactam-beta-lactamase inhibitor combinations (BLBI) (P=0.045), and fluoroquinolones (P=0.009) consumption was observed. The observed opportunity (23,540 ± 3703 vs 26,145 ± 2838, p=0.359) and compliance (81.6% ± 0.5% vs 80.1% ± 0.8%, P=0.209) of hand hygiene per year was maintained. In a multivariable model, older age, male sex, referral from residential care home for the elderly, presence of indwelling device, presence of endotracheal tube, and use of carbapenems, use of BLBI, use of proton pump inhibitors and history of hospitalization in the past 3 months were associated with higher risks of infections by MDROs among COVID-19 patients. Conclusion Infection control measures may control the surge of MDROs despite an increasing trend of antimicrobial consumption.
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Affiliation(s)
- Shuk-Ching Wong
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Pui-Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Yung-Chun So
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Kelvin Hei-Yeung Chiu
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Lithia Lai-Ha Yuen
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Christine Ho-Yan AuYeung
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Germaine Kit-Ming Lam
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Veronica Wing-Man Chan
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Jonathan Hon-Kwan Chen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Hong Chen
- Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| | - Xin Li
- Carol Yu Center for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pak-Leung Ho
- Carol Yu Center for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sophia Siu-Chee Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- Carol Yu Center for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vincent Chi-Chung Cheng
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
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14
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Jang SY, Cha Y, Kim Y, Kim KJ, Kim H, Choy W. Analysis of the Effects of COVID-19 on Hip Fractures in Korea Without Lockdown: Interrupted Time Series Analysis Using a Nationwide Cohort. J Korean Med Sci 2023; 38:e137. [PMID: 37158773 PMCID: PMC10166703 DOI: 10.3346/jkms.2023.38.e137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/26/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the change in the incidence rate, length of hospital stay (LOS), in-hospital mortality rate, and surgical method of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic in South Korea where lockdown restrictions were not implemented. METHODS We calculated the expected values of the incidence of hip fractures, in-hospital mortality and LOS of hip fracture patients in 2020 (COVID period) based hip fracture database of the Korean National Health Insurance Review and Assessment (HIRA) during a 9-year period from 2011 to 2019 (pre-COVID period). A generalized estimating equation model with Poisson distribution and logarithmic link function was used to estimate adjusted annual percent change (PC) of incidence rate and 95% confidence intervals (CIs). Then, we compared the annual incidence, in-hospital mortality rate and LOS in 2020 with the expected values. RESULTS The overall incidence rate of hip fracture in 2020 was not significantly different from the expected value (PC, -5%; 95% CI, -13 to 4; P = 0.280). In women, the incidence rate of hip fracture in age groups over 70 years was smaller than the predicted value (P < 0.001). The in-hospital mortality rate was not significantly different from the expected value (PC, 5%; 95% CI, -8 to 19; P = 0.461). The mean LOS was larger than the expected value by 2% (PC, 2%; 95% CI, 1 to 3; P < 0.001). In intertrochanteric fracture, the proportion of internal fixation was smaller than the predicted value by 2% (PC, -2%; 95% CI, -3 to -1; P < 0.001), and that of hemiarthroplasty was larger than the predicted value by 8% (PC, 8%; 95% CI, 4 to 14; P < 0.001). CONCLUSIONS In 2020, the incidence rate of hip fracture did not significantly decrease, and in-hospital mortality rate did not significantly increase compared to the expected rates, which were projected based on the HIRA hip fracture data from 2011 to 2019. Only LOS increased slightly.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Yongwoo Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kap-Jung Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Hayong Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Wonsik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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15
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Wang S, Chambers M, Martin K, Gilbert G, Gentile PM, Hwang R, Mashru R, Graf KW, Dolch HJ. Outcomes of hip fracture surgery during the COVID-19 pandemic. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03456-z. [PMID: 36534369 PMCID: PMC9762624 DOI: 10.1007/s00590-022-03456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/28/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate if changes to hospital operational models during the COVID-19 pandemic negatively impacted overall time to surgery (TtS) as well as morbidity and mortality rates of hip fractures (HFx). METHODS 416 patients treated for OTA 31 fractures at a single institution between January 2019 and November 2020 were reviewed. TtS as well as morbidity and mortality rates were obtained from pre-pandemic and pandemic groups. RESULTS 263 patients were treated pre-pandemic and 153 were treated during the pandemic. There were no significant differences in median TtS, readmission rates (p = 0.134), reoperation rates (p = 0.052), 30-day (p = 0.095) and 90-day (p = 0.22) mortality rates. CONCLUSION Reallocation of hospital resources in response to the COVID-19 pandemic did not negatively impact surgical timing or complications. TtS for HFx remains a challenge and often requires multidisciplinary care, which is complicated by a pandemic. However, this study demonstrates HFx standard of care can be maintained despite COVID-19 obstacles to treatment efficiency and efficacy.
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Affiliation(s)
- Sherrie Wang
- Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103 USA
| | - MaKenzie Chambers
- Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103 USA
| | - Kelsey Martin
- Cooper University Health Care, 3 Cooper Plaza, Camden, NJ 08103 USA
| | - Grace Gilbert
- Cooper University Health Care, 3 Cooper Plaza, Camden, NJ 08103 USA
| | | | - Rock Hwang
- Cooper University Health Care, 3 Cooper Plaza, Camden, NJ 08103 USA
| | - Rakesh Mashru
- Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103 USA ,Cooper University Health Care, 3 Cooper Plaza, Camden, NJ 08103 USA
| | - Kenneth W. Graf
- Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103 USA ,Cooper University Health Care, 3 Cooper Plaza, Camden, NJ 08103 USA
| | - Henry J. Dolch
- Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103 USA ,Cooper University Health Care, 3 Cooper Plaza, Camden, NJ 08103 USA
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Pectol RW, Kavolus MW, Sneed CR, Albano AY, Landy DC, Aneja A. Outcomes of Reamed Intramedullary Nailing for Lower Extremity Diaphyseal Fractures in COVID-Positive Patients: A Multi-institutional Observational Study. J Orthop Trauma 2022; 36:628-633. [PMID: 35916777 DOI: 10.1097/bot.0000000000002468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if reamed intramedullary nailing (IMN) of tibial and femoral shaft fractures exacerbated the hypercoagulable state of COVID infection, resulting in increased thromboembolic and pulmonary complications. DESIGN Retrospective chart review. SETTING Eleven Level I trauma centers. PATIENTS From January 1, 2020, to December 1, 2022, 163 patients with orthopaedic trauma and COVID positivity and 36 patients with tibial and femoral shaft fractures were included. INTERVENTION Reamed IMN. MAIN OUTCOME MEASURES Incidence of postoperative thromboembolic and respiratory complications. RESULTS Thirty-six patients with a median age of 52 years (range, 18-92 years; interquartile range, 29-72 years) met criteria. There were 21 and 15 patients with femoral and tibial shaft fractures. There were 15 patients sustaining polytrauma; of which, 10 had a new injury severity score of >17. All patients underwent reamed IMN in a median of 1 day (range, 0-12 days; interquartile range = 1-2 days) after injury. Two patients developed acute respiratory distress syndrome (ARDS) and 3 pneumonia. No patients had pulmonary embolism, deep vein thrombosis, or died within 30 days. CONCLUSION In this multi-institutional review of COVID-positive patients undergoing reamed IMN, there were no thromboembolic events. All patients developing pulmonary complications (ARDS or pneumonia) had baseline chronic obstructive pulmonary disease, were immune compromised, or sustained polytraumatic injuries with new injury severity score of >20. Given this, it seems reasonable to continue using reamed IMN for tibial and femoral shaft fractures after evaluation for COVID severity, comorbidities, and other injuries. LEVELS OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Richard W Pectol
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY
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17
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Rashid F, Mahmood A, Hawkes DH, Harrison WJ. Coronavirus in hip fractures (CHIP) 4 : has vaccination improved mortality outcomes in hip fracture patients? Bone Joint J 2022; 104-B:1362-1368. [PMID: 36453043 DOI: 10.1302/0301-620x.104b12.bjj-2022-0843.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
AIMS Prior to the availability of vaccines, mortality for hip fracture patients with concomitant COVID-19 infection was three times higher than pre-pandemic rates. The primary aim of this study was to determine the 30-day mortality rate of hip fracture patients in the post-vaccine era. METHODS A multicentre observational study was carried out at 19 NHS Trusts in England. The study period for the data collection was 1 February 2021 until 28 February 2022, with mortality tracing until 28 March 2022. Data collection included demographic details, data points to calculate the Nottingham Hip Fracture Score, COVID-19 status, 30-day mortality, and vaccination status. RESULTS A total of 337 patients tested positive for COVID-19. The overall 30-day mortality in these patients was 7.7%: 5.5% in vaccinated patients and 21.7% in unvaccinated patients. There was no significant difference between post-vaccine mortality compared with pre-pandemic 2019 controls (7.7% vs 5.0%; p = 0.068). Independent risk factors for mortality included unvaccinated status, Abbreviated Mental Test Score ≤ 6, male sex, age > 80 years, and time to theatre > 36 hours, in decreasing order of effect size. CONCLUSION The vaccination programme has reduced 30-day mortality rates in hip fracture patients with concomitant COVID-19 infection to a level similar to pre-pandemic. Mortality for unvaccinated patients remained high.Cite this article: Bone Joint J 2022;104-B(12):1362-1368.
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Affiliation(s)
- Fatima Rashid
- The Countess of Chester NHS Foundation Trust, Chester, UK
| | - Aatif Mahmood
- The Countess of Chester NHS Foundation Trust, Chester, UK
| | - David H Hawkes
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
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18
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Jawad MU, Delman CM, Campbell ST, Fitzpatrick EP, Soles GLS, Lee MA, Randall RL, Thorpe SW. Traumatic Proximal Femoral Fractures during COVID-19 Pandemic in the US: An ACS NSQIP ® Analysis. J Clin Med 2022; 11:jcm11226778. [PMID: 36431255 PMCID: PMC9697726 DOI: 10.3390/jcm11226778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/06/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022] Open
Abstract
In order to determine the impact of COVID-19 on the treatment and outcomes in patients with proximal femoral fracture’s (PFF), we analyzed a national US sample. This is a retrospective review of American College of Surgery’s (ACS) National Surgical Quality Improvement Program (NSQIP) for patients with proximal femoral fractures. A total of 26,830 and 26,300 patients sustaining PFF and undergoing surgical treatment were sampled during 2019 and 2020, respectively. On multivariable logistic regression, patients were less likely to have ‘presence of non-healing wound’ (p < 0.001), functional status ‘independent’ (p = 0.012), undergo surgical procedures of ‘hemiarthroplasty’(p = 0.002) and ‘ORIF IT, Peritroch, Subtroch with plates and screws’ (p < 0.001) and to be ‘alive at 30-days post-op’ (p = 0.001) in 2020 as compared to 2019. Patients were more likely to have a case status ‘emergent’, ‘loss of ≥10% body weight’, discharge destination of ‘home’ (p < 0.001 for each) or ‘leaving against medical advice’ (p = 0.026), postoperative ‘acute renal failure (ARF)’ (p = 0.011), ‘myocardial infarction (MI)’ (p = 0.006), ‘pulmonary embolism (PE)’ (p = 0.047), and ‘deep venous thrombosis (DVT)’ (p = 0.049) in 2020 as compared to 2019. Patients sustaining PFF and undergoing surgical treatment during pandemic year 2020 differed significantly in preoperative characteristics and 30-day postoperative complications when compared to patients from the previous year.
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Affiliation(s)
- Muhammad Umar Jawad
- Department of Orthopedic Surgery, Good Samaritan Regional Medical Center, Corvallis, OR 97330, USA
| | - Connor M. Delman
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Sean T. Campbell
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Ellen P. Fitzpatrick
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Gillian L. S. Soles
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Mark A. Lee
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - R. Lor Randall
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Steven W. Thorpe
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
- Correspondence:
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19
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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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20
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Özkan MÇ, Saçak B, Kesimer MD, Şahin B, Uğurlu MÜ, Yamansavcı Sirzai E, Sakar M, Aykut A, Çiçek İ, Yumuşakhuylu AC. Effect of the pandemic on surgical procedures in a tertiary care hospital: A retrospective review. Turk J Surg 2022; 38:243-249. [PMID: 36846060 PMCID: PMC9948666 DOI: 10.47717/turkjsurg.2022.5256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/08/2022] [Indexed: 12/24/2022]
Abstract
Objectives The aim of this study was to examine the impact of performing surgeries with necessary precautions and to evaluate demographic characteristics of operated patients during novel coronavirus-2019 (COVID-19) pandemic and the infection rates during hospitalization and within 14 days after surgery. Material and Methods Between March 15th, 2020 and April 30th, 2020, a total of 639 patients who had been operated on in our center were retrospectively analyzed. According to the triage system, the surgical procedures were classified as emergency, time-sensitive, and elective procedures. Data including age, sex, indication for surgery, the American Society of Anesthesiologists (ASA) class, pre- and postoperative symptoms, the presence and/ or absence of reverse transcriptase-polymerase chain reaction (RT-PCR) test result, type of surgery, surgical site, and documented COVID-19 infections during hospitalization and within 21 days after surgery were recorded. Results Of the patients, 60.4% were males and 39.6% were females with a mean age of 43.08 ± 22.68 years. Malignancy was the most common indication for surgery (35.5%), followed by trauma (29.1%). The abdominal area and head and neck region were the most frequent surgical sites in 27.4% and 24.9% of the patients, respectively. Of all surgical procedures, 54.9% were emergency and 43.9% were time-sensitive procedures. Of the patients, 84.2% were in ASA Class I-II while 15.8% patients were in ASA Class III, IV and V. General anesthesia was the most common anesthesia type in 83.9% of the patients. The overall rate of COVID-19 infection was 0.63% in the preoperative period. The rate of COVID-19 infection during and after surgery was 0.31%. Conclusion With similar infection rates to the general population, surgeries of all types can be performed safely taking preventive measures in the preand postoperative period. It would be wise to perform surgical treatment without delay in patients with an increased risk for mortality and morbidity in accordance with strict infection control principles.
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Affiliation(s)
- Melekber Çavuş Özkan
- Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - Bülent Saçak
- Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - Mehmet Deniz Kesimer
- Department of Orthopedics and Trauma Surgery, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - Bahadır Şahin
- Department of Urology, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - Mustafa Ümit Uğurlu
- Department of General Surgery, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - Esra Yamansavcı Sirzai
- Department of Thoracic Surgery, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - Mustafa Sakar
- Department of Neurosurgery, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - Aslan Aykut
- Department of Ophthalmology, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - İlker Çiçek
- Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - Ali Cemal Yumuşakhuylu
- Department of Otorhinolaryngology, Marmara University Faculty of Medicine, İstanbul, Türkiye
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21
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Diaz-Ledezma C, Mardones R. Predicting Prolonged Hospital Stays in Elderly Patients With Hip Fractures Managed During the COVID-19 Pandemic in Chile: An Artificial Neural Networks Study. HSS J 2022; 19:205-209. [PMID: 37051613 PMCID: PMC9434193 DOI: 10.1177/15563316221120582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/24/2022] [Indexed: 04/14/2023]
Abstract
Background: Prolonged length of stay (LOS) after a hip fracture is associated with increased mortality. Purpose: We sought to create a model to predict prolonged LOS in elderly Chilean patients with hip fractures managed during the COVID-19 pandemic. Methods: Employing an official database, we created an artificial neural network (ANN), a computational model corresponding to a subset of machine learning, to predict prolonged LOS (≥14 days) among 2686 hip fracture patients managed in 43 Chilean public hospitals during 2020. We identified 18 clinically relevant variables as potential predictors; 80% of the sample was used to train the ANN and 20% was used to test it. The performance of the ANN was evaluated via measuring its discrimination power through the area under the curve of the receiver operating characteristic curve (AUC-ROC). Results: Of the 2686 patients, 820 (30.2%) had prolonged LOS. In the training sample (2,125 cases), the ANN correctly classified 1,532 cases (72.09%; AUC-ROC: 0.745). In the test sample (561 cases), the ANN correctly classified 401 cases (71.48%; AUC-ROC: 0.742). The most relevant variables to predict prolonged LOS were the patient’s admitting hospital (relative importance [RI]: 0.11), the patient’s geographical health service providing health care (RI: 0.11), and the patient’s surgery being conducted within 2 days of admission (RI: 0.10). Conclusions: Using national-level big data, we developed an ANN that predicted with fair accuracy prolonged LOS in elderly Chilean patients with hip fractures during the COVID-19 pandemic. The main predictors of a prolonged LOS were unrelated to the patient’s individual health and concerned administrative and organizational factors.
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Affiliation(s)
- Claudio Diaz-Ledezma
- Hospital El Carmen, Santiago, Chile
- Clínica Las Condes, Santiago, Chile
- Claudio Diaz-Ledezma, MD, Hospital El Carmen,
Avenida Rinconada 1208, Oficina 28, 5to Piso, Maipú, Santiago, Chile.
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22
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Comparative Outcomes and Surgical Timing for Operative Fragility Hip Fracture Patients during the COVID-19 Pandemic: A Retrospective Cohort Study. Geriatrics (Basel) 2022; 7:geriatrics7040084. [PMID: 36005260 PMCID: PMC9407975 DOI: 10.3390/geriatrics7040084] [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: 06/22/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic had wide-reaching effects on healthcare delivery, including care for hip fractures, a common injury among older adults. This study characterized factors related to surgical timing and outcomes, length-of-stay, and discharge disposition among patients treated for operative hip fractures during the first wave of the COVID-19 pandemic, compared to historical controls. A retrospective, observational cohort study was conducted from 16 March-20 May 2020 with a consecutive series of 64 operative fragility hip fracture patients at three tertiary academic medical centers. Historical controls were matched based on sex, surgical procedure, age, and comorbidities. Primary outcomes included 30-day mortality and time-to-surgery. Secondary outcomes included 30-day postoperative complications, length-of-stay, discharge disposition, and time to obtain a COVID-19 test result. There was no difference in 30-day mortality, complication rates, length-of-stay, anesthesia type, or time-to-surgery, despite a mean time to obtain a final preoperative COVID-19 test result of 17.6 h in the study group. Notably, 23.8% of patients were discharged to home during the COVID-19 pandemic, compared to 4.8% among controls (p = 0.003). On average, patients received surgical care within 48 h of arrival during the COVID-19 pandemic. More patients were discharged to home rather than a facility with no change in complications, suggesting an opportunity for increased discharge to home.
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23
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Freitas T, Ibrahim A, Lourenço A, Chen-Xu J. Mortality in COVID-19 patients after proximal femur fracture surgery: a systematic review and meta-analysis. Hip Int 2022:11207000221116764. [PMID: 35959769 DOI: 10.1177/11207000221116764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND COVID-19 infection first emerged in December 2019 in China and has since rapidly spread to become a worldwide pandemic. Orthopaedic surgery suffered a significant decline in the volume of surgical cases, while the orthopaedic trauma services maintained or increased the activity. Emergency operations for proximal femur fractures (PFF) in the elderly population assumed levels comparable to before the pandemic, with the 1-year mortality rate ranging from 14% to 36%. AIMS To determine whether patients with PFF affected by COVID-19 have a higher risk of postoperative mortality through a systematic review and meta-analysis. METHODS PubMed, Web of Science, Scopus and BMC were searched from January 2020 to January 2021 to identify original studies reporting the mortality in COVID-19 patients after PFF surgery. Study and participants' characteristics, mortality rate and odds ratio (OR) were extracted. Risk of bias assessment was carried, and visual inspection of the funnel plot was used to assess publication bias. A random-effects model for meta-analysis was adopted. RESULTS Among 656 articles that came from the search query and hand-search, 10 articles were eligible after applying inclusion and exclusion criteria. Overall, the sum of the study participants was 1882, with 351 COVID-19 positive patients (18.7%) and a total number of 117 deaths, with an overall mortality rate of 33.3%. The mortality rate of COVID-19 positive patients varied from 14.8% to 60% and was higher than of those without COVID-19, with OR ranging from 2.424 to 72.00. The inverse variance method showed an OR = 3.652. All studies showed a statistically significant p-value. CONCLUSIONS The postoperative mortality in hip fracture patients with concomitant COVID-19 was 3.65 times higher than the mortality in non-COVID patients. The currently available literature demonstrates that COVID-19 infection represents a substantial risk factor for postoperative mortality in the already susceptible hip fracture population.
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Affiliation(s)
- Tânia Freitas
- Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Public Health of University of Porto (ISPUP), Porto, Portugal
| | - Abdulrazak Ibrahim
- Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Public Health of University of Porto (ISPUP), Porto, Portugal.,National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal
| | - António Lourenço
- Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Public Health of University of Porto (ISPUP), Porto, Portugal.,National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal
| | - José Chen-Xu
- Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Public Health of University of Porto (ISPUP), Porto, Portugal.,National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal
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24
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Tsourdi E, Hofbauer LC, Rauner M. The Impact of COVID-19 in Bone Metabolism: Basic and Clinical Aspects. Horm Metab Res 2022; 54:540-548. [PMID: 35419776 DOI: 10.1055/a-1825-9641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The use of standard procedures for the diagnosis of osteoporosis and assessment of fracture risk significantly decreased during the COVID-19 pandemic, while the incidence of fragility fractures was mostly unaltered. Both COVID-19 per se and its treatments are associated with a negative impact on bone health. Preclinical models show that mice infected with SARS-CoV2 even without symptoms display loss of trabecular bone mass two weeks post infection, due to increased numbers of osteoclasts. Osteoporosis medications do not aggravate the clinical course of COVID-19, while preclinical data suggests possible beneficial effects of some therapies. While vitamin D deficiency is clearly associated with a worse clinical course of COVID-19, evidence of improved patient outcome with vitamin D supplementation is lacking. Osteoporosis treatment should not be generally discontinued, and recommendations for substituting therapies are available. Osteoporosis therapies do not interfere with the efficacy or side-effect profiles of COVID-19 vaccines and should not be stopped or indefinitely delayed because of vaccination.
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Affiliation(s)
- Elena Tsourdi
- Department of Medicine III, University Clinic Dresden Medical Center, Dresden, Germany
- Center for Healthy Aging, University Clinic Dresden Medical Center, Dresden, Germany
| | - Lorenz C Hofbauer
- Department of Medicine III, University Clinic Dresden Medical Center, Dresden, Germany
- Center for Healthy Aging, University Clinic Dresden Medical Center, Dresden, Germany
| | - Martina Rauner
- Department of Medicine III, University Clinic Dresden Medical Center, Dresden, Germany
- Center for Healthy Aging, University Clinic Dresden Medical Center, Dresden, Germany
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25
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Migliorini F, Vaishya R, Eschweiler J, Oliva F, Hildebrand F, Maffulli N. Vitamins C and D and COVID-19 Susceptibility, Severity and Progression: An Evidence Based Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070941. [PMID: 35888660 PMCID: PMC9318801 DOI: 10.3390/medicina58070941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/02/2022] [Accepted: 07/12/2022] [Indexed: 04/07/2023]
Abstract
Background and Objectives: Starting in early December 2019, the novel Coronavirus Disease (COVID-19) from infection with COVID-19 has caused a global pandemic. Many aspects of its pathogenesis and related clinical consequences are still unclear. Early diagnosis and dynamic monitoring of prognostic factors are essential to improve the ability to manage COVID-19 infection. This study aimed to provide an account of the role played by vitamins C and D on the onset, progression and severity of COVID-19. Clinical features and infection-related risk factors are also briefly discussed. Material and Methods: In March 2022, the main online databases were accessed. All the articles that investigate the possible role of vitamins C and D on COVID-19 susceptibility, severity and progression were considered. Results: The current evidence on vitamin C and D supplementation in patients with COVID-19 infection is inconsistent and controversial. In some studies, vitamins were used as coadjuvant of a formal experimental therapy, while in others as main treatment. Ethnicity and hospital setting (inpatient/outpatient) were also variable. Moreover, there was no consensus between studies in administration protocol: high heterogeneity in dosage, administration, and duration of the treatment were evident. Finally, some studies administered vitamins pre- and/or during COVID infection, in patients with different risk factors and infection severity. Conclusions: While waiting to develop a targeted, safe and effective therapy, it is important to investigate individual predisposition and proper disease management. Concluding, available data on the use of nutraceuticals in COVID-19 are inconsistent. However, there is a lack of evidence-based guidelines which recommend vitamin C and D supplementation in patients with COVID-19, and results from high quality randomised controlled trials (RCTs) are inconsistent. Current investigations so far are mostly observational, and include a relatively small sample size which can lead to biased results. Large-scale multicentre studies are therefore needed.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.E.); (F.H.)
- Correspondence: ; Tel.: +49-0241-80-35529
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals Institutes of Orthopaedics, New Delhi 110076, India;
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.E.); (F.H.)
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (N.M.)
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.E.); (F.H.)
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (N.M.)
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST5 5BG, UK
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
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26
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Zajonz D, Vaitl P, Edel M, Fuchs O, Kübler F, Schneider P, Roth A, Prietzel T. Effects of SARS-CoV‑2 infections on inpatient mortality of geriatric patients after proximal femoral fracture surgery. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:573-579. [PMID: 35776154 PMCID: PMC9191536 DOI: 10.1007/s00132-022-04268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The medical challenges caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) pose a tremendous burden on the healthcare system. This study aimed to analyze the effects of a SARS-CoV‑2 infections or disease progression on inpatient mortality of geriatric patients after proximal femoral fracture surgery. METHODS A retrospective analysis was conducted in all patients with a proximal femoral fracture surgically treated in an urban regional trauma center from 01/01/2020 to 01/31/2021. According to PCR test results detecting SARS-CoV‑2, the patients were divided into two groups (SARS-CoV‑2 positive vs. SARS-CoV‑2 negative). Patient data, disease progression data, and treatment-related information were evaluated for all patients. Statistical data analysis was performed using unpaired Student's t test or non-parametric Mann-Whitney U test. RESULTS A total of 311 patients (women: 70.4%, age: 82.0 ± 11.0 years) were included in this study. Of these 3.9% (12/311) had a positive test result for SARS-CoV‑2. Significantly more deceased patients were found in the group tested positive for SARS-CoV‑2 (SARS-CoV‑2 positive: 41.7%, SARS-CoV‑2 negative: 5.4%, p < 0.001). In addition, the number of proximal femoral fracture associated deaths correlated with the number of positive test results performed in the Clinic. The length of stay of SARS-CoV‑2 COVID-19 survivors tended to be greater than in those who were tested negative (SARS-CoV‑2 COVID-19 positive: 15.6 ± 13.1 days, SARS-CoV‑2 COVID-19 negative: 11.5 ± 6.5 days, p = 0.683). Furthermore, a significant difference in age was found in SARS-CoV‑2 survivors and SARS-CoV‑2 decedents (deceased: 95.5 ± 7.5 years, alive: 83.5 ± 7.3 years, p = 0.020). CONCLUSION The study was conducted before the introduction of SARS-CoV‑2 vaccination. The results therefore refer to immune naive (unvaccinated) patients. In our study, more than 40% of all patients with proximal femoral fractures who tested positive for SARS-CoV‑2 died during hospitalization. An additional, critical factor in this respect was the age of the infected patients. Nonetheless, a positive correlation was demonstrated between the mortality rate and the number of positive SARS-CoV‑2 detections. Regarding the greater length of stay of patients tested positive for SARS-CoV‑2, the limited transfer options (further rehabilitation, skilled nursing facility) of the infected ones can be considered as causal. Particularly the vulnerable older patients are increasingly endangered by a combination of proximal femoral fracture and SARS-CoV‑2.
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Affiliation(s)
- Dirk Zajonz
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
- ZESBO - Center for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany.
- Clinic for Orthopedics, Trauma and Reconstructive Surgery, Zeisigwald Hospital BETHANIA, Zeisigwaldstraße 101, 09130, Chemnitz, Germany.
| | - Peter Vaitl
- Clinic for Orthopedics, Trauma and Reconstructive Surgery, Zeisigwald Hospital BETHANIA, Zeisigwaldstraße 101, 09130, Chemnitz, Germany
| | - Melanie Edel
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
- ZESBO - Center for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - Oliver Fuchs
- Clinic for Orthopedics, Trauma and Reconstructive Surgery, Zeisigwald Hospital BETHANIA, Zeisigwaldstraße 101, 09130, Chemnitz, Germany
| | - Fabian Kübler
- Clinic for Orthopedics, Trauma and Reconstructive Surgery, Zeisigwald Hospital BETHANIA, Zeisigwaldstraße 101, 09130, Chemnitz, Germany
| | - Peter Schneider
- Clinic for Orthopedics, Trauma and Reconstructive Surgery, Zeisigwald Hospital BETHANIA, Zeisigwaldstraße 101, 09130, Chemnitz, Germany
| | - Andreas Roth
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Torsten Prietzel
- ZESBO - Center for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
- Clinic for Orthopedics, Trauma and Reconstructive Surgery, Zeisigwald Hospital BETHANIA, Zeisigwaldstraße 101, 09130, Chemnitz, Germany
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27
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Qin HC, He Z, Luo ZW, Zhu YL. Management of hip fracture in COVID-19 infected patients. World J Orthop 2022; 13:544-554. [PMID: 35949705 PMCID: PMC9244961 DOI: 10.5312/wjo.v13.i6.544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/07/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Given that the global population of elderly individuals is expanding and the difficulty of recovery, hip fractures will be a huge challenge and a critical health issue for all of humanity. Although people have spent more time at home during the coronavirus disease 2019 (COVID-19) pandemic, hip fractures show no sign of abating. Extensive studies have shown that patients with hip fracture and COVID-19 have a multifold increase in mortality compared to those uninfected and a more complex clinical condition. At present, no detailed research has systematically analyzed the relationship between these two conditions and proposed a comprehensive solution. This article aims to systematically review the impact of COVID-19 on hip fracture and provide practical suggestions. We found that hip fracture patients with COVID-19 have higher mortality rates and more complicated clinical outcomes. Indirectly, COVID-19 prevents hip fracture patients from receiving regular medical treatment. With regard to the problems we encounter, we provide clinical recommendations based on existing research evidence and a clinical flowchart for the management of hip fracture patients who are COVID-19 positive. Our study will help clinicians adequately prepare in advance when dealing with such patients and optimize treatment decisions.
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Affiliation(s)
- Hao-Cheng Qin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhong He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu-Lian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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28
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Mora‐Traverso M, Molina‐Garcia P, Prieto‐Moreno R, Borges‐Cosic M, Cruz Guisado V, Pino Algarrada R, Moreno‐Ramírez P, Gomez‐Jurado G, Gomez Tarrias C, Hidalgo Isla M, Jimenez Andrés P, Linares Gago M, Lirola‐Liebanas A, Mesa‐Ruiz A, Muñoz‐Garach A, Salazar‐Graván S, Estevez‐Lopez F, Martín‐Matillas M, Ariza‐Vega P. An m‐Health telerehabilitation and health education program on physical performance in patients with hip fracture and their family caregivers: Study protocol for the ActiveHip+ randomized controlled trial. Res Nurs Health 2022; 45:287-299. [DOI: 10.1002/nur.22218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Marta Mora‐Traverso
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service Virgen de las Nieves University Hospital Granada Spain
| | - Pablo Molina‐Garcia
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service Virgen de las Nieves University Hospital Granada Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences Sport and Health University Research Institute (iMUDS), University of Granada Granada Spain
| | - Rafael Prieto‐Moreno
- Department of Physical and Sport Education, PA‐HELP “Physical Activity for HEaLth Promotion” Research Group, Faculty of Sports Sciences University of Granada Granada Spain
| | - Milkana Borges‐Cosic
- Department of Physical and Sport Education, PA‐HELP “Physical Activity for HEaLth Promotion” Research Group, Faculty of Sports Sciences University of Granada Granada Spain
- Department of Physical Education, Faculty of Education Sciences University of Cádiz Cádiz Spain
| | - Victor Cruz Guisado
- Department of Physical Medicine and Rehabilitation University Hospital Jerez de la Frontera Cadiz Spain
| | - Rogelio Pino Algarrada
- Department of Physical Medicine and Rehabilitation University Hospital Puerto Real Cadiz Spain
| | - Paz Moreno‐Ramírez
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Gema Gomez‐Jurado
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Consuelo Gomez Tarrias
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Margarita Hidalgo Isla
- Department of Physical Medicine and Rehabilitation University Hospital Puerto Real Cadiz Spain
| | - Patricia Jimenez Andrés
- Department of Physical Medicine and Rehabilitation University Hospital Jerez de la Frontera Cadiz Spain
| | - Marta Linares Gago
- Department of Physical Medicine and Rehabilitation University Hospital Puerto Real Cadiz Spain
| | - Ana Lirola‐Liebanas
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Antonio Mesa‐Ruiz
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Araceli Muñoz‐Garach
- Department of Endocrinology and Nutrition University Hospital Virgen de las Nieves Granada Spain
| | - Susana Salazar‐Graván
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Fernando Estevez‐Lopez
- Department of Child and Adolescent Psychiatry/Psychology Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Miguel Martín‐Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences Sport and Health University Research Institute (iMUDS), University of Granada Granada Spain
| | - Patrocinio Ariza‐Vega
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service Virgen de las Nieves University Hospital Granada Spain
- Department of Physical and Sport Education, PA‐HELP “Physical Activity for HEaLth Promotion” Research Group, Faculty of Sports Sciences University of Granada Granada Spain
- Department of Physiotherapy, Faculty of Health Science University of Granada Granada Spain
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29
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Huzum B, Curpan AS, Puha B, Serban DN, Veliceasa B, Necoara RM, Alexa O, Serban IL. Connections between Orthopedic Conditions and Oxidative Stress: Current Perspective and the Possible Relevance of Other Factors, Such as Metabolic Implications, Antibiotic Resistance, and COVID-19. Medicina (B Aires) 2022; 58:medicina58030439. [PMID: 35334615 PMCID: PMC8951198 DOI: 10.3390/medicina58030439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/06/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
The general opinion in the literature is that these topics remain clearly understudied and underrated, with many unknown aspects and with controversial results in the respective areas of research. Based on the previous experience of our groups regarding such matters investigated separately, here we attempt a short overview upon their links. Thus, we summarize here the current state of knowledge regarding the connections between oxidative stress and: (a) orthopedic conditions; (b) COVID-19. We also present the reciprocal interferences among them. Oxidative stress is, of course, an interesting and continuously growing area, but what exactly is the impact of COVID-19 in orthopedic patients? In the current paper we also approached some theories on how oxidative stress, metabolism involvement, and even antibiotic resistance might be influenced by either orthopedic conditions or COVID-19. These manifestations could be relevant and of great interest in the context of this current global health threat; therefore, we summarize the current knowledge and/or the lack of sufficient evidence to support the interactions between these conditions.
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Affiliation(s)
- Bogdan Huzum
- Department of Orthopaedic and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.H.); (B.P.); (B.V.); (O.A.)
- Department of Physiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Alexandrina Stefania Curpan
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University of Iasi, Carol I Avenue, 20A, 700554 Iasi, Romania
- Correspondence: (A.S.C.); (D.N.S.)
| | - Bogdan Puha
- Department of Orthopaedic and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.H.); (B.P.); (B.V.); (O.A.)
| | - Dragomir Nicolae Serban
- Department of Physiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Correspondence: (A.S.C.); (D.N.S.)
| | - Bogdan Veliceasa
- Department of Orthopaedic and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.H.); (B.P.); (B.V.); (O.A.)
| | - Riana Maria Necoara
- Radiology-Imaging Clinic, “Sf. Spiridon” Clinical Emergency Hospital, 700111 Iasi, Romania;
| | - Ovidiu Alexa
- Department of Orthopaedic and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.H.); (B.P.); (B.V.); (O.A.)
| | - Ionela Lacramioara Serban
- Department of Physiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
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30
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Vialonga MD, Menken LG, Tang A, Yurek JW, Sun L, Feldman JJ, Liporace FA, Yoon RS. Survivorship Analysis in Asymptomatic COVID-19+ Hip Fracture Patients: Is There an Increase in Mortality? Hip Pelvis 2022; 34:25-34. [PMID: 35355631 PMCID: PMC8931945 DOI: 10.5371/hp.2022.34.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Mortality rates following hip fracture surgery have been well-studied. This study was conducted to examine mortality rates in asymptomatic patients presenting for treatment of acute hip fractures with concurrent positive COVID-19(+) tests compared to those with negative COVID-19(–) tests. Materials and Methods A total of 149 consecutive patients undergoing hip fracture surgery during the COVID-19 pandemic at two academic medical centers were reviewed retrospectively. Patients were divided into two groups for comparative analysis: one group included asymptomatic patients with COVID-19+ tests versus COVID-19– tests. The primary outcome was mortality at 30-days and 90-days. Results COVID-19+ patients had a higher mortality rate than COVID-19– patients at 30-days (26.7% vs 6.0%, P=0.005) and 90-days (41.7% vs 17.2%, P=0.046) and trended towards an increased length of hospital stay (10.1±6.2 vs 6.8±3.8 days, P=0.06). COVID-19+ patients had more pre-existing respiratory disease (46.7% vs 11.2%, P=0.0002). Results of a Cox regression analysis showed an increased risk of mortality at 30-days and 90-days from COVID-19+ status alone without an increased risk of death in patients with pre-existing chronic respiratory disease. Conclusion Factors including time to surgery, age, preexisting comorbidities, and postoperative ambulatory status have been proven to affect mortality and complications in hip fracture patients; however, a positive COVID-19 test result adds another variable to this process. Implementation of protocols that will promote prompt orthogeriatric assessments, expedite patient transfer, limit operating room traffic, and optimize anesthesia time can preserve the standard of care in this unique patient population.
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Affiliation(s)
- Mason D Vialonga
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Luke G Menken
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Alex Tang
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - John W Yurek
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Li Sun
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - John J Feldman
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Frank A Liporace
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Richard S Yoon
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
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31
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Postoperative mortality in the COVID-positive hip fracture patient, a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:927-935. [PMID: 35195751 PMCID: PMC8864596 DOI: 10.1007/s00590-022-03228-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/04/2022] [Indexed: 11/12/2022]
Abstract
Purpose The extent to which concomitant COVID-19 infection increases short-term mortality following hip fracture is not fully understood. A systemic review and meta-analysis of COVID-19 positive hip fracture patients (CPHFPs) undergoing surgery was conducted to explore the association of COVID-19 with short-term mortality. Methods Review of the literature identified reports of short-term 30-day postoperative mortality in CPHFPs. For studies including a contemporary control group of COVID-19 negative patients, odds ratios of the association between COVID-19 infection and short-term mortality were calculated. Short-term mortality and the association between COVID-19 infection and short-term mortality were meta-analyzed and stratified by hospital screening type using random effects models. Results Seventeen reports were identified. The short-term mortality in CPHFPs was 34% (95% C.I., 30–39%). Short-term mortality differed slightly across studies that screened all patients, 30% (95% C.I., 22–39%), compared to studies that conditionally screened patients, 36% (95% C.I., 31–42%), (P = 0.22). The association between COVID-19 infection and short-term mortality produced an odds ratio of 7.16 (95% C.I., 4.99–10.27), and this was lower for studies that screened all patients, 4.08 (95% C.I., 2.31–7.22), compared to studies that conditionally screened patients, 8.32 (95% C.I., 5.68–12.18), (P = 0.04). Conclusion CPHFPs have a short-term mortality rate of 34%. The odds ratio of short-term mortality was significantly higher in studies that screened patients conditionally than in studies that screened all hip fracture patients. This suggests mortality prognostication should consider how COVID-19 infection was identified as asymptomatic patients may fare slightly better. Supplementary Information The online version contains supplementary material available at 10.1007/s00590-022-03228-9.
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32
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A-Lai GH, Ding NY, Lin YD. Outcomes of lung-surgery patients suffered perioperative COVID-19: A systematic review of case reports and case series. Asian J Surg 2022; 45:1050-1052. [PMID: 35183420 PMCID: PMC8841213 DOI: 10.1016/j.asjsur.2022.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Gu-Ha A-Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ning-Ying Ding
- Anesthesia Operation Center of West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Yi-Dan Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
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33
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Walters S, Raja H, Ahmad R, Tsitskaris K. Short-Term Hip Fracture Outcomes during the COVID-19 Pandemic. Surg J (N Y) 2022; 8:e8-e13. [PMID: 35059496 PMCID: PMC8763468 DOI: 10.1055/s-0041-1741511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction
Despite many significant changes as a result of the coronavirus disease 2019 (COVID-19) pandemic, and reductions in overall trauma workload, patients with fragility hip fractures continued to present to hospital. As we plan for ongoing service provision during future waves of the pandemic, valuable lessons can be learned from patients that have been treated surgically during the “first wave.”
Methods
All patients admitted to our center (a busy District General Hospital in London, United Kingdom) with a hip fracture during a 13-week period representing the initial rise (“United Kingdom first wave”) in COVID-19 cases, from February 17
th
to May 17
th
, 2020 (study group) were compared with hip fracture patients from the equivalent 13-week period in February to May 2019 (control group). The primary outcome was 30-day mortality, and additional information was collected in terms of length of stay (LOS), SARS-CoV-2 antigen testing, and cause of death.
Results
During the COVID-19 study period, 69 patients were admitted with a hip fracture, compared with 70 patients in the control group (
p
= 0.949). There was no significant difference in 30-day mortality between the two groups (5.8 vs. 7.1%,
p
= 0.747). Mean LOS was shorter in the COVID-19 period compared with the control group (11.6 vs. 19.6 days,
p
<0.001, effect size 0.572).
Forty-six patients (66.7%) had a SARS-CoV-2 antigen swab test, as testing was not available in the early period, and 10 patients (14.5%) tested positive. None of the patients, who presented before the antigen testing was available, had clinical suspicion of COVID-19 retrospectively. Two “COVID-19 positive” patients (20%) died within 30 days of admission. Conclusion
We report reassuring short-term results demonstrating no statistically significant difference in the 30-day mortality rate of hip fracture patients admitted during the United Kingdom's first wave of the COVID-19 pandemic compared to the equivalent period in the previous year. Hip fracture incidence remained stable, and LOS was reduced, likely due to recent departmental changes as well as a drive to discharge patients quickly during the pandemic. We agree with existing reports that elderly hip fracture patients with COVID-19 have a higher risk of perioperative mortality, however, our results suggest that overall mortality for the whole hip fracture population was similar to the previous year, in which deaths were more commonly attributed to respiratory infections associated with other pathogens. Further work may be needed to evaluate the outcomes during subsequent waves of the pandemic as mutations in the virus and conditions may affect outcomes.
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Affiliation(s)
- Samuel Walters
- Department of Trauma & Orthopaedic Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Hassan Raja
- Department of Trauma & Orthopaedic Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Rachel Ahmad
- Department of Trauma & Orthopaedic Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Konstantinos Tsitskaris
- Department of Trauma & Orthopaedic Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom
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García-Seisdedos Pérez-Tabernero F, Calvo SG, Luengo-Alonso G, Couso MR, Calvo E. Impact of Sars-Cov-2 pandemic on hip fractures: Clinical and radiographic outcomes. Geriatr Orthop Surg Rehabil 2022; 12:21514593211036785. [PMID: 35251750 PMCID: PMC8892171 DOI: 10.1177/21514593211036785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: Hip fractures affecting older people are at a higher risk of complications during the SARS-CoV-2 pandemic. The aim of this study is to provide data about proximal femoral fractures management and early outcomes during COVID-19 pandemic compared to the same period in 2019. Material and Methods: Retrospective and comparative study performed in two different periods were analyzed: from March 15, 2020, to April 30, 2020 (the first six weeks of Spain´s current confinement) and the same period in 2019. Data regarding demographics (age and sex, housing), type of fracture, surgical performance, early outcomes (at 30 days), and at 1-year follow-up were collected. A total of 146 patients were evaluated, 89 in 2019 and 57 in 2020. Results: Despite the drop ∼35.6% in hip fractures during SARS-CoV-2 period, distribution (age (P = 0.985), sex (P = 0.43), housing (P = 0.61), type of fracture (P = 0.41)) and Charlson comorbidity index (P = 0.12) were similar to a 2019 period. Surgical performance did not worsen in spite of the tough situation and the use of personal protective equipment, improving in some radiological variables (tip-to-apex and calcar reduction). In terms of postoperative outcomes, although there is a tendency to a short-term mortality increase (from 3.4% to 5.2%, P = 0.22), there were no differences at 1-year follow-up (20.2% in 2019 and 20.4% in 2020, P=0.587). In the same line, although in both groups the patients lost functionality at 1 year, there were no significant differences (P = 0.42). Conclusion: Even in challenging times, protocols and adequate organization ensure proper outcomes, reaching satisfying clinical and surgical outcomes during the COVID-19 pandemic, despite an increasing trend in short term mortality not seen at 1-year follow-up.
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Affiliation(s)
| | - Santiago Gabardo Calvo
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Gonzalo Luengo-Alonso
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Myriam Rodríguez Couso
- Department of Geriatrics, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Emilio Calvo
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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35
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Rashid F, Hawkes D, Mahmood A, Harrison WJ. Hip fracture mortality in patients co-infected with coronavirus disease 2019: a comparison of the first two waves of the United Kingdom pandemic during the pre-vaccine era. INTERNATIONAL ORTHOPAEDICS 2022; 46:171-178. [PMID: 34999906 PMCID: PMC8742699 DOI: 10.1007/s00264-021-05269-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/14/2021] [Indexed: 12/15/2022]
Abstract
Aims In the UK, deaths associated with COVID-19 have occurred in two waves. Evidence has shown an increase in 30-day mortality for hip fracture patients co-infected with COVID-19. However, there are no studies analysing mortality trends between the first two waves of the UK pandemic. Additionally, hospital versus community acquired COVID-19 infection between the two waves has not been analysed. Furthermore, predictive factors of 30-day mortality have not been fully evaluated. Methods Data from two audits conducted by the CHIP collaborative group were used: a published regional audit in England of nine hospitals providing the COVID-19 negative cases and an unpublished UK national audit of 43 hospitals, which provided the COVID-19 positive cases. Data collection for the COVID-19 positive cases was from 23 March to 31 December 2020. September 1, 2020 was used to define the transition between the two waves. Results There were 517 COVID-19 positive hip fracture patients and 1445 COVID-19 negative hip fracture patients. Overall, 30-day mortality rates were 5.7% in the COVID-19 negative group and 22.4% in the COVID-19 positive patients (p < 0.001). A difference in survival function between the first and second waves was found (p = 0.038). To allow for significant demographic differences, a matched analysis of 185 patients found a 26.5% 30-day mortality in the first wave compared to 21.1% in the second wave (p = 0.222). Within the COVID-19 positive groups, the virus was hospital acquired in 66.7% of cases in the first wave and 72.8% of cases in the second wave (p = 0.130). Independent predictors of mortality were found to include COVID-19 positive status, AMTS ≤ 6, male gender and age. Conclusion There was a reduction in 30-day mortality for hip fracture patients co-infected with COVID-19 between the two UK pandemic waves but this was not statistically significant. There was no reduction in hospital acquired COVID-19 infection between the two waves.
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Affiliation(s)
- Fatima Rashid
- The Countess of Chester NHS Foundation, Liverpool Road, Chester, CH2 1UL, UK.
| | - David Hawkes
- The Countess of Chester NHS Foundation, Liverpool Road, Chester, CH2 1UL, UK
| | - Aatif Mahmood
- The Countess of Chester NHS Foundation, Liverpool Road, Chester, CH2 1UL, UK
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36
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Association Between COVID-19 and Mortality in Hip Fracture Surgery in the National COVID Cohort Collaborative (N3C): A Retrospective Cohort Study. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202201000-00004. [PMID: 34982060 PMCID: PMC8735795 DOI: 10.5435/jaaosglobal-d-21-00282] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 12/27/2022]
Abstract
Background: This study investigated the outcomes of coronavirus disease (COVID-19)-positive patients undergoing hip fracture surgery using a national database. Methods: This is a retrospective cohort study comparing hip fracture surgery outcomes between COVID-19 positive and negative matched cohorts from 46 sites in the United States. Patients aged 65 and older with hip fracture surgery between March 15 and December 31, 2020, were included. The main outcomes were 30-day all-cause mortality and all-cause mortality. Results: In this national study that included 3303 adults with hip fracture surgery, the 30-day mortality was 14.6% with COVID-19-positive versus 3.8% in COVID-19-negative, a notable difference. The all-cause mortality for hip fracture surgery was 27.0% in the COVID-19-positive group during the study period. Dicussion: We found higher incidence of all-cause mortality in patients with versus without diagnosis of COVID-19 after undergoing hip fracture surgery. The mortality in hip fracture surgery in this national analysis was lower than other local and regional reports. The medical community can use this information to guide the management of hip fracture patients with a diagnosis of COVID-19.
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37
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Prieto-Moreno R, Estévez-López F, Molina-Garcia P, Mora-Traverso M, Deschamps K, Claeys K, de Buyser J, Ariza-Vega P. ActiveHip+: A feasible mHealth system for the recovery of older adults after hip surgery during the COVID-19 pandemic. Digit Health 2022; 8:20552076221139694. [PMID: 36420319 PMCID: PMC9677169 DOI: 10.1177/20552076221139694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/01/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE Half of older adults undergoing hip surgery do not recover their previous functional status. mHealth is a promising tool for rehabilitating older adults after hip surgery. This study aimed to test the feasibility of the ActiveHip+ mHealth system in older adults after hip surgery. METHODS Sixty-nine older adults who had undergone hip surgery and their family caregivers were recruited from hospitals in Spain and Belgium and used the ActiveHip+ mHealth system for 12 weeks. Assessments were made during hospital stay and 3 months after surgery. Feasibility assessment included: adoption (participation proportion), usage (access to the app), satisfaction with the app (Net Promoter Score) and user perception of the quality of the app (Mobile App Rating Scale). Clinical assessment included: patient-reported outcomes, such as functional status (Functional Independence Measure) and performance-based outcomes, such as physical fitness (Short Physical Performance Battery). RESULTS The ActiveHip+ mHealth system obtained satisfactory feasibility results in both countries. In Spain, we observed 85% adoption, 64% usage, 8.86/10 in satisfaction with the app and 4.42/5 in perceived quality of the app. In Belgium, we observed 82% adoption, 84% usage, 5.16/10 in satisfaction with the app and 3.52/5 in app's perceived quality. The intervention had positive effects on levels of functional status, pain and physical fitness. CONCLUSIONS The ActiveHip+ mHealth system is a feasible tool to conduct the rehabilitation in older adults after hip surgery. Although the intervention seemed beneficial clinically, we do not recommend its implementation in clinical settings until appropriately designed randomised clinical trials confirm these results.
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Affiliation(s)
- Rafael Prieto-Moreno
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - Fernando Estévez-López
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Pablo Molina-Garcia
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - Marta Mora-Traverso
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - Kevin Deschamps
- Department of Rehabilitation Sciences, KU Leuven, Musculoskeletal Rehabilitation Research Group, Campus Brugge, Leuven, Flanders, Belgium
- Clinical Motion Analysis Laboratorium, University Hospitals Leuven, Campus Pellenberg, Leuven, Flanders, Belgium
- Division of Podiatry, Haute Ecole Leonard De Vinci, Institut D’Enseignement Supérieur Parnasse Deux-Alice, Bruxelles, Belgium
- Department of Podiatry, Artevelde University College, Gent, Belgium
| | - Kurt Claeys
- Department of Rehabilitation Sciences, KU Leuven, Musculoskeletal Rehabilitation Research Group, Campus Brugge, Leuven, Flanders, Belgium
| | - Janou de Buyser
- Department of Rehabilitation Sciences, KU Leuven, Musculoskeletal Rehabilitation Research Group, Campus Brugge, Leuven, Flanders, Belgium
| | - Patrocinio Ariza-Vega
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
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Ariza-Vega P, Prieto-Moreno R, Castillo-Pérez H, Martínez-Ruiz V, Romero-Ayuso D, Ashe MC. Family Caregivers' Experiences with Tele-Rehabilitation for Older Adults with Hip Fracture. J Clin Med 2021; 10:jcm10245850. [PMID: 34945145 PMCID: PMC8708159 DOI: 10.3390/jcm10245850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 01/17/2023] Open
Abstract
Background: There is a knowledge gap for implementing tele-rehabilitation (telerehab) after hip fracture. We recently conducted a clinical trial (ClinicalTrials.gov Identifier: NCT02968589) to test a novel online family caregiver-supported rehabilitation program for older adults with hip fracture, called @ctivehip. In this qualitative substudy, our objective was to use semi-structured interviews to explore family caregivers experience with the telerehab program. Methods: Twenty-one family caregivers were interviewed between three and six months after the older adults completed @ctivehip. One occupational therapist with research and clinical experience, but not involved in the main trial, conducted and transcribed the interviews. We conducted a multi-step content analysis, and two authors completed one coding cycle and two recoding cycles. Results: Family caregivers who enrolled in @ctivehip were satisfied with the program, stated it was manageable to use, and perceived benefits for older adults’ functional recovery after hip fracture. They also suggested improvements for the program content, such as more variety with exercises, and increased monitoring by health professionals. Conclusions: This work extends existing literature and generates research hypotheses for future studies to test telerehab content and program implementation.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain; (P.A.-V.); (D.R.-A.)
- Physical Medicine and Rehabilitation Service, Biohealth Research Institute, Virgen de las Nieves University Hospital, 18012 Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, 18071 Granada, Spain
| | - Rafael Prieto-Moreno
- Physical Medicine and Rehabilitation Service, Biohealth Research Institute, Virgen de las Nieves University Hospital, 18012 Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, 18071 Granada, Spain
- Correspondence:
| | | | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain;
- Center for Biomedical Research in Network of Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18014 Granada, Spain
| | - Dulce Romero-Ayuso
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain; (P.A.-V.); (D.R.-A.)
| | - Maureen C. Ashe
- Centre for Hip Health and Mobility, Department of Family Practice, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
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Cromer SJ, Yu EW. Challenges and Opportunities for Osteoporosis Care During the COVID-19 Pandemic. J Clin Endocrinol Metab 2021; 106:e4795-e4808. [PMID: 34343287 PMCID: PMC8385842 DOI: 10.1210/clinem/dgab570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) has both directly and indirectly affected osteoporosis diagnosis and treatment throughout the world. METHODS This mini-review summarizes the available evidence regarding the effects of COVID-19, its treatment, and the consequences of the pandemic itself on bone health. Additionally, we review evidence and expert recommendations regarding putative effects of osteoporosis medications on COVID-19 outcomes and vaccine efficacy and summarize recommendations for continuation of osteoporosis treatment during the pandemic. RESULTS The use of standard screening procedures to assess for osteoporosis and fracture risk declined dramatically early in the pandemic, while rates of fragility fractures were largely unchanged. COVID-19, its treatments, and public health measures to prevent viral spread are each likely to negatively affect bone health. Osteoporosis treatments are not known to increase risk of adverse events from COVID-19, and preclinical data suggest possible beneficial effects of some therapies. Vitamin D deficiency is clearly associated with adverse outcomes from COVID-19, but it remains unclear whether vitamin D supplementation may improve outcomes. Osteoporosis treatment should be continued whenever possible, and recommendations for substituting therapies, if required, are available. CONCLUSION The COVID-19 pandemic has decreased screening and disrupted treatment for osteoporosis. Osteoporosis medications are safe and effective during the pandemic and should be continued whenever possible. Further studies are needed to fully understand the impact of the COVID-19 pandemic on long-term bone health.
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Affiliation(s)
- Sara J Cromer
- Division of Endocrinology, Diabetes, and Metabolism; Massachusetts General Hospital; Boston, MA
- Harvard Medical School;Boston, MA
| | - Elaine W Yu
- Division of Endocrinology, Diabetes, and Metabolism; Massachusetts General Hospital; Boston, MA
- Harvard Medical School;Boston, MA
- Corresponding Author: Elaine W. Yu, MD, MGH Endocrine Unit, 50 Blossom Street, Thier 1051, Boston, MA 02114,
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Ghosh S, John A, D'sa P, Kurian B, Ayodele P, Gadgil A. "Surgically Treated COVID-19-Positive Trauma Patients Had a Higher Fatality Rate" - A Rural District General Hospital's Perspective in the United Kingdom. Cureus 2021; 13:e18905. [PMID: 34703678 PMCID: PMC8530003 DOI: 10.7759/cureus.18905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Our study analyses the influence of the COVID-19 pandemic on perioperative death in elderly patients undergoing surgery for fractures who test positive for the virus during their admission in a rural hospital setting in the UK. Methods One hundred and fifty-six consecutive patients with age more than 75 years, who underwent surgery for fractures in Glangwili General Hospital during the second wave of the pandemic between 20th November 2020 and 20th January 2021, were included in this study. The 28-day mortality rate was estimated, and the results were compared to a matched cohort of patients from a similar duration before the pandemic (20th November 2019 to 20th January 2020). Results A total of 41 out of 156 patients were tested positive for COVID-19 in this study cohort. The overall 28-day mortality rate was 8.9% (n=15 patients) in comparison to 4% (n=8) in the comparative cohort of 196 patients from the pre-pandemic era. Of the 41 patients who tested positive for COVID-19, 11 patients died within 28 days of surgery, resulting in a mortality rate of 26.8% with a relative risk of 7.7(p=0.0461). Furthermore, 91% (n=10) of COVID-19-positive patients who died had an underlying cardiac disease and/or proximal femoral fractures. The 28-day mortality rate in those tested negative for COVID-19 was 3.5% (n=4). Conclusion There is a significantly increased risk of death in the perioperative period on contracting COVID-19, in patients who are 75 years of age or older, especially those with associated cardiac comorbidities and who have sustained proximal femoral fractures.
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Affiliation(s)
- Soubhik Ghosh
- Trauma and Orthopaedics, Glangwili General Hospital, Carmarthen, GBR
| | - Anoop John
- Trauma and Orthopaedics, Glangwili General Hospital, Carmarthen, GBR
| | - Prashanth D'sa
- Trauma and Orthopaedics, University Hospital of Wales, Cardiff, GBR
| | - Bijai Kurian
- Trauma and Orthopaedics, Glangwili General Hospital, Carmarthen, GBR
| | - Peace Ayodele
- Trauma and Orthopaedics, Glangwili General Hospital, Carmarthen, GBR
| | - Anirudh Gadgil
- Trauma and Orthopaedics, Glangwili General Hospital, Carmarthen, GBR
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The effect of COVID-19 positivity on inflammatory parameters and thirty day mortality rates in patients over sixty five years of age with surgically treated intertrochanteric fractures. INTERNATIONAL ORTHOPAEDICS 2021; 45:3025-3031. [PMID: 34471936 PMCID: PMC8409697 DOI: 10.1007/s00264-021-05201-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/22/2021] [Indexed: 01/08/2023]
Abstract
Purpose To evaluate the effect of COVID-19 positivity on inflammatory parameters and 30-day mortality rates in patients over 65 years of age who were operated on for intertrochanteric femur fractures (IFF). Methods Eighty-seven patients (31 males, 56 females) who had a dynamic hip screw (DHS) or proximal femur nail (PFN) for the IFF between March 2020 and November 2020 were included in the study. The patients were divided into two groups as COVID-19 confirmed and probable positive (Group 1) and COVID-19 negative (Group 2). Time to surgery, operation duration, length of hospital stay, 30-day mortality, rates of the intensive care unit (ICU) referral, and inflammatory parameters such as haemoglobin, CRP, sedimentation, PCT, D-Dimer, and ferritin were evaluated. Results No significant difference was observed in terms of demographic data such as age, gender, comorbidity, and fracture type between the groups. Thirty-day mortality, ICU referral rate, blood transfusion rate, and hospitalization period were higher in Group 1 (p = 0.016, p = 0.012, p = 0.031, and p = 0.011, respectively). The inflammatory parameters were higher in Group 1 compared to Group 2 in the preoperative and postoperative periods (p < 0.05). Conclusion COVID-19 positivity increases inflammatory parameters (as expected) and increases the 30-day mortality and ICU requirement in patients with surgically treated IFF.
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Patralekh MK, Jain VK, Iyengar KP, Upadhyaya GK, Vaishya R. Mortality escalates in patients of proximal femoral fractures with COVID-19: A systematic review and meta-analysis of 35 studies on 4255 patients. J Clin Orthop Trauma 2021; 18:80-93. [PMID: 33897205 PMCID: PMC8056882 DOI: 10.1016/j.jcot.2021.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Concerns have been raised about the escalated mortality in patients of proximal femoral fractures (PPFs) with COVID-19. A meta-analysis to evaluate the mortality in patients with PPFs managed during the current COVID-19 pandemic was conducted. METHODS A systematic review and meta-analysis of all published studies were conducted with a search on PubMed, Scopus, Web of Science, and Cochrane Library databases using appropriate keywords from January 01, 2020 to January 29, 2021. RESULTS 35 relevant studies reporting 4255 patients with hip fracture in the current ongoing pandemic, out of which 692 patients were COVID-19 positive. Twenty studies reported mortality and other relevant statistics on hip fracture patients with and without COVID-19 (4123 hip fracture patients in the year 2020-21, out of which 560 had or were suspected of having COVID -19). A meta-analysis of mortality statistics in patients with and without COVID revealed increased odds of mortality among COVID patients [odds ratio (OR) 6.31, 95% confidence interval (CI) [5.09, 7.83] and meta-analysis on the subgroup of surgically treated patients also showed markedly increased mortality risk among those with COVID-19 (OR) 5.99, 95% CI [3.88,9.24]. CONCLUSION The mortality risk is markedly increased in hip fracture with concomitant COVID-19 as compared to those without it. This increased risk persisted in those managed surgically. It could be due to the inflammation induced by the fracture or surgery for fracture fixation, further exacerbating inflammation, leading to cytokine storm. It is imperative that such patients are informed regarding increased mortality risk during the consent and shared decision-making process.
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Affiliation(s)
- Mohit Kumar Patralekh
- Department of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110 029, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Gaurav Kumar Upadhyaya
- Department of Orthopaedics, All India Institute of Medical Sciences, Rae Bareli, UP, India
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
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Zagra L, D'Apolito R, Guindani N, Zatti G, Rivera F, Ravasi F, Mosconi M, Momoli A, Massè A, Franceschini M, D'Angelo F, Dallari D, Catani F, Casiraghi A, Bove F, Castelli CC. Do standards of care and early outcomes of periprosthetic fractures change during the COVID-19 pandemic? A multicentre study. J Orthop Traumatol 2021; 22:22. [PMID: 34128114 PMCID: PMC8202961 DOI: 10.1186/s10195-021-00584-w] [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: 03/30/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. MATERIALS AND METHODS Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien-Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. RESULTS Median age was 81 years (range 70-96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1-4), median VAS score on admission was 3 (range, 0-6), median CFS was 4 (range, 1-8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1-5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1-5). The median LOS was 12.8 days (range 2-36 days), and 21 patients (55.3%) were discharged home. CONCLUSIONS The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Rocco D'Apolito
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy
| | - Nicola Guindani
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Giovanni Zatti
- Department of Orthopaedic Surgery ASST Di Monza, Università Milano Bicocca, Via Pergolesi 33, 20900, Monza, Italy
| | - Fabrizio Rivera
- Department of Orthopaedic Surgery, Ospedale SS Annunziata, Via Ospedali 14, 12038, Savigliano, Italy
| | - Flavio Ravasi
- Department of Orthopaedic Surgery, ASST Melegnano Martesana- Ospedale Di Vizzolo Predabissi, Via Pandina 1, 20077, Vizzolo Predabissi, Italy
| | - Mario Mosconi
- Department of Orthopaedic Surgery, IRCCS Policlinico San Matteo Di Pavia, Viale C. Golgi 19, 27100, Pavia, Italy
| | - Alberto Momoli
- Department of Orthopaedic Surgery, Ospedale San Bortolo, Viale F. Rodolfi 37, 36100, Vicenza, Italy
| | - Alessandro Massè
- Department of Orthopaedic Surgery, Ospedale Città Della Salute E Della Scienza Università Di Torino, Via G. Zuretti 29, 10126, Turin, 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
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Policlinico Universitario Di Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Alessandro Casiraghi
- Department of Orthopaedic Surgery, ASST Degli Spedali Civili Di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Federico Bove
- Department of Orthopaedic Surgery, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Claudio Carlo Castelli
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
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Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case-Control Study from a Single Center in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105205. [PMID: 34068405 PMCID: PMC8153577 DOI: 10.3390/ijerph18105205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
The mortality of hip fracture (HF) patients is increased by concomitant COVID-19; however, evidence is limited to only short follow-up. A retrospective matched case–control study was designed with the aim to report the 90-day mortality and determine the hazard ratio (HR) of concomitant HF and COVID-19 infection. Cases were patients hospitalized for HF and diagnosed with COVID-19. Controls were patients hospitalized for HF not meeting the criteria for COVID-19 diagnosis and were individually matched with each case through a case–control (1:3) matching algorithm. A total of 89 HF patients were treated during the study period, and 14 of them were diagnosed as COVID-19 positive (overall 15.7%). Patients’ demographic, clinical, and surgical characteristics were similar between case and control groups. At 90 days after surgery, 5 deaths were registered among the 14 COVID-19 cases (35.7%) and 4 among the 42 HF controls (9.5%). COVID-19-positive cases had a higher risk of mortality at 30 days (HR = 4.51; p = 0.0490) and 90 days (HR = 4.50; p = 0.025) with respect to controls. Patients with concomitant HF and COVID-19 exhibit high perioperative mortality, which reaches a plateau of nearly 30–35% after 30 to 45 days and is stable up to 90 days. The mortality risk is more than four-fold higher in patients with COVID-19.
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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.
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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
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