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Kohut P, Mezera V, Langenhan R, Reimers N, Kilper A. Proximal femoral fractures in patients with COVID-19 : Pneumonia and admission from a nursing home are the strongest predictors of mortality. Z Gerontol Geriatr 2024:10.1007/s00391-024-02317-0. [PMID: 38831113 DOI: 10.1007/s00391-024-02317-0] [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: 02/02/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Proximal femoral fractures are severe injuries in geriatric patients. Additionally, geriatric patients are at a high risk of death due to coronavirus disease 2019 (COVID-19). OBJECTIVE To identify predictors of mortality in geriatric patients with COVID-19 and concurrent proximal femoral fractures. MATERIAL AND METHODS Patients who underwent surgical treatment for proximal femoral fractures and also tested positive for COVID-19 were included. The age, gender, the American Society of Anesthesiology (ASA) score and the admission from a nursing home were considered as variables. The rate of reoperations, the mortality at 3 months and discharge home were evaluated as outcomes. RESULTS In this study 46 patients with COVID-19 (female/male 31/15, median age 87.0 years with an interquartile range [IQR] of 9.8 years) met the inclusion criteria. Of these, 32 patients (69.6%) had to be cared for in the intensive care unit and 26 patients (56.5%) had a severe course of COVID-19 with pneumonia. The median length of hospital stay for survivors was 19 (IQR 17.5) days and 4 of the patients (8.7%) required surgical revision. The in-hospital and 3‑month mortality were 40.0% (n = 17) and 43.5% (n = 20), respectively. The factors which influenced the in-hospital and 3‑month mortality rates were admission from a nursing home, the presence of pneumonia (increased the risk of death) and female gender (protective). CONCLUSION The occurrence of COVID-19 in patients with proximal femoral fractures has a high mortality. Admission from a nursing home and the presence of pneumonia increased the risk of death, whereas women were at lower risk.
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Affiliation(s)
- Petr Kohut
- Clinic of Orthopedics, Traumatology and Hand Surgery, Klinikum Chemnitz, Chemnitz, Germany
- Clinic of Orthopedics and Traumatology, DIAKOMED Diakoniekrankenhaus, Hartmannsdorf, Germany
| | - Vojtech Mezera
- 3rd Department of Internal Medicine-Metabolism and Gerontology, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
- Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic.
- Geriatric Center, Pardubice Hospital, Pardubice, Czech Republic.
| | - Ronny Langenhan
- Clinic of Orthopedics, Traumatology and Hand Surgery, Klinikum Chemnitz, Chemnitz, Germany
- Clinic of Orthopedics, Traumatology and Hand Surgery, Hegau-Bodensee-Klinikum Singen, Singen, Germany
| | - Niklas Reimers
- Clinic of Orthopedics, Traumatology and Hand Surgery, Klinikum Chemnitz, Chemnitz, Germany
| | - Anica Kilper
- Clinic of Orthopedics, Traumatology and Hand Surgery, Klinikum Chemnitz, Chemnitz, Germany
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Popp D, Nia A, Silvaieh S, Sator T, Tiefenboeck TM, Schmoelz L, Babeluk R, Hajdu S, Widhalm HK. The Epidemiological Transition of Surgically Treated Proximal Hip Fractures in Austria over the Course of the Pandemic-Back to Normal or a New Normal? Healthcare (Basel) 2023; 11:3110. [PMID: 38132000 PMCID: PMC10742678 DOI: 10.3390/healthcare11243110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a significant impact on the treatment protocols of orthopedic and trauma departments, but its specific effect on the mortality of hip fracture patients due to possible delays in surgery remains uncertain. This study aimed to investigate whether the COVID-19 pandemic worsened the mortality of patients with hip fractures. MATERIALS AND METHODS This study included 246 prospectively enrolled patients who suffered from hip fractures during the Austrian State of Emergency period between 1 March and 30 June 2020 and 2021 and were admitted to a tertiary care trauma center. This cohort was compared with a retrospective control group of 494 patients admitted for hip fractures during the same timeframe in 2017, 2018, and 2019. These groups were compared to a prospective recruited "post-COVID-19 collective consisting of the years 2022 and 2023 including 313 patients. RESULTS This study found a 22% reduction in admissions during the COVID-19 period compared to the pre-COVID period (p = 0.018), as well as significant changes in gender (p = 0.013) and place of accident (p = 0.049). No other changes in demographic variables were observed. The 30-day mortality rate was 14.67% in the pre-COVID period, compared to 15.18% during the COVID-19 period (p = 0.381). No differences were observed in surgical complication rates or in the relationship between comorbidity burden and survival. CONCLUSION This study did not show a higher perioperative mortality rate due to COVID-19. However, under current circumstances, with potentially reduced surgical and hospital bed capacities, it is expected that this condition might require a high degree of resources in times when resources are potentially scarce, such as during an ongoing pandemic. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Domenik Popp
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria (T.S.); (T.M.T.); (L.S.); (S.H.); (H.K.W.)
| | - Arastoo Nia
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria (T.S.); (T.M.T.); (L.S.); (S.H.); (H.K.W.)
| | - Sara Silvaieh
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Thomas Sator
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria (T.S.); (T.M.T.); (L.S.); (S.H.); (H.K.W.)
| | - Thomas M. Tiefenboeck
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria (T.S.); (T.M.T.); (L.S.); (S.H.); (H.K.W.)
| | - Lukas Schmoelz
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria (T.S.); (T.M.T.); (L.S.); (S.H.); (H.K.W.)
| | - Rita Babeluk
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria (T.S.); (T.M.T.); (L.S.); (S.H.); (H.K.W.)
| | - Stefan Hajdu
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria (T.S.); (T.M.T.); (L.S.); (S.H.); (H.K.W.)
| | - Harald K. Widhalm
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria (T.S.); (T.M.T.); (L.S.); (S.H.); (H.K.W.)
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Rincón-Hoyos JA, Vallejo-Yepes P, Restrepo-Giraldo JN, Torres-Valencia H, Buitrago-Vanegas M, Valencia-Rivas M, Casas-Galindo J, López-Trujillo JC. Morbidity and mortality in hip surgery patients due to fracture during the COVID-19 pandemic. Injury 2023; 54 Suppl 6:110731. [PMID: 37085352 PMCID: PMC10105622 DOI: 10.1016/j.injury.2023.04.018] [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: 01/09/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND The COVID-19 epidemic generated major changes in general surgical management protocols. The literature has reported high mortality rates for hip fracture surgery in patients with COVID-19. This study describes the morbidity and mortality in patients undergoing surgery due to hip fractures in 12 Colombian institutions between March and September 2020. METHODOLOGY This was a retrospective observational descriptive study. Medical records of 12 hospitals were reviewed. Consecutive patients who underwent hip fracture surgery from March 6 to September 6, 2020, were included. Data collected were sociodemographic profile, type of fracture, surgical treatment, complications, and early (1 month) or mid-term (1-6 months) mortality associated or not with COVID-19. RESULTS Five hundred twenty patients with hip fractures requiring surgery in the 12 institutions were included. 364 (70%) were women; mean age was 77.7 years (SD: 13.8), mean BMI was 25.1, 91.73% of patients had at least one comorbidity, 60.38% were classified as ASA II and 25.77% as ASA III. There were 267 (51.34%) pertrochanteric fractures, 227 (43.65%) femoral neck fractures, and 26 (5.0%) subtrochanteric fractures. 274 (52.69%) patients were treated with osteosynthesis, 244 (46.92%) with arthroplasty, and 2 (0.38%) with girdlestone. Surgery was performed less than 24 h after the fracture for 115 (22.11%) patients, between 24 and 72 h for 208 (40.0%) patients, and more than 72 h for 197 (37.88%) patients. One hundred six patients in total suffered a medical or surgical complication throughout the different follow-up stages, amongst the most frequent were respiratory failure, coronary events, surgical site infection, cutting-out and peri‑implant fracture. 25 (4.8%) patients required attention in the Intensive Care Unit (ICU). 13 patients had COVID-19 throughout the follow-up period. 27 patients died due to any cause, and 3 of them had reported a positive COVID-19 test any time during follow-up period, of which one died during the first month, and two died between 1 and 6 months. Statistically significant associations were found between age older than 75 years old, ASA classification, ICU requirement, and death. CONCLUSION 520 patients received surgical treatment for hip fracture during the first six months of the COVID-19 pandemic in 12 medical centers in Colombia. 21.10% suffered a complication during the early stage (30 days) and 4.77% during the midterm stage (1-6 months). 4.8% were admitted in the ICU during the early stage. All-cause death was 27 patients, early death was 11 (40.74%) and midterm death was 16 (59.25%). 13 patients were positive for COVID-19, 3 died, one (1/5=20%) on the first 30 days and the other two (2/8=25%) from month 1 to 6.
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Affiliation(s)
| | - Pablo Vallejo-Yepes
- Hip and Orthopedic Trauma Surgeon, Los Cobos Medical Center, Bogotá, Colombia
| | | | - Heiller Torres-Valencia
- Orthopedic and trauma surgeon, Hospital Departamental Universitario San Juan de Dios, Armenia, Colombia
| | | | | | - Jorge Casas-Galindo
- Hip and Orthopedic Trauma Surgeon, Clínica Universitaria Colombia, Bogotá, Colombia
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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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Cosentino A, Odorizzi G, Berger W. The impact of Covid-19 in proximal femur fractures. An observational study of the mortality rate. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023108. [PMID: 37326267 PMCID: PMC10308462 DOI: 10.23750/abm.v94i3.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/02/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIM Fractures of the proximal femur in the elderly are probably the leading cause of death in the orthopedic patients. Furthermore, after the spread of the pandemic, the mortality rate in the elderly has certainly increased. The aim of our study is to evaluate whether the mortality following proximal femur fractures is affected by the concomitant pandemic. METHODS We admitted to our study patients over 65 years old, who presented to our Emergency Room with a diagnosis of proximal femur fracture in the first quarter of the years 2019, the period before the development of the pandemic, of 2020 during the pandemic and of 2021 with the new wave of Covid-19. 2022 was not taken into consideration because the mortality data are not yet available and to have at least one year follow-up after surgery. All patients were divided by fracture's type and treatment; the time elapsed from trauma to surgery and from trauma to discharge was also evaluated. For each deceased patient, we considered the time elapsed from the operation to death and whether there was an episode of positivity to Covid-19 following the trauma and after discharge (all patients had a negative swab at the time of admission). CONCLUSIONS Fractures of the proximal femur in the elderly patient are undoubtedly an important cause leading to the death. The spreading of the Covid-19 pandemic has allowed our department to reduce the gap between trauma and intervention time and from trauma to discharge which is undoubtedly a positive prognostic factor. However, the concurrence of a positivity from the virus does not seem to influence the mortality times following the fracture.
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Affiliation(s)
- Andrea Cosentino
- Franz Tappeiner Hospital, Department of Orthopedic and Traumathology, via Rossini 5, 39012, Meran (Bz), Italy.
| | - Gianni Odorizzi
- Franz Tappeiner Hospital, Department of Orthopedic and Traumathology, via Rossini 5, 39012, Meran (Bz), Italy.
| | - Wilhelm Berger
- Franz Tappeiner Hospital, Department of Orthopedic and Traumathology, via Rossini 5, 39012, Meran (Bz), Italy.
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Hwang S, Ahn C, Won M. Comparing the 30-Day Mortality for Hip Fractures in Patients with and without COVID-19: An Updated Meta-Analysis. J Pers Med 2023; 13:jpm13040669. [PMID: 37109055 PMCID: PMC10142352 DOI: 10.3390/jpm13040669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
We conducted an updated meta-analysis to evaluate the 30-day mortality of hip fractures during the COVID-19 pandemic and assess mortality rates by country. We systematically searched Medline, EMBASE, and the Cochrane Library up to November 2022 for studies on the 30-day mortality of hip fractures during the pandemic. Two reviewers used the Newcastle-Ottawa tool to independently assess the methodological quality of the included studies. We conducted a meta-analysis and systematic review including 40 eligible studies with 17,753 patients with hip fractures, including 2280 patients with COVID-19 (12.8%). The overall 30-day mortality rate for hip fractures during the pandemic was 12.6% from published studies. The 30-day mortality of patients with hip fractures who had COVID-19 was significantly higher than those without COVID-19 (OR, 7.10; 95% CI, 5.51-9.15; I2 = 57%). The hip fracture mortality rate increased during the pandemic and varied by country, with the highest rates found in Europe, particularly the United Kingdom (UK) and Spain. COVID-19 may have contributed to the increased 30-day mortality rate in hip fracture patients. The mortality rate of hip fracture in patients without COVID-19 did not change during the pandemic.
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Affiliation(s)
- Sojune Hwang
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Moonho Won
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
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Yu Y, Zheng P. Determination of risk factors of postoperative pneumonia in elderly patients with hip fracture: What can we do? PLoS One 2022; 17:e0273350. [PMID: 35998192 PMCID: PMC9398012 DOI: 10.1371/journal.pone.0273350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Postoperative pneumonia is a serious complication in elderly patients with hip fracture. It is necessary to identify the influencing factors of postoperative pneumonia in patients with hip fracture. Methods Elderly patients with hip fractures admitted to a tertiary hospital in China from January 1, 2020 to August 31, 2021 were included. The characteristics of patients with and without postoperative pneumonia were evaluated and compared. Logistic multivariate regression analyses were conducted to assess the risk factors of postoperative pneumonia. Results 267 patients with hip fracture were included, the incidence of postoperative pneumonia in patients with hip fracture was 13.11%. There were significant differences in the age, diabetes mellitus, anemia, hypoalbuminemia, anesthesia method and duration of surgery between infection and no infection group, no significant differences in the gender, BMI, hypertension, hyperlipidemia, type of fracture, preoperative oxygen saturation, white blood cell count, platelet count, red blood cell count, creatinine, alanine aminotransferase, aspartate aminotransferase, estimated blood loss during surgery were detected between infection and no infection group. Logistic regression analysis showed that age≥70y (OR2.326, 95%CI1.248~3.129), diabetes mellitus (OR2.123, 95%CI1.021~3.551), anemia (OR3.199,95%CI1.943~5.024), hypoalbuminemia (OR2.377, 95%CI1.211~3.398), general anesthesia (OR1.947, 95%CI1.115~3.038), duration of surgery≥120min (OR1.621, 95%CI1.488~2.534) were the risk factors of postoperative pneumonia in elderly patients with hip fracture (all p<0.05). Escherichia Coli (33.33%), Klebsiella pneumoniae (28.57%), Staphylococcus aureus (21.43%) were the most common bacteria of pulmonary infection. Conclusion There are many risk factors for postoperative pneumonia in elderly patients with hip fractures after surgery. In clinical practice, medical workers should take targeted interventions for those risk factors to reduce postoperative pneumonia.
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Affiliation(s)
- Yibing Yu
- Department of Orthopedics, Wuhan Fourth Hospital, Wuhan Orthopedic Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peiwen Zheng
- Department of Orthopedics, Wuhan Fourth Hospital, Wuhan Orthopedic Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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Veronesi F, Contartese D, Martini L, Visani A, Fini M. Speculation on the pathophysiology of musculoskeletal injury with COVID-19 infection. Front Med (Lausanne) 2022; 9:930789. [PMID: 35911401 PMCID: PMC9329661 DOI: 10.3389/fmed.2022.930789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/28/2022] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) primarily affects the respiratory tract, but also many other organs and tissues, leading to different pathological pictures, such as those of the musculoskeletal tissues. The present study should be considered as a speculation on the relationship between COVID-19 infection and some frequent musculoskeletal pathologies, in particular sarcopenia, bone loss/osteoporosis (OP) and fracture risk and osteoarthritis (OA), to hypothesize how the virus acts on these pathologies and consequently on the tissue regeneration/healing potential. The study focuses in particular on the modalities of interaction of COVID-19 with Angiotensin-Converting Enzyme 2 (ACE2) and on the “cytokine storm.” Knowing the effects of COVID-19 on musculoskeletal tissues could be important also to understand if tissue regenerative/reparative capacity is compromised, especially in elderly and frail patients. We speculate that ACE2 and serine proteases together with an intense inflammation, immobilization and malnutrition could be the responsible for muscle weakness, altered bone remodeling, increase in bone fracture risk and inflammatory joint pathologies. Future preclinical and clinical studies may focus on the regenerative/reparative properties of the musculoskeletal tissues after COVID-19 infection, toward a personalized treatment usually based on scaffolds, cells, and growth factors.
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Pires RE, Reis IGN, Waldolato GS, Pires DD, Bidolegui F, Giordano V. What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?: A Systematic Review. JBJS Rev 2022; 10:01874474-202206000-00001. [PMID: 35658089 DOI: 10.2106/jbjs.rvw.22.00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
» COVID-19 is a disease that is challenging science, health-care systems, and humanity. An astonishingly wide spectrum of manifestations of multi-organ damage, including musculoskeletal, can be associated with SARS-CoV-2. » In the acute phase of COVID-19, fatigue, myalgia, and arthralgia are the most common musculoskeletal symptoms. » Post-COVID-19 syndrome is a group of signs and symptoms that are present for >12 weeks. The associated musculoskeletal manifestations are fatigue, arthralgia, myalgia, new-onset back pain, muscle weakness, and poor physical performance. » Data on COVID-19 complications are growing due to large absolute numbers of cases and survivors in these 2 years of the pandemic. Additional musculoskeletal manifestations encountered are falls by the elderly, increased mortality after hip fracture, reduced bone mineral density and osteoporosis, acute sarcopenia, rhabdomyolysis, Guillain-Barré syndrome, muscle denervation atrophy, fibromyalgia, rheumatological disease triggering, septic arthritis, adhesive capsulitis, myositis, critical illness myopathy, onset of latent muscular dystrophy, osteonecrosis, soft-tissue abscess, urticarial vasculitis with musculoskeletal manifestations, and necrotizing autoimmune myositis. » A wide range of signs and symptoms involving the musculoskeletal system that affect quality of life and can result in a decrease in disability-adjusted life years. This powerful and unpredictable disease highlights the importance of multimodality imaging, continuing education, and multidisciplinary team care to support preventive measures, diagnosis, and treatment.
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Affiliation(s)
- Robinson E Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Hospital Felicio Rocho, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Instituto Orizonti, Belo Horizonte, Brazil
| | - Igor G N Reis
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo S Waldolato
- Serviço de Ortopedia e Traumatologia, Hospital Felicio Rocho, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Instituto Orizonti, Belo Horizonte, Brazil
| | - Diego D Pires
- Cedimagem Medicina Diagnóstica, Grupo Alliar, Juiz de Fora, Brazil
| | - Fernando Bidolegui
- Servicio de Ortopedia y Traumatologia, Hospital Sirio-Libanes, ECICARO, Buenos Aires, Argentin
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
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Fusini F, Massè A, Risitano S, Ferrera A, Enrietti E, Zoccola K, Bianco G, Zanchini F, Colò G. Should we operate on all patients with COVID-19 and proximal femoral fractures? An analysis of thirty, sixty, and ninety day mortality rates based on patients' clinical presentation and comorbidity: a multicentric study in Northern Italy. INTERNATIONAL ORTHOPAEDICS 2021. [PMID: 34401931 DOI: 10.1007/s00264-021-05166-3/tables/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE This study aims to evaluate 30-60-90-day mortality of operated proximal femur fractures (PFFs) suffering from COVID-19 and correlation with patients' clinical presentation and comorbidities. METHODS Between February 1, 2020, and December 31, 2020, patients with COVID-19 infection and surgically treated PFF were included. Patients' demographic characteristics, oxygen (O2) therapy, comorbidities, and AO type fracture were collected. Chi-square test or Fisher test and hazard ratio were used to assessing the correlation between mortality rate, patient characteristics, and COVID-19 status. Kaplan-Meyer curve was used to analyze 30-60-90-day mortality. Level of significance was set as p < 0.05. RESULTS Fifty-six patients (mean age of 82.7 ± 8.85 years) were included. Thirty-day mortality rate was 5%, which increased to 21% at 60 days and 90 days. Eleven patients died, eight due to AO type A-like and three due to AO type B-like fractures. No significant difference in mortality rate between patients with cardiopulmonary comorbidity or no cardiopulmonary comorbidity was found (p = 0.67); a significant difference in patients with chronic obstructive pulmonary disease (COPD) or history of pulmonary embolism (PE) and patients without COPD was found (p = 0.0021). A significant difference between asymptomatic/mild symptomatic COVID-19 status and symptomatic COVID-19 status was found (p = 0.0415); a significant difference was found for O2 therapy with < 4 L/min and O2 therapy ≥ 4 L/min (p = 0.0049). CONCLUSION Thirty-day mortality rate of COVID-19 infection and PFFs does not differ from mortality rate of non-COVID-19 PFFs. However, patients with pre-existing comorbidities and symptomatic COVID-19 infection requiring a high volume of O2 therapy have a higher incidence of 60-90-day mortality when surgically treated.
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Affiliation(s)
- Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Strada S Rocchetto 99, 12084, Mondovì, Italy.
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città Della Salute E Della Scienza Di Torino, via Zuretti 29, 10126, Turin, Italy
| | - Salvatore Risitano
- Department of Orthopaedic and Traumatology, Maggiore Hospital of Chieri, ASL TO5, via De Maria 1, 10023, Chieri, Italy
| | - Andrea Ferrera
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città Della Salute E Della Scienza Di Torino, via Zuretti 29, 10126, Turin, Italy
| | - Emilio Enrietti
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città Della Salute E Della Scienza Di Torino, via Zuretti 29, 10126, Turin, Italy
| | - Kristijan Zoccola
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy
| | - Giuseppe Bianco
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Strada S Rocchetto 99, 12084, Mondovì, Italy
| | - Fabio Zanchini
- Clinical Orthopaedics, University of Campania "Luigi Vanvitelli", via L. de Crecchio 4, 80138, Naples, Italy
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy
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Fusini F, Massè A, Risitano S, Ferrera A, Enrietti E, Zoccola K, Bianco G, Zanchini F, Colò G. Should we operate on all patients with COVID-19 and proximal femoral fractures? An analysis of thirty, sixty, and ninety day mortality rates based on patients' clinical presentation and comorbidity: a multicentric study in Northern Italy. INTERNATIONAL ORTHOPAEDICS 2021; 45:2499-2505. [PMID: 34401931 PMCID: PMC8366488 DOI: 10.1007/s00264-021-05166-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
Purpose This study aims to evaluate 30–60–90-day mortality of operated proximal femur fractures (PFFs) suffering from COVID-19 and correlation with patients’ clinical presentation and comorbidities. Methods Between February 1, 2020, and December 31, 2020, patients with COVID-19 infection and surgically treated PFF were included. Patients’ demographic characteristics, oxygen (O2) therapy, comorbidities, and AO type fracture were collected. Chi-square test or Fisher test and hazard ratio were used to assessing the correlation between mortality rate, patient characteristics, and COVID-19 status. Kaplan-Meyer curve was used to analyze 30–60–90-day mortality. Level of significance was set as p < 0.05. Results Fifty-six patients (mean age of 82.7 ± 8.85 years) were included. Thirty-day mortality rate was 5%, which increased to 21% at 60 days and 90 days. Eleven patients died, eight due to AO type A-like and three due to AO type B-like fractures. No significant difference in mortality rate between patients with cardiopulmonary comorbidity or no cardiopulmonary comorbidity was found (p = 0.67); a significant difference in patients with chronic obstructive pulmonary disease (COPD) or history of pulmonary embolism (PE) and patients without COPD was found (p = 0.0021). A significant difference between asymptomatic/mild symptomatic COVID-19 status and symptomatic COVID-19 status was found (p = 0.0415); a significant difference was found for O2 therapy with < 4 L/min and O2 therapy ≥ 4 L/min (p = 0.0049). Conclusion Thirty-day mortality rate of COVID-19 infection and PFFs does not differ from mortality rate of non-COVID-19 PFFs. However, patients with pre-existing comorbidities and symptomatic COVID-19 infection requiring a high volume of O2 therapy have a higher incidence of 60–90-day mortality when surgically treated.
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Affiliation(s)
- Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Strada S Rocchetto 99, 12084, Mondovì, Italy.
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città Della Salute E Della Scienza Di Torino, via Zuretti 29, 10126, Turin, Italy
| | - Salvatore Risitano
- Department of Orthopaedic and Traumatology, Maggiore Hospital of Chieri, ASL TO5, via De Maria 1, 10023, Chieri, Italy
| | - Andrea Ferrera
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città Della Salute E Della Scienza Di Torino, via Zuretti 29, 10126, Turin, Italy
| | - Emilio Enrietti
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città Della Salute E Della Scienza Di Torino, via Zuretti 29, 10126, Turin, Italy
| | - Kristijan Zoccola
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy
| | - Giuseppe Bianco
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Strada S Rocchetto 99, 12084, Mondovì, Italy
| | - Fabio Zanchini
- Clinical Orthopaedics, University of Campania "Luigi Vanvitelli", via L. de Crecchio 4, 80138, Naples, Italy
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy
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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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Aprato A, Guindani N, Massè A, Castelli CC, Cipolla A, Antognazza D, Benazzo F, Bove F, Casiraghi A, Catani F, Dallari D, D’Apolito R, Franceschini M, Momoli A, Ravasi F, Rivera F, Zagra L, Zatti G, D’Angelo F. Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5340. [PMID: 34067826 PMCID: PMC8156362 DOI: 10.3390/ijerph18105340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Background: From 10 March up until 3 May 2020 in Northern Italy, the SARS-CoV-2 spread was not contained; disaster triage was adopted. The aim of the present study is to assess the impact of the COVID-19-pandemic on the Orthopedic and Trauma departments, focusing on: hospital reorganization (flexibility, workload, prevalence of COVID-19/SARS-CoV-2, standards of care); effects on staff; subjective orthopedic perception of the pandemic. Material and Methods: Data regarding 1390 patients and 323 surgeons were retrieved from a retrospective multicentric database, involving 14 major hospitals. The subjective directors' viewpoints regarding the economic consequences, communication with the government, hospital administration and other departments were collected. Results: Surgical procedures dropped by 73%, compared to 2019, elective surgery was interrupted. Forty percent of patients were screened for SARS-CoV-2: 7% with positive results. Seven percent of the patients received medical therapy for COVID-19, and only 48% of these treated patients had positive swab tests. Eleven percent of surgeons developed COVID-19 and 6% were contaminated. Fourteen percent of the staff were redirected daily to COVID units. Communication with the Government was perceived as adequate, whilst communication with medical Authorities was considered barely sufficient. Conclusions: Activity reduction was mandatory; the screening of carriers did not seem to be reliable and urgent activities were performed with a shortage of workers and a slower workflow. A trauma network and dedicated in-hospital paths for COVID-19-patients were created. This experience provided evidence for coordinated responses in order to avoid the propagation of errors.
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Affiliation(s)
- Alessandro Aprato
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Nicola Guindani
- Regional Health Care and Social Agency Papa Giovanni XXIII, 25127 Bergamo, Italy;
| | - Alessandro Massè
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Claudio C. Castelli
- Regional Health Care and Social Agency Papa Giovanni XXIII, 25127 Bergamo, Italy;
| | - Alessandra Cipolla
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Delia Antognazza
- Department of Biotechnology and Life Sciences (DBSV), Università degli Studi dell’Insubria, 21100 Varese, Italy; (D.A.); (F.D.)
| | - Francesco Benazzo
- Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy;
| | - Federico Bove
- Azienda Ospedaliera Niguarda Ca’ Granda, 20162 Milano, Italy;
| | | | - Fabio Catani
- Orthopaedics and Traumatology, Modena University Hospital, Università degli Studi di Modena e Reggio Emilia, 41121 Modena, Italy;
| | - Dante Dallari
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Rocco D’Apolito
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (R.D.); (L.Z.)
| | | | - Alberto Momoli
- Orthopaedics and Traumatology, San Bortolo Hospital, 36100 Vicenza, Italy;
| | - Flavio Ravasi
- ASST-Melegnano-Martesana, Ortopedia di Cernusco sul Naviglio, 20070 Vizzolo Predabissi, Italy;
| | | | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (R.D.); (L.Z.)
| | - Giovanni Zatti
- Orthopaedics and Traumatology, University of Milano–Bicocca, 20900 Monza, Italy;
| | - Fabio D’Angelo
- Department of Biotechnology and Life Sciences (DBSV), Università degli Studi dell’Insubria, 21100 Varese, Italy; (D.A.); (F.D.)
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