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Piccirilli E, Cariati I, Primavera M, Triolo R, Gasbarra E, Tarantino U. Augmentation in fragility fractures, bone of contention: a systematic review. BMC Musculoskelet Disord 2022; 23:1046. [PMID: 36457070 PMCID: PMC9717408 DOI: 10.1186/s12891-022-06022-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Osteoporosis is a complex multifactorial disease characterized by reduced bone mass and microarchitectural deterioration of bone tissue linked to an increase of fracture risk. Fragility fractures occur in osteoporotic subjects due to low-energy trauma. Osteoporotic patients are a challenge regarding the correct surgical planning, as it can include fixation augmentation techniques to reach a more stable anchorage of the implant, possibly lowering re-intervention rate and in-hospital stay. METHODS The PubMed database and the Google Scholar search engine were used to identify articles on all augmentation techniques and their association with fragility fractures until January 2022. In total, we selected 40 articles that included studies focusing on humerus, hip, spine, and tibia. RESULTS Literature review showed a quantity of materials that can be used for reconstruction of bone defects in fragility fractures in different anatomic locations, with good results over the stability and strength of the implant anchorage, when compared to non-augmented fractures. CONCLUSION Nowadays there are no recommendations and no consensus about the use of augmentation techniques in osteoporotic fractures. Our literature review points at implementing the use of bone augmentation techniques with a specific indication for elderly patients with comminuted fractures and poor bone quality.
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Affiliation(s)
- Eleonora Piccirilli
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133, Rome, Italy
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Ida Cariati
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy.
| | - Matteo Primavera
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133, Rome, Italy
| | - Rebecca Triolo
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133, Rome, Italy
| | - Elena Gasbarra
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133, Rome, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133, Rome, Italy
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
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Tarantino U, Visconti VV, Bonanni R, Gatti A, Marcozzi M, Calabrò D, Cariati I. Osteosarcopenia and Long-COVID: a dangerous combination. Ther Adv Musculoskelet Dis 2022; 14:1759720X221130485. [PMID: 36317068 PMCID: PMC9614591 DOI: 10.1177/1759720x221130485] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022] Open
Abstract
SARS-CoV-2 has caused a global pandemic and an unprecedented public health crisis, infecting more than 580 million people worldwide. Moreover, recent evidence has suggested the emergence of a new syndrome known as Long-COVID, a term used to describe a diverse set of physical and mental symptoms that persist after a diagnosed SARS-CoV-2 infection. Epidemiological data have identified myalgias, muscle and joint dysfunction, and bone fragility as common sequelae in patients with moderate and severe forms of this disease. Significant musculoskeletal dysfunction has also been detected in some healed patients, although knowledge about pathophysiological mechanisms of Long-COVID is still rather scarce. In this context, SARS-CoV-2 infection has been suggested to amplify the effects of aging on the musculoskeletal system by aggravating the osteosarcopenic state. Based on this evidence, our review focused on the muscle and bone tissue alterations induced by SARS-CoV-2 infection and Long-COVID, summarizing the current knowledge on the underlying biological mechanisms and highlighting the need for a multidisciplinary approach to predict the musculoskeletal targets and long-term consequences of COVID-19 disease.
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Affiliation(s)
- Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome ‘Tor Vergata’, Rome, Italy,Department of Orthopaedics and Traumatology, ‘Policlinico Tor Vergata’ Foundation, Rome, Italy
| | - Virginia V. Visconti
- Department of Clinical Sciences and Translational Medicine, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Roberto Bonanni
- Department of Clinical Sciences and Translational Medicine, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Andrea Gatti
- Department of Orthopaedics and Traumatology, ‘Policlinico Tor Vergata’ Foundation, Rome, Italy
| | - Martina Marcozzi
- Department of Orthopaedics and Traumatology, ‘Policlinico Tor Vergata’ Foundation, Rome, Italy
| | - Davide Calabrò
- Department of Orthopaedics and Traumatology, ‘Policlinico Tor Vergata’ Foundation, Rome, Italy
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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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The Impact of Diabetes on Osteoporosis Management and Secondary Fracture Risk After Primary Fragility Fractures: A Propensity Score-Matched Cohort Study. J Am Acad Orthop Surg 2022; 30:e204-e212. [PMID: 34543247 DOI: 10.5435/jaaos-d-21-00185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/22/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Rates of osteoporosis evaluation and management after primary fragility fractures have remained low in recent years. The extent to which this treatment gap affects patients with diabetes is unclear. This study aimed to compare the risk of secondary fractures and rates of osteoporosis diagnosis and management after sentinel fractures in patients with and without diabetes. METHODS A propensity score-matched cohort study was conducted using the PearlDiver database. Patients aged 50 years and older with primary fragility fractures of the hip, wrist, spine, pelvis, humerus, and other locations were identified. Rates of secondary fractures, dual radiograph absorptiometry (DXA) scans, charted osteoporosis diagnoses (International Classification of Diseases, Ninth and Tenth Revisions), and osteoporosis pharmacotherapy within 2 years were compared for patients with and without diabetes using multivariable logistic regression. RESULTS Matching yielded 27,052 patients in each cohort. Index humerus fractures were more common in the diabetic cohort (15.0% versus 11.6%, P < 0.001), whereas wrist fractures were more prevalent among the nondiabetic cohort (15.2% versus 19.3%, P < 0.001). Incidence of secondary fractures at 2 years was higher for diabetic patients than nondiabetic patients (5.2% versus 4.7%; odds ratio [OR] 1.08; 95% confidence interval [CI], 0.99 to 1.17). Diabetic patients were significantly less likely to receive a DXA scan (13.2% versus 13.5%; OR 0.93; 95% CI, 0.88 to 0.98), be diagnosed with osteoporosis (9.3% versus 11.9%; OR 0.77; 95% CI, 0.73 to 0.82), or start pharmacotherapy (8.1% versus 8.7; OR 0.93; 95% CI, 0.87 to 0.99). CONCLUSION Despite diabetes being a well-established risk factor for fragility fractures, diabetic patients were significantly less likely to receive DXA scan evaluation, be formally diagnosed with osteoporosis, or be treated with osteoporosis pharmacotherapy after a sentinel fragility fracture. Incidence of secondary fractures within 2 years was also higher among diabetic patients.
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Impact and Strategies on Joint Surgery Centers without Lockdowns during the Peak of the COVID-19 Pandemic: A Multicenter Cross-Sectional Study. J Clin Med 2021; 10:jcm10225392. [PMID: 34830674 PMCID: PMC8618289 DOI: 10.3390/jcm10225392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/29/2022] Open
Abstract
The real psychological impact of COVID-19 remains difficult to quantify and may differ between hospital sizes and levels. Taiwan’s response to COVID-19 differed in that it successfully prevented its spread, without implementing any lockdowns before May 2021. Patients’ fear would be the major reason for the reduction of surgeries. The daily data for patients who underwent total knee arthroplasty (TKA), total hip arthroplasty, and hemiarthroplasty were collected from two major joint surgery centers of a university hospital and a community hospital in Taiwan. Compared with the previous year, the initial impact of the pandemic evidently reduced the total number of patients (outpatient: 20–29%; admission: 22–37%; surgery: 18–35%) in both hospitals. During the study period, the total number of TKAs decreased by 56–61% in both hospitals. The reduction in arthroplasty surgeries was attributable to patients’ fear. Even with confirmed COVID-19 cases, the university hospital experienced less impact than the community hospital. The TKA was the most affected of all surgery types. Even without local epidemics and restrictions in Taiwan, the worldwide pandemic inevitably led to a reduction of approximately 60% of the total TKA operation volume, especially for community hospitals. The surgery scheduling strategies helped maintain the routine arthroplasty services.
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Hampson G, Stone M, Lindsay JR, Crowley RK, Ralston SH. Diagnosis and Management of Osteoporosis During COVID-19: Systematic Review and Practical Guidance. Calcif Tissue Int 2021; 109:351-362. [PMID: 34003337 PMCID: PMC8129963 DOI: 10.1007/s00223-021-00858-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022]
Abstract
It is acknowledged that the COVID-19 pandemic has caused profound disruption to the delivery of healthcare services globally. This has affected the management of many long-term conditions including osteoporosis as resources are diverted to cover urgent care. Osteoporosis is a public health concern worldwide and treatment is required for the prevention of further bone loss, deterioration of skeletal micro-architecture, and fragility fractures. This review provides information on how the COVID-19 pandemic has impacted the diagnosis and management of osteoporosis. We also provide clinical recommendations on the adaptation of care pathways based on experience from five referral centres to ensure that patients with osteoporosis are still treated and to reduce the risk of fractures both for the individual patient and on a societal basis. We address the use of the FRAX tool for risk stratification and initiation of osteoporosis treatment and discuss the potential adaptations to treatment pathways in view of limitations on the availability of DXA. We focus on the issues surrounding initiation and maintenance of treatment for patients on parenteral therapies such as zoledronate, denosumab, teriparatide, and romosozumab during the pandemic. The design of these innovative care pathways for the management of patients with osteoporosis may also provide a platform for future improvement to osteoporosis services when routine clinical care resumes.
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Affiliation(s)
- G Hampson
- Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, Lambeth Palace Road, 5th Floor, North Wing, London, SE1 7EH, UK.
- Department of Rheumatology, Metabolic Bone Clinic, Guy's Hospital, London, UK.
| | - M Stone
- Metabolic Bone Service, University Hospital Llandough, Llandough, Penarth, CF64 2XX, UK
| | - J R Lindsay
- Osteoporosis and Bone Metabolism Service, Musgrave Park Hospital, Belfast, Northern Ireland, UK
| | - R K Crowley
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - S H Ralston
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
- Rheumatic Diseases Unit, NHS Lothian Western General Hospital Edinburgh, Edinburgh, EH4 2XU, UK
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Cariati I, Bonanni R, Onorato F, Mastrogregori A, Rossi D, Iundusi R, Gasbarra E, Tancredi V, Tarantino U. Role of Physical Activity in Bone-Muscle Crosstalk: Biological Aspects and Clinical Implications. J Funct Morphol Kinesiol 2021; 6:55. [PMID: 34205747 PMCID: PMC8293201 DOI: 10.3390/jfmk6020055] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 02/06/2023] Open
Abstract
Bone and muscle tissues influence each other through the integration of mechanical and biochemical signals, giving rise to bone-muscle crosstalk. They are also known to secrete osteokines, myokines, and cytokines into the circulation, influencing the biological and pathological activities in local and distant organs and cells. In this regard, even osteoporosis and sarcopenia, which were initially thought to be two independent diseases, have recently been defined under the term "osteosarcopenia", to indicate a synergistic condition of low bone mass with muscle atrophy and hypofunction. Undoubtedly, osteosarcopenia is a major public health concern, being associated with high rates of morbidity and mortality. The best current defence against osteosarcopenia is prevention based on a healthy lifestyle and regular exercise. The most appropriate type, intensity, duration, and frequency of exercise to positively influence osteosarcopenia are not yet known. However, combined programmes of progressive resistance exercises, weight-bearing impact exercises, and challenging balance/mobility activities currently appear to be the most effective in optimising musculoskeletal health and function. Based on this evidence, the aim of our review was to summarize the current knowledge about the role of exercise in bone-muscle crosstalk, highlighting how it may represent an effective alternative strategy to prevent and/or counteract the onset of osteosarcopenia.
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Affiliation(s)
- Ida Cariati
- PhD in Medical-Surgical Biotechnologies and Translational Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy;
- Department of Clinical Sciences and Translational Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Roberto Bonanni
- Department of Systems Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy; (R.B.); (V.T.)
| | - Federica Onorato
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (F.O.); (A.M.); (D.R.); (R.I.); (E.G.)
| | - Ambra Mastrogregori
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (F.O.); (A.M.); (D.R.); (R.I.); (E.G.)
| | - Danilo Rossi
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (F.O.); (A.M.); (D.R.); (R.I.); (E.G.)
| | - Riccardo Iundusi
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (F.O.); (A.M.); (D.R.); (R.I.); (E.G.)
| | - Elena Gasbarra
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (F.O.); (A.M.); (D.R.); (R.I.); (E.G.)
| | - Virginia Tancredi
- Department of Systems Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy; (R.B.); (V.T.)
- Centre of Space Bio-Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (F.O.); (A.M.); (D.R.); (R.I.); (E.G.)
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Tsourdi E, Yu EW, Jan de Beur SM, Drake MT. Vaccination for Coronavirus Disease 2019 (COVID-19) and Relationship to Osteoporosis Care: Current Evidence and Suggested Approaches. J Bone Miner Res 2021; 36:1042-1047. [PMID: 33831269 PMCID: PMC8249992 DOI: 10.1002/jbmr.4304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/30/2021] [Indexed: 02/06/2023]
Abstract
The development of coronavirus disease 2019 (COVID-19) vaccines has proceeded at an unprecedented pace, with numerous trials conducted simultaneously across the world as a result of massive technological and financial resource expenditures. With multiple vaccines having now received regulatory approval, public health efforts to promote widespread vaccine dissemination are currently underway. There has been particular emphasis placed on vaccination of older populations, the age group in which COVID-19 infection has been most lethal. However, such widespread vaccination approaches have necessarily raised important questions related to potential interactions with underlying diseases and concomitant treatments among persons to be vaccinated. Osteoporosis is a chronic condition marked by reduced bone strength and an associated increased risk for fracture that generally requires sustained medical intervention(s). Osteoporosis is neither associated with a higher risk of COVID-19 infection nor by more pronounced disease severity following infection, such that individuals with osteoporosis need not be more highly prioritized for COVID-19 vaccination. 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. Depending on the specific drug profile within an anti-osteoporosis medication category, minor adjustments to the timing of drug administration may be considered with respect to the patient's COVID-19 vaccination schedule. Herein we provide practical recommendations for the care of patients requiring treatment for osteoporosis in the setting of COVID-19 vaccination. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Elena Tsourdi
- Department of Medicine III, Universitätsklinikum Dresden, Dresden, Germany.,Center for Healthy Aging, Universitätsklinikum Dresden, Dresden, Germany
| | - Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Suzanne M Jan de Beur
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew T Drake
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.,Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
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Kong SH, Hwang BK, Yoon BH. The Impact of COVID-19 on the Optimal Management of Osteoporosis. J Bone Metab 2021; 28:115-122. [PMID: 34130363 PMCID: PMC8206610 DOI: 10.11005/jbm.2021.28.2.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/20/2021] [Indexed: 12/20/2022] Open
Abstract
Osteoporosis does not take a break while Coronavirus disease 2019 (COVID-19) stunned and overtook everyone’s lives. Medical resources were immediately shifted, self-isolation and telemedicine were expanded, ambulatory care services such as bone densitometry and osteoporosis-centered clinics came to a near halt. Progress with fracture prevention has been challenged because osteoporotic fracture with low energy injury is more prevalent even though restriction of people’s movement. Thus we must re-engage with chronic bone health concerns and fracture prevention. This review discusses challenges in management of osteoporosis during the COVID-19 pandemic and reinforces the need to implementing recommendations concerning the importance of bone fragility care with at least those patients who are already treated with antiosteoporotic drugs maintaining their adherence to treatments.
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Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Kwon Hwang
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Mokdong Hospital, Seoul, Korea
| | - Byung-Ho Yoon
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Mokdong Hospital, Seoul, Korea
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Grassi A, Andriolo L, Golinelli D, Tedesco D, Rosa S, Gramegna P, Ciaffi J, Meliconi R, Landini MP, Filardo G, Fantini MP, Zaffagnini S. 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; 18:5205. [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] [MESH Headings] [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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Affiliation(s)
- Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (A.G.); (S.Z.)
| | - Luca Andriolo
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (A.G.); (S.Z.)
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy; (D.G.); (S.R.); (M.P.F.)
| | - Dario Tedesco
- IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (D.T.); (M.P.L.)
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy; (D.G.); (S.R.); (M.P.F.)
| | - Pasquale Gramegna
- Medicina e Reumatologia, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (P.G.); (J.C.); (R.M.)
| | - Jacopo Ciaffi
- Medicina e Reumatologia, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (P.G.); (J.C.); (R.M.)
| | - Riccardo Meliconi
- Medicina e Reumatologia, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (P.G.); (J.C.); (R.M.)
| | - Maria Paola Landini
- IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (D.T.); (M.P.L.)
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy; (D.G.); (S.R.); (M.P.F.)
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (A.G.); (S.Z.)
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