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Shim EH, Ghodasara SK, Roskam JS, Gaccione AG, DiFazio LT, Lombardo G, Nemeth ZH. Effects of COVID-19 Status on Hip Fracture Surgical Outcomes: An ACS NSQIP Study. J Trauma Nurs 2024; 31:123-128. [PMID: 38742718 DOI: 10.1097/jtn.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Studies have indicated that patients infected with the SARS-CoV-2 virus fare worse clinically after a traumatic injury, especially those who are older and have other comorbidities. OBJECTIVE This study aims to understand the effects of Corona Virus Disease 19 (COVID-19) diagnosis on patients undergoing surgery for hip fractures. METHODS This is a retrospective review of the 2021 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Targeted Hip Fracture database for patients who underwent surgery. Two cohorts were formed based on patients' preoperative COVID-19 status, as tested within 14 days prior to the operation. Several clinical factors were compared. RESULTS The COVID-positive cohort consisted of 184 patients, all of whom had a laboratory-confirmed or clinically suspected SARS-CoV-2 infection, while the COVID-negative cohort consisted of 12,211 patients with no infection. A lower proportion of COVID-positive patients had an emergent operation compared to the COVID-negative cohort (58.70% vs. 73.09%, p < .001). Preoperatively, the COVID-positive cohort showed higher rates of coagulopathy/bleeding disorders (22.83% vs. 14.12%), congestive heart failure (16.30% vs. 9.84%), diabetes mellitus (28.26% vs. 19.24%), and dementia (42.39% vs. 28.07%), with p ≤ .005 for all. Postoperatively, a higher proportion of COVID-positive patients died (9.78% vs. 5.40%) or had pneumonia (8.70% vs. 3.65%), hospital readmission within 30 days (10.87% vs. 6.76%), and pressure sores (8.15% vs. 4.55%), with p ≤ .033 for all. CONCLUSION The diagnosis of COVID-19 in hip fracture patients was associated with higher rates of postoperative complications, including mortality, when compared to COVID-negative patients, indicating the severity of the viral infection.
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Affiliation(s)
- Esther H Shim
- Author Affiliations: Department of Surgery, Morristown Medical Center, Morristown, New Jersey
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Tsui KHM, Chau WW, Liu WH, Tam CY, Yee DKH, Tso CY, Zhang N, Cheung WH, Tang N, Wong RMY. COVID-19 hip fracture outcomes: The role of Ct values and D-dimer levels? J Orthop Translat 2023; 43:14-20. [PMID: 37920546 PMCID: PMC10618614 DOI: 10.1016/j.jot.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/11/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction The COVID-19 pandemic has caused high mortality rates in hip fracture patients, but data for Asian patients are lacking. Whilst Cycle threshold (Ct) values and D-dimer have been reported as predictors of mortality in COVID-19 patients, their prognostic roles in those with concomitant hip fracture remain unknown. The objectives of this study were to i) assess the clinical outcomes of COVID-19 hip fractures patients in the Chinese population, ii) identify risk factors of mortality and complications, and iii) determine the prognostic roles of Ct values and D-dimer levels. Methodology This cohort study was conducted during the 5th wave of the COVID-19 pandemic. Inclusion criteria were 1) hip fracture 2) ≥ 60 years old 3) low-energy trauma. Outcomes were 90-day all-cause mortality, complications, length of stay, discharge destination and mobility status. Logistic regression analysis was performed to identify risk factors for mortality and complications. Subgroup analysis was performed for patients with Ct < 30 and Ct > 30, comparing their outcomes of operations performed within 48 h vs beyond 48 h. Results 159 hip fracture patients were included, 42 patients were COVID-19 positive. COVID-19 group had significantly higher 90-day mortality rates (21.4% vs 9.4%), complication rates (45.2% vs 28.2%) and longer length of stay (17.06 vs 10.84 nights). COVID-19 was an independent risk factor for mortality and complications. Amongst the COVID-19 group, risk factors for poor outcomes were advanced age, steroids use, conservative treatment and American Society of Anaesthesiologists (ASA) score ≥ 3. Conservative treatment was associated with higher mortality (OR = 16.00; p = 0.025) in COVID-19 hip fracture patients. There was no significant difference between Ct values < 30 and >30 regarding mortality and complication rate. D-dimer and timing to operation did not affect outcomes. Conclusions Patients with concomitant COVID-19 and hip fracture are at high risk of mortality and complications. Ct values and D-dimer levels have no prognostic roles for hip fracture outcomes. Early operative treatment is recommended as soon as patients are medically fit.
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Affiliation(s)
- Kwan Hung Moya Tsui
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Wai Wang Chau
- Department of Orthopaedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong SAR, China
| | - Wing Hong Liu
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Cheuk Yin Tam
- Department of Orthopaedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong SAR, China
| | - Dennis King Hang Yee
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Yin Tso
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Ning Zhang
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wing-Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ning Tang
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
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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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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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