Early mortality outcomes of patients with fragility hip fracture and concurrent SARS-CoV-2 infection : a systematic review and meta-analysis

Harry Alcock, Eleanor Ann Moppett, Iain Keith Moppett, Harry Alcock, Eleanor Ann Moppett, Iain Keith Moppett

Abstract

Aims: Hip fracture is a common condition of the older, frailer person. This population is also at risk from SARS-CoV-2 infection. It is important to understand the impact of coexistent hip fracture and SARS-CoV-2 for informed decision-making at patient and service levels.

Methods: We undertook a systematic review and meta-analysis of observational studies of older (> 60 years) people with fragility hip fractures and outcomes with and without SARS-CoV-2 infection during the first wave of the COVID-19 pandemic. The primary outcome was early (30-day or in-hospital) mortality. Secondary outcomes included length of hospital stay and key clinical characteristics known to be associated with outcomes after hip fracture.

Results: A total of 14 cohort and five case series studies were included (692 SARS-CoV-2 positive, 2,585 SARS-CoV-2 negative). SARS-CoV-2 infection was associated with an overall risk ratio (RR) for early mortality of 4.42 (95% confidence interval (CI) 3.42 to 5.82). Early mortality was 34% (95% CI 30% to 38%) and 9% (95% CI 8% to 10%) in the infected and noninfected groups respectively. Length of stay was increased in SARS-CoV-2 infected patients (mean difference (MD) 5.2 days (3.2 to 7.2)). Age (MD 1.6 years (0.3 to 2.9)); female sex (RR 0.83 (95% CI 0.65 to 1.05)); admission from home (RR 0.51 (95% CI 0.26 to 1.00)); presence of dementia (RR 1.13 (95% CI 0.94 to 1.43)); and intracapsular fracture (RR 0.89 (95% CI 0.71 to 1.11)) were not associated with SARS-CoV-2 infection. There were statistically, but not clinically, significantly greater Nottingham Hip Fracture Scores in infected compared with non-infected patients (MD 0.7 (0.4 to 0.9)).

Conclusion: SARS-CoV-2 infection is associated with worse outcomes after hip fracture. This is not explained by differences in patient characteristics. These data can be used to support informed decision-making and may help track the impact of widespread adoption of system-level and therapeutic changes in management of the COVID-19 pandemic. Cite this article: Bone Jt Open 2021;2(5):314-322.

Keywords: COVID-19; Complications; Hip fracture; Mortality.

Conflict of interest statement

ICMJE COI statement: I. K. Moppett is a member of the National Hip Fracture Database Advisory Group.

Figures

Fig. 1
Fig. 1
Summary of risk of bias assessments for all included studies, using the Newcastle-Ottawa Scale.
Fig. 2
Fig. 2
Risk of bias for individual studies, using the Newcastle-Ottawa scale.
Fig. 3
Fig. 3
Funnel plot of included studies for risk of mortality associated with SARS-CoV-2 and hip fracture.
Fig. 4
Fig. 4
Risk ratio for early mortality associated with SARS-CoV-2 infection in older people with fragility hip fracture. CI, confidence interval.
Fig. 5
Fig. 5
Absolute risk for early mortality associated with SARS-CoV-2 infection in older people with fragility hip fracture. CI, confidence interval.
Fig. 6
Fig. 6
Mean difference in age between SARS-CoV-2 positive and negative patients with hip fracture. CI, confidence interval.
Fig. 7
Fig. 7
Mean difference in Nottingham Hip Fracture Score between SARS-CoV-2 positive and negative patients with hip fracture. CI, confidence interval.

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Source: PubMed

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