Hip Fractures in the Elderly During the COVID-19 Pandemic: A Latin-American Perspective With a Minimum 90-Day Follow-Up

Tomas Zamora, Felipe Sandoval, Hugo Demandes, Javier Serrano, Javiera Gonzalez, Maria Jesus Lira, Ianiv Klaber, Maximiliano Carmona, Eduardo Botello, Daniel Schweitzer, Tomas Zamora, Felipe Sandoval, Hugo Demandes, Javier Serrano, Javiera Gonzalez, Maria Jesus Lira, Ianiv Klaber, Maximiliano Carmona, Eduardo Botello, Daniel Schweitzer

Abstract

Introduction: Hip fracture patients have been severely affected by the COVID-19 pandemic; however, the sub acute effects of a concomitant SARS-CoV-2 infection and the outcomes in highly exposed developing countries are still unknown. Our objective is to describe the morbidity and mortality of elderly patients admitted for a hip fracture during the COVID-19 pandemic in Chile, with a minimum 90-day follow-up. Also, to elucidate predictors for mortality and to compare mortality results with the pre-pandemic era.

Material and methods: Multicentric retrospective review of patients admitted for a fragility hip fracture in 3 hospitals during the COVID-19 pandemic, and during the same time in 2019. All clinical information and images were recorded, and patients were followed for a minimum of 90-days. Morbidity and mortality were the primary outcomes. Uni/multivariable models were performed to elucidate predictors for mortality utilizing the Weibull's regression.

Results: Three hundred ninety-one cases were included. From the 2020 cohort (162 patients), 24 (15%) had a concomitant SARS-CoV-2 infection. Fourteen patients (58%) tested positive after admission. The COVID-19(+) group had a higher risk of in-hospital, 30-day, and 90-day mortality (p < 0.001). They also had a prolonged hospital stay and presented with more complications and readmissions (p < 0.05). Only COVID-19(+) status and older age were independent predictors for mortality with a HR = 6.5 (p = < 0.001) and 1.09 (p = 0.001), respectively. The 2020 cohort had twice the risk of mortality with a HR = 2.04 (p = 0.002) compared to the 2019 cohort. However, comparing only the COVID-19 (-) patients, there was no difference in mortality risk, with a HR = 1.30 (p = 0.343).

Discussion: The COVID-19 pandemic has significantly affected healthcare systems and elderly patients.

Conclusions: Hip fracture patients with a concomitant SARS-CoV-2 virus infection were associated with increased morbidity and mortality throughout the first 3 months. COVID-19 status and older age were significant predictors for mortality. Efforts should be directed into nosocomial infection reduction and prompt surgical management.

Level of evidence: Level III.

Keywords: COVID-19; fragility fracture; hip fracture; survival analysis.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2021.

Figures

Figure 1.
Figure 1.
Kaplan Meier curve of survival for the COVID-19 (-) and COVID-19 (+) patients from the 2020 cohort.
Figure 2.
Figure 2.
Kaplan Meier curve of survival for the COVID-19 (-) and COVID-19 (+) patients from the 2020 cohort, compared to the 2019 cohort.

References

    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi:10.1016/S0140-6736(20)30183-5
    1. Johns Hopkins Coronavirus Resource Center. 2020. Accessed December 8, 2020.
    1. Dyer O. Covid-19 hot spots appear across Latin America. BMJ. 2020;369:m2182. doi:10.1136/bmj.m2182
    1. Hartholt KA, Oudshoorn C, Zielinski SM, et al. The epidemic of hip fractures: are we on the right track? PLoS One. 2011;6(7):e22227. doi:10.1371/journal.pone.0022227
    1. Zamora T, Klaber I, Urrutia J. Hip fracture in the elderly. Clin Med Insights Geriatr. 2017;10:1–10. doi:10.1177/1179553017703998
    1. Slullitel PA, Lucero CM, Soruco ML, et al. Prolonged social lockdown during COVID-19 pandemic and hip fracture epidemiology. Int Orthop. 2020;44(10):1887–1895. doi:10.1007/s00264-020-04769-6
    1. Kayani B, Onochie E, Patil V, et al. The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures. Bone Jt J. 2020;102B(9):1136–1145. doi:10.1302/0301-620X.102B9.BJJ-2020-1127.R1
    1. Lim MA, Pranata R. Coronavirus disease 2019 (COVID-19) markedly increased mortality in patients with hip fracture—a systematic review and meta-analysis. J Clin Orthop Trauma. 2021;12(1):187–193. doi:10.1016/j.jcot.2020.09.015
    1. Hall AJ, Clement ND, MacLullich AMJ, White TO, Duckworth AD. IMPACT-scot 2 report on COVID-19 in hip fracture patients. Bone Joint J. 2021:1–10. doi:10.1302/0301-620x.103b.bjj-2020-2027.r1
    1. LeBrun DG, Konnaris MA, Ghahramani GC, et al. Hip fracture outcomes during the COVID-19 pandemic: early results from New York. J Orthop Trauma. 2020;34(8):403–410. doi:10.1097/BOT.0000000000001849
    1. Egol KA, Konda SR, Bird ML, et al. Increased mortality and major complications in hip fracture care during the COVID-19 pandemic: a New York City perspective. J Orthop Trauma. 2020;34(8):395–402. doi:10.1097/BOT.0000000000001845
    1. Narang A, Chan G, Aframian A, et al. Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study. Int Orthop. 2021;45(1):23–31. doi:10.1007/s00264-020-04739-y
    1. PAHO. Pan American Health Organization. Health in the Americas. Paho; 1998. Accessed January 2, 2021.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–349. doi:10.1016/j.jclinepi.2007.11.008
    1. Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676–682. doi:10.1093/aje/kwq433
    1. Neuhaus V, King J, Hageman MG, Ring DC. Charlson comorbidity indices and in-hospital deaths in patients with hip fractures trauma. Clin Orthop Relat Res. 2013;471(5):1712–1719. doi:10.1007/s11999-012-2705-9
    1. Palm H, Krasheninnikoff M, Holck K, et al. A new algorithm for hip fracture surgery. Acta Orthop. 2012;83(1):26–30. doi:10.3109/17453674.2011.652887
    1. Carroll KJ. On the use and utility of the Weibull model in the analysis of survival data. Control Clin Trials. 2003;24(6):682–701. doi:10.1016/S0197-2456(03)00072-2
    1. Zhang Z. Parametric regression model for survival data: Weibull regression model as an example. Ann Transl Med. 2016;4(24):484. doi:10.21037/atm.2016.08.45
    1. Clement ND, Ng N, Simpson CJ, et al. The prevalence, mortality, and associated risk factors for developing COVID-19 in hip fracture patients: a systematic review and meta-analysis. Bone Jt Res. 2020;9(12):873–883. doi:10.1302/2046-3758.912.BJR-2020-0473.R1
    1. Cheung ZB, Forsh DA. Early outcomes after hip fracture surgery in COVID-19 patients in New York City. J Orthop. 2020;21:291–296. doi:10.1016/j.jor.2020.06.003
    1. Kronbichler A, Kresse D, Yoon S, Lee KH, Effenberger M, Shin J Il. Asymptomatic patients as a source of COVID-19 infections: a systematic review and meta-analysis. Int J Infect Dis. 2020;98:180–186. doi:10.1016/j.ijid.2020.06.052
    1. Dupley L, Oputa TJ, Bourne JT, et al. 30-day mortality for fractured neck of femur patients with concurrent COVID-19 infection. Eur J Orthop Surg Traumatol. 2020;31(2):341–347. doi:10.1007/s00590-020-02778-0
    1. Van Praet JT, Claeys B, Coene AS, Floré K, Reynders M. Prevention of nosocomial COVID-19: another challenge of the pandemic. Infect Control Hosp Epidemiol. 2020;41(11):1355–1356. doi:10.1017/ice.2020.166
    1. The Lancet. COVID-19 in Latin America: a humanitarian crisis. Lancet. 2020;396(10261):1463. doi:10.1016/S0140-6736(20)32328-X
    1. Garcia PJ, Alarcón A, Bayer A, et al. COVID-19 response in Latin America. Am J Trop Med Hyg. 2020;103(5):1765–1772. doi:10.4269/ajtmh.20-0765
    1. Pintado JF, Gibaja W, Vallejos RA, Rosas W, Guerra-Farfan E, Nuñez JH. How COVID-19 has affected emergent visits to a Latin-American trauma department: experience at a Peruvian National Trauma Referral Center. Injury. 2020;51(12):2834–2839. doi:10.1016/j.injury.2020.11.005
    1. Almaadany FS, Samadov E, Namazov I, et al. Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: an International Cohort Study. Lancet. 2020;396(10243):27–38. doi:10.1016/S0140-6736(20)31182-X
    1. Hasan SS, Radford S, Kow CS, Zaidi STR. Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis. J Thromb Thrombolysis. 2020;50(4):814–821. doi:10.1007/s11239-020-02235-z
    1. Donnelly JP, Wang XQ, Iwashyna TJ, Prescott HC. Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system. JAMA. 2021;325(3):304–306. doi:10.1001/jama.2020.21465
    1. Tripathy SK, Varghese P, Panigrahi S, et al. Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: a systematic review and meta-analysis. World J Orthop. 2021;12(1):35–50. doi:10.5312/WJO.V12.I1.35
    1. Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323(18):1843–1844. doi:10.1001/jama.2020.3786

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