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29.08.2020 | COVID-19 | Original Paper | Ausgabe 1/2021 Zur Zeit gratis

International Orthopaedics 1/2021

Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study

Zeitschrift:
International Orthopaedics > Ausgabe 1/2021
Autoren:
A. Narang, G. Chan, A. Aframian, Z. Ali, A. Carr, H. Goodier, C. Morgan, C. Park, K. Sugand, T. Walton, M. Wilson, A. Belgaumkar, K. Gallagher, K. Ghosh, C. Gibbons, A. Keightley, Z. Nawaz, C. Wakeling, K. Sarraf, B. A. Rogers, W. K. M. Kieffer
Wichtige Hinweise
The original version of this article was revised: The published online version contains mistake, as the Figure 1 legend should read “Kaplan-Meier survival curve for 30-day survival for 2020 cohort COVID-19 positive vs COVID-19 negative” whilst the Figure 2 legend should read "Kaplan-Meier survival curve for 30-day survival 2020 COVID-19 negative group vs 2019 cohort”.
A correction to this article is available online at https://​doi.​org/​10.​1007/​s00264-020-04824-2.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Abstract

Purpose

Thirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients.

Methods

A multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019.

Results

Actual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57–5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification.

Conclusion

COVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.

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