Hip fracture care and mortality among patients treated in dedicated COVID-19 and non-COVID-19 circuits

• Published in: European geriatric medicine 2021-08, Vol.12 (4), p.749-757
• Main Authors: Ojeda-Thies, Cristina, Cuarental-García, Javier, García-Gómez, Elena, Salazar-Zamorano, Carlos Hugo, Alberti-Maroño, Javier, Ramos-Pascua, Luis Rafael
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cohort Studies; COVID-19 - prevention & control; Female; Geriatrics/Gerontology; Hip Fractures - mortality; Hip Fractures - surgery; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Pandemics; Research Paper; Retrospective Studies; SARS-CoV-2
• ISSN: 1878-7649; 1878-7657; 1878-7657
• DOI: 10.1007/s41999-021-00455-x

Key summary points Aim What were the effects of the COVID-19 pandemic and patient cohorting on the mortality and care provided for patients with hip fractures? Findings Mortality due to COVID-19 infection was higher before patient cohorting, and no nosocomial infections were detected after cohorting. Survival of patients treated in the COVID-19 circuit was similar to non-COVID-19 controls, in spite of longer surgical delay and length of stay. Message Separate circuits for COVID-19 and non-COVID-19 patients allows adequate hip fracture care, without observing increased mortality when delaying surgery until stabilization among patients with severe respiratory illness. Introduction To analyze the effect of the COVID-19 pandemic on the provision of fragility hip fracture care, comparing patients treated before cohorting and in separate COVID-19 and non-COVID-19 circuits with the corresponding months in 2018 and 2019. Materials and methods Retrospective single-center cohort study including 64 patients with fragility hip fractures treated during the COVID-19 pandemic (March 1st–May 1st, 2020), compared to 172 patients treated in 2018 and 2019. Dedicated COVID-19 and non-COVID-19 circuits were established on March 14th. Patients treated before cohorting (17 patients), in COVID-19 (14 patients) and non-COVID-19 circuits (33 patients) were included. Results Baseline characteristics were similar for 2018–19 and 2020. Patients in 2020 had a lower median surgical delay (50.5 vs. 91.3 h) and length of stay (9.0 vs. 14.0 days), while those with COVID-19, had longer surgical delays and length of stay (87.7 h and 15.0 days, respectively). Thirty-days mortality was higher among patients before cohorting, but similar in Covid-19 and non-Covid-19 pathways compared to 2018–19 (7.1% and 3.0% vs 5.2%, respectively). 23.5% of patients treated before circuiting suffered coronavirus infectious disease-19 disease after discharge. Following separation, no secondary cases of coronavirus infectious disease-19 were observed. Conclusions Separate circuits for patients with and without coronavirus infectious disease-19 provided adequate hip fracture care. We did not observe increased mortality rates among hip fracture patients with preoperatively confirmed or suspected coronavirus infectious disease-19, compared to negative cases and 2018–19. Delaying surgery among patients with severe respiratory illness until a favourable trend could be observed did not lead to increased mortality.