Hip & pelvis

  • 제34권1호
  • /
  • Pages.25-34
  • /
  • 2022
  • /
  • 2287-3260(pISSN)
  • /
  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
권호 표지
DOI QR코드

DOI QR Code

Survivorship Analysis in Asymptomatic COVID-19+ Hip Fracture Patients: Is There an Increase in Mortality?

  • Mason D. Vialonga (Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health) ;
  • Luke G. Menken (Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health) ;
  • Alex Tang (Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health) ;
  • John W. Yurek (Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health) ;
  • Li Sun (Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health) ;
  • John J. Feldman (Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health) ;
  • Frank A. Liporace (Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health) ;
  • Richard S. Yoon (Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health)
  • 투고 : 2021.09.20
  • 심사 : 2022.01.14
  • 발행 : 2022.03.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Mortality rates following hip fracture surgery have been well-studied. This study was conducted to examine mortality rates in asymptomatic patients presenting for treatment of acute hip fractures with concurrent positive COVID-19(+) tests compared to those with negative COVID-19(-) tests. Materials and Methods: A total of 149 consecutive patients undergoing hip fracture surgery during the COVID-19 pandemic at two academic medical centers were reviewed retrospectively. Patients were divided into two groups for comparative analysis: one group included asymptomatic patients with COVID-19+ tests versus COVID-19- tests. The primary outcome was mortality at 30-days and 90-days. Results: COVID-19+ patients had a higher mortality rate than COVID-19- patients at 30-days (26.7% vs 6.0%, P=0.005) and 90-days (41.7% vs 17.2%, P=0.046) and trended towards an increased length of hospital stay (10.1±6.2 vs 6.8±3.8 days, P=0.06). COVID-19+ patients had more pre-existing respiratory disease (46.7% vs 11.2%, P=0.0002). Results of a Cox regression analysis showed an increased risk of mortality at 30-days and 90-days from COVID-19+ status alone without an increased risk of death in patients with pre-existing chronic respiratory disease. Conclusion: Factors including time to surgery, age, preexisting comorbidities, and postoperative ambulatory status have been proven to affect mortality and complications in hip fracture patients; however, a positive COVID-19 test result adds another variable to this process. Implementation of protocols that will promote prompt orthogeriatric assessments, expedite patient transfer, limit operating room traffic, and optimize anesthesia time can preserve the standard of care in this unique patient population.

키워드

참고문헌

  1. Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med. 2010;3:1-17.  https://doi.org/10.2147/IJGM.S5906
  2. Rapp K, Buchele G, Dreinhofer K, Bucking B, Becker C, Benzinger P. Epidemiology of hip fractures: systematic literature review of German data and an overview of the international literature. Z Gerontol Geriatr. 2019;52:10-6.  https://doi.org/10.1007/s00391-018-1382-z
  3. Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury. 2008;39:1157-63.  https://doi.org/10.1016/j.injury.2008.03.022
  4. Parker M, Johansen A. Hip fracture. BMJ. 2006;333:27-30.  https://doi.org/10.1136/bmj.333.7557.27
  5. Stevens JA, Rudd RA. The impact of decreasing U.S. hip fracture rates on future hip fracture estimates. Osteoporos Int. 2013;24:2725-8.  https://doi.org/10.1007/s00198-013-2375-9
  6. Guzon-Illescas O, Perez Fernandez E, Crespi Villarias N, et al. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019;14:203. 
  7. Abate SM, Mantefardo B, Basu B. Postoperative mortality among surgical patients with COVID-19: a systematic review and meta-analysis. Patient Saf Surg. 2020;14:37. 
  8. Doglietto F, Vezzoli M, Gheza F, et al. Factors associated with surgical mortality and complications among patients with and without coronavirus disease 2019 (COVID-19) in Italy. JAMA Surg. 2020;155:691-702.  https://doi.org/10.1001/jamasurg.2020.2713
  9. Price A, Shearman AD, Hamilton TW, Alvand A, Kendrick B; COVID-19 NOC Surgical Team. 30-day outcome after orthopaedic surgery in patients assessed as negative for COVID-19 at the time of surgery during the peak of the pandemic. Bone Jt Open. 2020;1:474-80.  https://doi.org/10.1302/2633-1462.18.BJO-2020-0119.R1
  10. Massey PA, McClary K, Zhang AS, Savoie FH, Barton RS. Orthopaedic surgical selection and inpatient paradigms during the coronavirus (COVID-19) pandemic. J Am Acad Orthop Surg. 2020;28:436-50.  https://doi.org/10.5435/JAAOS-D-20-00360
  11. Arafa M, Nesar S, Abu-Jabeh H, Jayme MOR, Kalairajah Y. COVID-19 pandemic and hip fractures: impact and lessons learned. Bone Jt Open. 2020;1:530-40.  https://doi.org/10.1302/2633-1462.19.BJO-2020-0116.R1
  12. Al Farii H, Al Rawahi S, Samaila E, Lavini F, Magnan B, Al Maskari S. Thirty-day mortality in COVID-19 positive patients with hip fractures: a case-series and literature review. Geriatr Orthop Surg Rehabil. 2020;11:2151459320972681. 
  13. Dupley L, Oputa TJ, Bourne JT. 30-day mortality for fractured neck of femur patients with concurrent COVID-19 infection. Eur J Orthop Surg Traumatol. 2021;31:341-7.  https://doi.org/10.1007/s00590-020-02778-0
  14. Wong AW, Fidler L, Marcoux V, et al. Practical considerations for the diagnosis and treatment of fibrotic interstitial lung disease during the coronavirus disease 2019 pandemic. Chest. 2020;158:1069-78.  https://doi.org/10.1016/j.chest.2020.04.019
  15. George PM, Wells AU, Jenkins RG. Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy. Lancet Respir Med. 2020;8:807-15.  https://doi.org/10.1016/S2213-2600(20)30225-3
  16. Gallay L, Uzunhan Y, Borie R, et al. Risk factors for mortality after COVID-19 in patients with preexisting interstitial lung disease. Am J Respir Crit Care Med. 2021;203:245-9.  https://doi.org/10.1164/rccm.202007-2638LE
  17. Carretta E, Bochicchio V, Rucci P, Fabbri G, Laus M, Fantini MP. Hip fracture: effectiveness of early surgery to prevent 30- day mortality. Int Orthop. 2011;35:419-24.  https://doi.org/10.1007/s00264-010-1004-x
  18. Cheung ZB, Forsh DA. Early outcomes after hip fracture surgery in COVID-19 patients in New York City. J Orthop. 2020;21:291-6.  https://doi.org/10.1016/j.jor.2020.06.003
  19. Malik-Tabassum K, Crooks M, Robertson A, To C, Maling L, Selmon G. Management of hip fractures during the COVID-19 pandemic at a high-volume hip fracture unit in the United Kingdom. J Orthop. 2020;20:332-7.  https://doi.org/10.1016/j.jor.2020.06.018
  20. Formiga F, Lopez-Soto A, Sacanella E, Coscojuela A, Suso S, Pujol R. Mortality and morbidity in nonagenarian patients following hip fracture surgery. Gerontology. 2003;49:41-5.  https://doi.org/10.1159/000066501
  21. Zuckerman JD. Hip fracture. N Engl J Med. 1996;334:1519-25.  https://doi.org/10.1056/NEJM199606063342307
  22. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302:1573-9.  https://doi.org/10.1001/jama.2009.1462
  23. Bonanad C, Garcia-Blas S, Tarazona-Santabalbina F, et al. The effect of age on mortality in patients with COVID-19: a meta-analysis with 611,583 subjects. J Am Med Dir Assoc. 2020;21:915-8.  https://doi.org/10.1016/j.jamda.2020.05.045
  24. von Friesendorff M, McGuigan FE, Wizert A, et al. Hip fracture, mortality risk, and cause of death over two decades. Osteoporos Int. 2016;27:2945-53.  https://doi.org/10.1007/s00198-016-3616-5
  25. Soreide K, Hallet J, Matthews JB, et al. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg. 2020;107:1250-61.  https://doi.org/10.1002/bjs.11670
  26. Shah S, Diwan S, Kohan L, et al. The technological impact of COVID-19 on the future of education and health care delivery. Pain Physician. 2020;23(4S):S367-80.  https://doi.org/10.36076/ppj.2020/23/S367
  27. 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;34:395-402.  https://doi.org/10.1097/BOT.0000000000001845
  28. Grassi A, Andriolo L, Golinelli D, et al. Higher 90-day mortality after surgery for hip fractures in patients with COVID19: a case-control study from a single center in Italy. Int J Environ Res Public Health. 2021;18:5205. 
  29. Wang KC, Xiao R, Cheung ZB, Barbera JP, Forsh DA. Early mortality after hip fracture surgery in COVID-19 patients: a systematic review and meta-analysis. J Orthop. 2020;22:584-91. https://doi.org/10.1016/j.jor.2020.11.012