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Review
. 2020 Nov-Dec:22:584-591.
doi: 10.1016/j.jor.2020.11.012. Epub 2020 Nov 17.

Early mortality after hip fracture surgery in COVID-19 patients: A systematic review and meta-analysis

Kevin C Wang  1 , Ryan Xiao  1 , Zoe B Cheung  1 , Joseph P Barbera  1 , David A Forsh  1
Affiliations
Review

Early mortality after hip fracture surgery in COVID-19 patients: A systematic review and meta-analysis

Kevin C Wang et al. J Orthop. 2020 Nov-Dec.

Abstract

Objective: The aim of this systematic review and meta-analysis was to assess the risk of early mortality in hip fracture patients with COVID-19 infection who undergo surgical intervention.

Data sources: MEDLINE (PubMed) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases.

Study selection: Studies were included in the systematic review if they reported postoperative mortality in patients with COVID-19 infection who underwent operative intervention for hip fracture. From this selection of studies, only investigations that reported postoperative mortality in a COVID-positive and a non-COVID group were included in the meta-analysis.

Data extraction: Data regarding patient demographics, age, and sex were recorded. Additional data that was extracted included study location, data collection period, length of follow-up, COVID testing methodology, COVID testing results, and number of patients who underwent operative versus nonoperative management. The primary outcome of interest was postoperative mortality.

Data synthesis: Random effects meta-analyses were performed to assess the pooled relative risk of postoperative mortality according to COVID status. Odds ratios and 95% confidence intervals (CI) were calculated.

Conclusions: The overall pooled mortality rate in the early postoperative period for hip fracture patients with concomitant COVID-19 infection was 32.6%. The relative risk for postoperative mortality in COVID-positive patients compared to non-COVID patients was 5.66 (95% CI 4.01-7.98; p < 0.001). The currently available literature demonstrates that COVID-19 infection represents a substantial risk factor for early postoperative mortality in the already susceptible hip fracture population. Further investigations will be needed to assess longer-term morbidity and mortality in this patient population.

Level of evidence: Therapeutic Level IV.

Keywords: COVID-19; Coronavirus; Hip fracture; Mortality; Pandemic.

PubMed Disclaimer

Conflict of interest statement

Dr. Forsh has financial relationships with Stryker (paid consultant). None of the other authors have any financial interests or affiliations with institutions, organizations, or companies relevant to the manuscript. None of the authors received payment or funding support in kind for any aspect of the submitted work.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram outlining the search strategy.
Fig. 2
Fig. 2
Forest plot of postoperative mortality in COVID+ versus non-COVID hip fracture patients.
Fig. 3
Fig. 3
Forest plot of postoperative mortality in hip fracture patients with COVID+ testing versus COVID- testing.
Fig. 4
Fig. 4
Forest plot of postoperative mortality with less than 30-day follow-up in hip fracture patients with COVID+ testing versus COVID- testing.
Fig. 5
Fig. 5
Forest plot of postoperative mortality with a minimum 30-day follow-up in hip fracture patients with COVID+ testing versus COVID- testing.
Fig. 6
Fig. 6
Funnel plot of included studies demonstrating no apparent publication bias.
Fig. 7
Fig. 7
Risk of bias in the included studies according to the OHATS criteria.
See this image and copyright information in PMC

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