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. 2020 Dec;9(12):873-883.
doi: 10.1302/2046-3758.912.BJR-2020-0473.R1.

The prevalence, mortality, and associated risk factors for developing COVID-19 in hip fracture patients: a systematic review and meta-analysis

Nicholas D Clement  1 , Nathan Ng  1 , Cameron J Simpson  1 , Robyn F L Patton  2 , Andrew James Hall  1   3 , A Hamish R W Simpson  3 , Andrew D Duckworth  1   3
Affiliations

The prevalence, mortality, and associated risk factors for developing COVID-19 in hip fracture patients: a systematic review and meta-analysis

Nicholas D Clement et al. Bone Joint Res. 2020 Dec.

Abstract

Aims: The aims of this meta-analysis were to assess: 1) the prevalence of coronavirus disease 2019 (COVID-19) in hip fracture patients; 2) the associated mortality rate and risk associated with COVID-19; 3) the patient demographics associated with COVID-19; 4) time of diagnosis; and 5) length of follow-up after diagnosis of COVID-19.

Methods: Searches of PubMed, Medline, and Google Scholar were performed in October 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Search terms included "hip", "fracture", and "COVID-19". The criteria for inclusion were published clinical articles reporting the mortality rate associated with COVID-19 in hip fracture patients. In total, 53 articles were identified and following full text screening 28 articles satisfied the inclusion criteria.

Results: A total of 28 studies reported the mortality of COVID-19-positive patients, of which 21 studies reported the prevalence of COVID-19-positive patients and compared the mortality rate to COVID-19-negative patients. The prevalence of COVID-19 was 13% (95% confidence interval (CI) 11% to 16%) and was associated with a crude mortality rate of 35% (95% CI 32% to 39%), which was a significantly increased risk compared to those patients without COVID-19 (odds ratio (OR) 7.11, 95% CI 5.04 to 10.04; p < 0.001). COVID-19-positive patients were more likely to be male (OR 1.51, 95% CI 1.16 to 1.96; p = 0.002). The duration of follow-up was reported in 20 (71.4%) studies. A total of 17 studies reported whether a patient presented with COVID-19 (n = 108 patients, 35.1%) or developed COVID-19 following admission (n = 200, 64.9%), of which six studies reported a mean time to diagnosis of post-admission COVID-19 at 15 days (2 to 25).

Conclusion: The prevalence of COVID-19 was 13%, of which approximately one-third of patients were diagnosed on admission, and was associated with male sex. COVID-19-positive patients had a crude mortality rate of 35%, being seven times greater than those without COVID-19. Due to the heterogenicity of the reported data minimum reporting standards of outcomes associated with COVID-19 are suggested. Cite this article: Bone Joint Res 2020;9(12):873-883.

Keywords: COVID-19; Fracture; Hip; Mortality; Outcome.

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Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flow diagram for the studies identified and included in the review. NOF, neck of femur fracture; T&O, Trauma and Orthopaedics.
Fig. 2
Fig. 2
Prevalence of coronavirus disease 2019 (COVID-19) according to the 21 studies that included data for COVID-19-positive and -negative patients. CI, confidence interval.
Fig. 3
Fig. 3
Crude mortality rate of hip fracture patients with coronavirus disease 2019 (COVID-19) according to the 28 included studies. CI, confidence interval.
Fig. 4
Fig. 4
Mortality risk associated with coronavirus disease 2019 (COVID-19) in hip fracture patients according to the 21 studies that included data for COVID-19-positive and -negative patients. CI, confidence interval; M-H, Mantel-Haenszel.
Fig. 5
Fig. 5
Six studies that reported the age and SD of both coronavirus disease 2019 (COVID-19)-positive and -negative patients were in the meta-analysis, and assessed whether there was an association of age with a positive diagnosis of COVID-19 in hip fracture patients. CI, confidence interval; IV, inverse variance.
Fig. 6
Fig. 6
Nine studies that reported the sex of both coronavirus disease 2019 (COVID-19)-positive and negative patients were in the meta-analysis, and were assessed for an association with a positive diagnosis of COVID-19 in hip fracture patients. CI, confidence interval; M-H, Mantel-Haenszel.
Fig. 7
Fig. 7
Kaplan–Meier survival curves for patients with (n=68, red line) and without (n=1501, black line) perioperative coronavirus disease 2019 (COVID-19) perioperatively, using data from Clement et al. The grey, purple, and orange lines indicate hypothesized seven, 14, and 21 day delays in time of acquiring COVID-19, respectively. This graph shows the effect on the rate of 30- and 60-day mortality rates, with an approximate variation of 10% in cumulative survival rates.
See this image and copyright information in PMC

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