Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;20(3):705-717.
doi: 10.1002/msc.1674. Epub 2022 Aug 5.

COVID-19 during the index hospital admission confers a 'double-hit' effect on hip fracture patients and is associated with a two-fold increase in 1-year mortality risk

Andrew J Hall  1   2   3   4   5 , Nicholas D Clement  1   3   4 ; IMPACT Revisited Group; Alasdair M J MacLullich  2   4   6 , Timothy O White  1   3 , Andrew D Duckworth  1   2   3
Affiliations

COVID-19 during the index hospital admission confers a 'double-hit' effect on hip fracture patients and is associated with a two-fold increase in 1-year mortality risk

Andrew J Hall et al. Musculoskeletal Care. 2022 Sep.

Abstract

Purpose: The aims were to: (1) determine 1-year mortality rates for hip fracture patients during the first UK COVID-19 wave, and (2) assess mortality risk associated with COVID-19.

Methods: A nationwide multicentre cohort study was conducted of all patients presenting to 17 hospitals in March-April 2020. Follow-up data were collected one year after initial hip fracture ('index') admission, including: COVID-19 status, readmissions, mortality, and cause of death.

Results: Data were available for 788/833 (94.6%) patients. One-year mortality was 242/788 (30.7%), and the prevalence of COVID-19 within 365 days of admission was 142/788 (18.0%). One-year mortality was higher for patients with COVID-19 (46.5% vs. 27.2%; p < 0.001), and highest for those COVID-positive during index admission versus after discharge (54.7% vs. 39.7%; p = 0.025). Anytime COVID-19 was independently associated with 50% increased mortality risk within a year of injury (HR 1.50, p = 0.006); adjusted mortality risk doubled (HR 2.03, p < 0.001) for patients COVID-positive during index admission. No independent association was observed between mortality risk and COVID-19 diagnosed following discharge (HR 1.16, p = 0.462). Most deaths (56/66; 84.8%) in COVID-positive patients occurred within 30 days of COVID-19 diagnosis (median 11.0 days). Most cases diagnosed following discharge from the admission hospital occurred in downstream hospitals.

Conclusion: Almost half the patients that had COVID-19 within 365 days of fracture had died within one year of injury versus 27.2% of COVID-negative patients. Only COVID-19 diagnosed during the index admission was associated independently with an increased likelihood of death, indicating that infection during this time may represent a 'double-hit' insult, and most COVID-related deaths occurred within 30 days of diagnosis.

Keywords: COVID-19; audit; frailty; hip fracture; mortality; nosocomial; orthopaedics.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflict of interest or financial/non‐financial interests related to this work.

Figures

FIGURE 1
FIGURE 1
Timing of positive COVID‐19 cases and the duration of survival from date of COVID‐19 diagnosis
FIGURE 2
FIGURE 2
Kaplan‐Meier curve for survival at 365 days following index admission date according to COVID‐19 status (Negative = red line, Positive = blue line). Log rank p < 0.0001; 72.8% versus 53.5% survival at 365 days
FIGURE 3
FIGURE 3
Kaplan‐Meier curve for survival at 365 days following index admission date according to COVID‐19 status. Survival at 365 days: 72.8% for COVID‐Negative (red line); 45.3% for COVID‐Positive During Index Stay (green line), and 60.3% for COVID‐Positive After Index Stay (blue line). Log rank tests demonstrated a significant (p < 0.05) difference between each of the groups
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. BGS . (2020). COVID‐19: Managing the COVID‐19 pandemic in care homes for older people. British Geriatrics Society (BGS).
    1. Caldicott, F. (1999). The Caldicott report. IHRIM, 40(2), 17–19. - PubMed
    1. Clement, N. D. , Hall, A. J. , Kader, N. , Ollivere, B. , Oussedik, S. , Kader, D. F. , Deehan, D. J. , & Duckworth, A. D. (2021). The rate of COVID‐19 and associated mortality after elective hip and knee arthroplasty prior to cessation of elective services in UK. The Bone & Joint Journal, 103‐B(4), 681–688. 10.1302/0301-620X.103B.BJJ-2020-1776.R1 - DOI - PubMed
    1. Clement, N. D. , Hall, A. J. , Makaram, N. S. , Robinson, P. G. , Patton, R. F. L. , Moran, M. , Macpherson, G. J. , Duckworth, A. D. , & Jenkins, P. J. (2020). IMPACT‐restart: The influence of COVID‐19 on postoperative mortality and risk factors associated with SARS‐CoV‐2 infection after orthopaedic and trauma surgery. The Bone & Joint Journal, 102‐B(12), 1774–1781. 10.1302/0301-620X.102B12.BJJ-2020-1395.R2 - DOI - PubMed
    1. Clement, N. D. , Ng, N. , Simpson, C. J. , Patton, R. F. L. , Hall, A. J. , Simpson, A. H. R. W. , & Duckworth, A. D. (2020). The prevalence, mortality, and associated risk factors for developing COVID‐19 in hip fracture patients: A systematic review and meta‐analysis. Bone and Joint Research, 9(12), 873–883. 10.1302/2046-3758.912.BJR-2020-0473.R1 - DOI - PMC - PubMed