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. 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.

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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

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