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
Multicenter Study
. 2024 Jan;34(1):285-291.
doi: 10.1007/s00590-023-03620-z. Epub 2023 Jul 18.

A multi-institutional study of short-term mortality in COVID-positive patients undergoing hip fracture surgery: is survival better than expected?

Jeffrey A Foster  1 , David C Landy  2 , Richard W Pectol  2 , Ramkumar T Annamalai  3 , Arun Aneja  2 ; “COVID-ORTHO” Research Group
Collaborators, Affiliations
Multicenter Study

A multi-institutional study of short-term mortality in COVID-positive patients undergoing hip fracture surgery: is survival better than expected?

Jeffrey A Foster et al. Eur J Orthop Surg Traumatol. 2024 Jan.

Abstract

Purpose: Early reports of 30-day mortality in COVID-positive patients with hip fracture were often over 30% and were higher than historical rates of 10% in pre-COVID studies. We conducted a multi-institutional retrospective cohort study to determine whether the incidence of 30-day mortality and complications in COVID-positive patients undergoing hip fracture surgery is as high as initially reported.

Methods: A retrospective chart review was performed at 11 level I trauma centers from January 1, 2020 to May 1, 2022. Patients 50 years or older undergoing hip fracture surgery with a positive COVID test at the time of surgery were included. The primary outcome measurements were the incidence of 30-day mortality and complications. Post-operative outcomes were reported using proportions with 95% confidence interval (C.I.).

Results: Forty patients with a median age of 71.5 years (interquartile range, 50-87 years) met the criteria. Within 30-days, four patients (10%; 95% C.I. 3-24%) died, four developed pneumonia, three developed thromboembolism, and three remained intubated post-operatively. Increased age was a statistically significant predictor of 30-day mortality (p = 0.01), with all deaths occurring in patients over 80 years.

Conclusion: In this multi-institutional analysis of COVID-positive patients undergoing hip fracture surgery, 30-day mortality was 10%. The 95% C.I. did not include 30%, suggesting that survival may be better than initially reported. While COVID-positive patients with hip fractures have high short-term mortality, the clinical situation may not be as dire as initially described, which may reflect initial publication bias, selection bias introduced by testing, or other issues.

Levels of evidence: Therapeutic Level III.

Keywords: 30-day mortality; COVID;; Complications; Hip fracture surgery; Short-term mortality.

PubMed Disclaimer

Similar articles

See all similar articles

References

    1. Kirksey MA, Yang EI, Kuvadia M, Miller AO (2020) Management considerations for the COVID-19 patient with severe disease: a case scenario and literature review. HSS J 16(Suppl 1):153–159. https://doi.org/10.1007/s11420-020-09789-x - DOI - PubMed - PMC
    1. Statement on the thirteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic (2022). World Health Organization, World Health Organization
    1. Hall AJ, Clement ND, Group IR, MacLullich AMJ, White TO, Duckworth AD (2022) 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. Musculoskeletal Care 20(3):705–717. https://doi.org/10.1002/msc.1674 - DOI - PubMed - PMC
    1. Puzzitiello RN, Pagani NR, Moverman MA, Moon AS, Menendez ME, Ryan SP (2020) Inflammatory and coagulative considerations for the management of orthopaedic trauma patients with COVID-19: a review of the current evidence and our surgical experience. J Orthop Trauma 34(8):389–394. https://doi.org/10.1097/BOT.0000000000001842 - DOI - PubMed
    1. Pectol RW, Kavolus MW, Sneed CR, Albano AY, Landy DC, Aneja A, the C-Org (2022) Outcomes of reamed intramedullary nailing for lower extremity diaphyseal fractures in COVID-positive patients: a multi-institutional observational study. J Orthop Trauma 36(12):628–633. https://doi.org/10.1097/BOT.0000000000002468 - DOI - PubMed

Publication types

LinkOut - more resources