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
. 2022 Dec;20(6):e429-e446.
doi: 10.1016/j.surge.2022.02.009. Epub 2022 Mar 28.

IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit: Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic

Andrew J Hall  1 , Nicholas D Clement  2 ; IMPACT-Global Group; Cristina Ojeda-Thies  3 , Alasdair Mj MacLullich  4 , Giuseppe Toro  5 , Antony Johansen  6 , Tim O White  7 , Andrew D Duckworth  7
Collaborators, Affiliations
Multicenter Study

IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit: Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic

Andrew J Hall et al. Surgeon. 2022 Dec.

Abstract

Aims: This international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients.

Methods: A multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1st March-31st May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded.

Results: A total of 7090 patients were included, with a mean age of 82.2 (range 50-104) years and 4959 (69.9%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) were positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p = 0.001), residential care (OR 2.15, p < 0.001), inpatient fall (OR 2.23, p = 0.003), cancer (OR 0.63, p = 0.009), ASA grades 4 (OR 1.59, p = 0.008) or 5 (OR 8.28, p < 0.001), and longer admission (OR 1.06 for each increasing day, p < 0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p < 0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p < 0.001). Increasing age (HR 1.03, p = 0.028), male sex (HR 2.35, p < 0.001), renal disease (HR 1.53, p = 0.017), and pulmonary disease (HR 1.45, p = 0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders.

Conclusion: The prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality risk. Among COVID-19-positive patients, those who were older, male, with renal or pulmonary disease had a significantly higher 30-day mortality risk.

Keywords: Audit; COVID-19; Communicable disease; Frailty; Geriatric; Hip fracture; Infection; Meta-audit; Nosocomial; Orthopaedic; Outcomes; Prognosis; Reporting standards; Risk; Trauma.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart showing all patients, included and excluded patients, mortality outcomes according to COVID-19 status, and distribution of patients from participating nations.
Fig. 2
Fig. 2
Kaplan Meier curve for 30-day survival according to whether a patient was COVID negative (black) or COVID positive (red) within 30-days of admission. Log rank p < 0.001, 92.6% (95% CI 92.4 to 92.8) versus 72.7% (95% CI 69.4 to 76.0) at 30-days.
Fig. 3
Fig. 3
Kaplan Meier curve for 30-day survival according to whether a patient was COVID negative (black), COVID positive at admission (red) or COVID positive after admission (grey). Log rank p = 0.661, between COVID positive patients preoperatively (75.1%, 95% CI 69.4 to 80.8) versus postoperatively (71.4%, 95% CI 67.1 to 75.7) at 30-days.
Fig. 4
Fig. 4
ROC curve for lymphocyte count (grey) and albumin (black dashed) as a predictor of COVID-19 on admission. Lymphocyte: Area under the curve 60.7% (95% CI 56.7%–64.6%, p < 0.001). Threshold of 0.93 or less has 58.2% specificity and 56.6% sensitivity. Albumin: Area under the curve 61.3% (95% CI 57.5%–65.2%, p < 0.001). Threshold of 36 g/dL or less has 59.1% specificity and 57.1%sensitivity.
Fig. 5
Fig. 5
ROC curve for length of hospital stay (dashed line) as a predictor of developing COVID-19 following admission. Area under the curve 71.6% (95% CI 68.8%–74.4%, p < 0.001). Threshold of 10 days or more has 65% specificity and sensitivity.
Fig. 6
Fig. 6
Suggested reporting standards for studies investigating COVID-19 in hip fracture patients.
See this image and copyright information in PMC

References

    1. Jenkins P.J. British Orthopaedic Association (BOA); 2020. The early effect of COVID-19 on trauma and elective orthopaedic surgery.https://www.boa.ac.uk/resources/knowledge-hub/the-early-effect-of-covid-... [Internet]. BOA. [cited 2022 Jan 14]. Available from:
    1. Scott C.E., Holland G., Powell-Bowns M.F., Brennan C.M., Gillespie M., Mackenzie S.P., et al. Population mobility and adult orthopaedic trauma services during the COVID-19 pandemic: fragility fracture provision remains a priority. Bone Jt Open. 2020;1(6) - PMC - PubMed
    1. Luceri F., Morelli I., Accetta R., Mangiavini L., Maffulli N., Peretti G.M. Italy and COVID-19: the changing patient flow in an orthopedic trauma center emergency department. J Orthop Surg Res. 2020;15(1):323. doi: 10.1186/s13018-020-01816-1. - DOI - PMC - PubMed
    1. Clement N.D., Hall A.J., Makaram N.S., Robinson P.G., Patton R.F.L., Moran M., et al. IMPACT-Restart: the influence of COVID-19 on postoperative mortality and risk factors associated with SARS-CoV-2 infection after orthopaedic and trauma surgery. Bone Joint J. 2020;102-B(12):1774–1781. doi: 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., et al. The prevalence, mortality, and associated risk factors for developing COVID-19 in hip fracture patients: a systematic review and meta-analysis. Bone Jt Res. 2020;9(12):873–883. doi: 10.1302/2046-3758.912.BJR-2020-0473.R1. - DOI - PMC - PubMed

Publication types

LinkOut - more resources