1414 The Impact Of COVID-19 On Individuals with Neck of Femur Fracture in The United Kingdom: A Systematic Review and Meta-analysis

Abstract Aim All Neck of Femur fracture patients have a significant 30 – day mortality despite efforts to improve their outcomes. Incidence of NOF cases remained high during the pandemic in the UK and as a result numerus cases were complicated with SARS-CoV-2 infection. We performed a systematic review and meta-analysis of all UK published studies related to NOF fractures and 30-day mortality outcomes during the COVID 19 pandemic. Method A systematic review and meta-analysis was performed and reported as per the PRISMA checklist. Two reviewers independently searched on Medline for UK studies that were published between 1stof March 2020 and 1stof November 2020. Outcomes compared were 30-day mortality, time to surgery and anaesthetic risk. Results A total of 5 articles were included in our study. These studies were all case series with evidence level 3 or 4. A total of 286 patients complicated with COVID infection with a range of 30-day mortality 30.5%-50%. OR 6.02(95CI: 4.10-8.85), Chi24.82, I2 58%. Increased time to surgery due to Coronavirus related delays was also noted for the majority of studies. Mortality scores (Charlson Comorbidity Index, Nottingham Hip fracture score) failed to accurately predict the mortality risk. Conclusions Concurrent infection of COVID -19 in patients with NOF fractures increases the 30-day mortality 6 times compared to the negative group. Efforts should be made to optimise time to surgery as well as postoperative care via higher dependency units. Updates in mortality predicting scores is deemed necessary to include the SARS-CoV-2 infection as a factor.

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The effect of time to surgery in neck of femur fracture patients with ASA Grade of 3 and above

Hip International ◽

10.1177/1120700020972025 ◽

2020 ◽

pp. 112070002097202

Author(s):

Hiba Khan ◽

Al-Achraf Khoriati ◽

Stefan Lazic ◽

Jack Navein ◽

Ritesh Sharma ◽

...

Keyword(s):

High Risk ◽

Femur Fracture ◽

Mortality Rates ◽

Time Frame ◽

Neck Of Femur ◽

Time To Surgery ◽

Femur Fractures ◽

American Society ◽

Neck Of Femur Fracture ◽

The Impact

Introduction: Hip fractures are an important cause of morbidity and mortality. Early surgery has been shown to reduce mortality rates and surgical complications. The American Society of Anesthesiologists (ASA) grade is a widely used tool to assess preoperative health of patients. This study aims to assess is whether delay in surgical time has a greater impact on the mortality rates for high risk patients. Method: Retrospective study using the National Hip Fracture Database (NHFD) of 4883 neck of femur fracture patients. Time of surgery, ASA grade, reason for delay and mortality at 120 days was analysed, using statistical analysis software. Results: There was a significant increase in mortality ( p < 0.001) with increasing ASA grade. Surgical delays of more than 36 hours increased mortality by 2.9%. The impact of delaying surgery became more pronounced as the ASA grade increased. ASA 3 and above had an optimum time to surgery of between 12 and 24 hours giving the statistically significant lowest mortality rate ( p = 0.004). Discussion: Surgical delay beyond the 36-hour target for surgery has a greater impact on mortality for patients with higher ASA grades. The effect is most profound in the high-risk ASA grade 5 patients with delayed patients showing a 37.5% increase in mortality in this group. This would imply that by prioritising this higher risk group and operating on it within a specific time frame there would be a subsequent fall in mortality associated with neck of femur fractures.

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Meta-analysis Comparing Total Hip Arthroplasty With Hemiarthroplasty in the Treatment of Displaced Neck of Femur Fracture

The Journal of Arthroplasty ◽

10.1016/j.arth.2007.12.009 ◽

2009 ◽

Vol 24 (3) ◽

pp. 400-406 ◽

Cited By ~ 37

Author(s):

Seo-Kiat Goh ◽

Miny Samuel ◽

David Hsien Ching Su ◽

Edwin Shih-Yen Chan ◽

Seng-Jin Yeo

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femur Fracture ◽

Meta Analysis ◽

Neck Of Femur ◽

Total Hip ◽

Neck Of Femur Fracture

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Abstract 20116: The Impact of Atrial Fibrillation Type on the Risk of Thromboembolism, Mortality and Bleeding: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.132.suppl_3.20116 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Anand Ganesan ◽

Derek Chew ◽

Trent Hartshorne ◽

Joseph B Selvanayagam ◽

Philip Aylward ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Risk Ratio ◽

Meta Analysis ◽

Case Series ◽

Outcome Data ◽

Risk Models ◽

Thromboembolic Risk ◽

All Cause Mortality ◽

The Impact

Introduction: Thromboembolic risk stratification schemes and clinical guidelines for atrial fibrillation regard risk as independent of classification into paroxysmal (PAF) and nonparoxysmal atrial fibrillation (NPAF). The aim of the current study was to conduct a systematic review and meta-analysis evaluating the impact of AF type on thromboembolism, bleeding and mortality. Hypothesis: AF type would predict rates of thromebolism, mortality and bleeding. Methods: Pubmed was searched for randomized controlled trials, cohort studies, and case series reporting prospectively collected clinical outcomes stratified by AF type. The incidence of thromboembolism, mortality and bleeding was extracted. Results: AF clinical outcome data was extracted from 12 studies containing 99,996 patients. The pooled unadjusted risk ratio (RR) for thromboembolism in NPAF vs. PAF was RR 1.339 (95% CI: 1.140-1.644, P<0.001). In studies providing estimates of thromboembolism risk adjusted for baseline clinical risk factors, the pooled adjusted hazard ratio (HR) in NPAF vs. PAF was HR 1.384 (95% CI, 1.191-1.608, P<0.001). The pooled unadjusted risk ratio for all-cause mortality in NPAF vs. PAF was RR 1.462 (95% CI: 1.255-1.703 P<0.001). The pooled adjusted HR for all-cause mortality in NPAF vs. PAF was HR 1.217 (95% CI: 1.085-1.365, P<0.001. Rates of bleeding in NPAF and PAF were similar, unadjusted RR 1.00 (95% CI 0.919-1.087, P=0.994), pooled adjusted HR 1.025 (95% CI: 0.898-1.170, P=0.715). Conclusions: These data suggest a need for re-evaluation of the paradigm of thromboembolic risk equivalence between PAF and NPAF, and emphasize AF type as a powerful predictor of AF-related morbidity and mortality. Future studies exploring integration of AF type into thromboembolic risk models are needed.

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The impact of COVID-19 on morbidity and mortality in neck of femur fracture patients

Bone & Joint Open ◽

10.1302/2633-1462.111.bjo-2020-0141.r1 ◽

2020 ◽

Vol 1 (11) ◽

pp. 669-675

Author(s):

Alex E. Ward ◽

Daniel Tadross ◽

Fiona Wells ◽

Lawrence Majkowski ◽

Umna Naveed ◽

...

Keyword(s):

Acute Kidney Injury ◽

Length Of Stay ◽

Bacterial Pneumonia ◽

Femur Fracture ◽

Kidney Injury ◽

High Rate ◽

Neck Of Femur ◽

Increased Risk ◽

Neck Of Femur Fracture ◽

The Impact

Aims Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients. Methods All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality. Results Overall, 132 patients were included. Of these, 34.8% (n = 46) were diagnosed with COVID-19. Bacterial pneumonia was observed at a significantly higher rate in those patients with COVID-19 (56.5% vs 15.1%; p =< 0.000). Non respiratory complications such as acute kidney injury (30.4% vs 9.3%; p =0.002) and urinary tract infection (10.9% vs 3.5%; p =0.126) were also more common in those patients with COVID-19. Length of stay was increased by a median of 21.5 days in patients diagnosed with COVID-19 (p < 0.000). 30-day mortality was significantly higher in patients with COVID-19 (37.0%) when compared to those without (10.5%; p <0.000). Conclusion This study has shown that patients with a neck of femur fracture have a high rate of mortality and complications such as bacterial pneumonia and acute kidney injury when diagnosed with COVID-19 within the perioperative period. We have demonstrated the high risk of in hospital transmission of COVID-19 and the association between the infection and an increased length of stay for the patients affected. Cite this article: Bone Joint Open 2020;1-11:669–675.

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Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-018027 ◽

2017 ◽

Vol 7 (9) ◽

pp. e018027 ◽

Cited By ~ 5

Author(s):

Maite Ruiz-Goikoetxea ◽

Samuele Cortese ◽

Maite Aznarez-Sanado ◽

Sara Magallon ◽

Elkin O Luis ◽

...

Keyword(s):

Systematic Review ◽

Linear Mixed Model ◽

Meta Analysis ◽

Case Series ◽

Sensitivity Analyses ◽

Bibliographic Databases ◽

Unintentional Injuries ◽

Generalised Linear Mixed Model ◽

Adhd Medications ◽

The Impact

IntroductionAttention-deficit hyperactivity disorder (ADHD) has been related to increased rates of unintentional injuries. However, the magnitude of the effect and to which extent variables such as sex, age or comorbidity can influence this relationship is unknown. Additionally, and importantly, it is unclear if, and to which degree, ADHD medications can decrease the number of unintentional injuries. Due to the amount of economic and social resources invested in the treatment of injuries, filling these gaps in the literature is highly relevant from a public health standpoint. Here, we present a protocol for a systematic review and meta-analysis to estimate the relationship between ADHD and unintentional injuries and assess the impact of pharmacological treatment for ADHDMethods and analysisWe will combine results from 114 bibliographic databases for studies relating ADHD and risk of injuries. Bibliographic searches and data extraction will be carried out independently by two researchers. The studies’ risk of bias will be assessed using the Newcastle-Ottawa Scale. Articles reporting ORs or HRs of suffering an injury in ADHD compared with controls (or enough data to calculate them) will be combined using Robust Variance Estimation, a method that permits to include multiple non-independent outcomes in the analysis. All analyses will be carried out in Stata. Age, sex and comorbid conduct disorders will be considered as potential causes of variance and their effect analysed through meta-regression and subgroup analysis. Sensitivity analyses will exclude articles with longer follow-ups, non-stringent definitions of ADHD or controls and statistically uncontrolled/controlled outcomes. Studies implementing a self-controlled case series methodology to investigate if ADHD drugs reduce the risk of injuries will be combined with a generalised linear mixed model using the Poisson distribution and a log link function.Registration detailsPROSPERO—Prospective Register of Systematic Reviews (CRD42017064967)

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1671 The Effect Of COVID-19 On the Management and Outcome of Neck of Femur Fractures in A District General Hospital - A Comparative Study

British Journal of Surgery ◽

10.1093/bjs/znab259.1066 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P Linardatou Novak ◽

B Davies ◽

A Bacon ◽

A MacDowell

Keyword(s):

Length Of Stay ◽

Femur Fracture ◽

Average Length ◽

Multidisciplinary Care ◽

District General Hospital ◽

Neck Of Femur ◽

Time To Surgery ◽

Average Length Of Stay ◽

Femur Fractures ◽

Neck Of Femur Fracture

Abstract Aim We wanted to see how the virus has impacted the management and outcome of our neck of femur fracture patients during Spring 2020. Method We performed a retrospective study of all neck of femur fracture patients presenting to our hospital from 23rd March 2020 (start of official lockdown in UK) until the end of May 2020 and compared them to patients presenting in the same time period in 2019. We recorded patient demographics, COVID-19 swab results, time to surgery, length of stay, transfers between wards, and 30-day mortality rates. Results We identified 75 patients in 2020 compared to 88 in 2019. Average length of stay was 11.4 days compared to 14.3 a year earlier. Mean time to surgery was 32.3 hours compared to 31.6 in 2019. The 30-day mortality increased significantly from 5.7% (5/88) in 2019 to 16% (12/75) in 2020 (p < 0.05) From 73 patients tested for COVID-19, 3 had a positive swab. Of these, 2 died. During their admission, 14 patients were transferred to 3 or more wards; in this group, 30-day mortality was 42.9% (6/14). Conclusions There has been a significant increase in 30-day mortality during COVID-19. Despite maintaining our time to surgery and reducing overall length of stay, we saw an increase in mortality, associated with multiple ward transfers rather than a high number of COVID-19 positive swab cases. Changes in pathways and wards configurations led to some patients requiring multiple transfers. This can cause difficulties in coordinated, multidisciplinary care for patients with NOF Fractures.

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The impact of COVID-19 on 30-day mortality in patients with neck of femur fractures

Bone & Joint Open ◽

10.1302/2046-3758.17.bjo-2020-0066.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 326-329 ◽

Cited By ~ 1

Author(s):

James E. Archer ◽

Siddhant Kapoor ◽

Danielle Piper ◽

Abdulrahman Odeh

Keyword(s):

Hip Fracture ◽

Femur Fracture ◽

Early Mobilization ◽

Early Assessment ◽

Optimal Care ◽

Neck Of Femur ◽

Hip Fracture Surgery ◽

Femur Fractures ◽

Neck Of Femur Fracture ◽

The Impact

Aims The COVID-19 pandemic presents a significant threat to patients with neck of femur fractures. The 30-day mortality for these patients has gradually been reducing in the UK due to a multitude of inputs aimed at improving their outcomes. We provided an early assessment of 30-day mortality in neck of femur fracture patients who contracted COVID-19. Methods We identified 18 patients who were admitted from three acute hospital sites who underwent an operation for a neck of femur fracture and were diagnosed with COVID-19 between 25 March and 25 April 2020. We collected information on their age, American Association of Anesthesiologists (ASA) grade, diagnosis, surgical procedure, complications, and 30-day mortality. Results Our study identified 18 patients who were all diagnosed with a positive swab result during the postoperative period. Female patients made up two-thirds of the patient cohort and the mean age of patients was 82 years (55 to 101). In all, ten patients sustained intracapsular fractures with eight sustaining extracapsular fractures. The 30-day mortality in this group of patients was 22.2% as compared to 4% 30-day mortality in those without COVID-19. Conclusion Our results show a 30-day mortality of 22.2%, which is higher than the national average provided by the 2019 National Hip Fracture Database report. However, while 30-day mortality has increased in those patients with COVID-19, this should not impact upon the provision of hip fracture surgery as it provides significant benefits to the patient such as pain relief and early mobilization. However, the information presented in this study should form an important part of the informed consent process for surgery. A multidisciplinary approach is crucial in ensuring optimal care for this complex patient group. Cite this article: Bone Joint Open 2020;1-7:326–329.

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