The impact of COVID-19 infection on hip fracture 30-day mortality

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

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The impact of COVID-19 infection on hip fractures 30-day mortality

Trauma ◽

10.1177/1460408620951352 ◽

2020 ◽

pp. 146040862095135

Author(s):

Ahmed Fadulelmola ◽

Rob Gregory ◽

Gavin Gordon ◽

Fiona Smith ◽

Andrew Jennings

Keyword(s):

Hip Fractures ◽

Hospital Admissions ◽

The Elderly ◽

Primary Outcome Measure ◽

Time To Death ◽

Global Pandemic ◽

Significant Difference ◽

The Mean ◽

The Impact ◽

Mean Time

Introduction A novel virus, SARS-CoV-2 has caused a fatal global pandemic which particularly affects the elderly and those with co-morbidities. Hip fractures affect elderly populations, necessitate hospital admissions, and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method Data related to seventy-five adult hip fractures admitted to two units during March and April 2020 was reviewed. The mean age was 83.5 years (range 65-98 years) and most (53, 70.7%) were females. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in COVID-19 positive group (10/20, 50%) compared to COVID-19 negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval 17.0-22.5). The mean time from admission to surgery was 43.1 hours and 38.3 hours, in COVID-19 positive and COVID-19 negative groups, respectively. All COVID-19 positive patients had shown symptoms of fever and cough, and all ten cases who died were from hypoxia. Seven (35%) cases had radiological lung findings consistent with viral pneumonitis which resulted in mortality (70% of mortality). 30% (n = 6) contracted the COVID-19 infection in the community and 70% (n = 14) developed symptoms after hospital admission. Conclusion Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest x-ray for patients presenting with hip fractures, helps in early planning of high-risk surgeries and allows counselling of the patients and family using realistic prognosis.

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Az ellenoldali csípőtáji törésig eltelt időt befolyásoló prognosztikai tényezők vizsgálata

Orvosi Hetilap ◽

10.1556/650.2018.31179 ◽

2018 ◽

Vol 159 (38) ◽

pp. 1543-1547

Author(s):

Krisztina Juhász ◽

Imre Boncz ◽

Péter Kanizsai ◽

Andor Sebestyén

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Hip Fracture ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Hip Fractures ◽

Age Groups ◽

Significant Difference ◽

Neck Fracture ◽

The Impact

Abstract: Introduction: Although several national studies reported on the risk factors for contralateral hip fracture, there are no data about the prognostic factors of the time until contralateral hip fractures. Aim: The aim of the study was to analyse the impact of different prognostic factors on the time until the development of contralateral fracture and to determine the incidence of contralateral hip fractures after femoral neck fractures. Method: Patients aged 60 years and over with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their femoral neck fracture in Hungary in 2000. Risk factors as age, sex, comorbidities, type of fracture and surgery, place of living and hospitals providing treatment for primary fracture were analysed by one way ANOVA focusing on the time until the development of contralateral hip fracture. Results: 312 patients met the inclusion criteria. The incidence of contralateral hip fracture after femoral neck fracture ranged between 1.5% and 2.1%, the cumulative incidence was 8.24%. The mean time until the development of contralateral hip fracture was 1159.8 days. The incidence of contralateral hip fracture showed no significant deviation. Significantly shorter time (p = 0.010) was detected until the contralateral hip fracture in older patients with femoral neck fracture. Conclusions: The yearly incidence of contralateral hip fracture showed no significant difference by patients with femoral neck fracture over 60 years. The shorter time until the contralateral hip fracture by the older age groups highlights the need of elaboration of prevention strategies. Orv Hetil. 2018; 159(38): 1543–1547.

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The impact of direct oral anti-coagulants on hip fracture management : a systematic review and meta-analysis

Acta Orthopaedica Belgica ◽

10.52628/87.2.17 ◽

2021 ◽

Vol 87 (2) ◽

pp. 321-326

Author(s):

Samuel Holmes ◽

Sarmad Bahnam

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Mortality Risk ◽

Meta Analysis ◽

The Elderly ◽

Operative Management ◽

Control Group ◽

Independent Analysis ◽

Fracture Management ◽

The Impact

Hip fractures are a common presentation in the elderly, a group who commonly have co-morbidities requiring the use of anticoagulants. Recently, direct oral anti-coagulants (DOAC) have become a popular method of anticoagulating patients. The primary aim of this review is to determine if the use of DOAC in elderly patients with hip fractures results in delays to theatre and/or an increased mortality risk. Major databases including Pubmed, MEDLINE and Embase were searched for relevant studies and the included studies reference lists were screened for further studies. A total of 6 studies were included in meta-analysis which was undertaken using RevMan software with 95% confidence interval (CI). Compared to control groups, patients who were anticoagulated with DOAC and required operative management of a hip fracture experienced a statistically significant delay to treatment. However independent analysis showed these patients did not experience an increased mortality risk when compared to the control group. While data is limited, treating clinicians should be comforted by these findings as operative manage- ment can be safely delayed to reduce the risk of intraoperative bleeding.

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Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318813976 ◽

2018 ◽

Vol 9 ◽

pp. 215145931881397 ◽

Cited By ~ 2

Author(s):

Aunaly Palmer ◽

Lisa A. Taitsman ◽

May J. Reed ◽

Bala G. Nair ◽

Itay Bentov

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Demographic Data ◽

Geriatric Medicine ◽

The Elderly ◽

Energy Mechanism ◽

Intraoperative Hypotension ◽

Short Term Mortality ◽

The Mean ◽

Poor Outcomes

Hip fractures result in significant morbidity and mortality in elders. Indicators of frailty are associated with poor outcomes. Commonly used frailty tools rely on motor skills that cannot be performed by this population. We determined the association between the Charlson Comorbidity Score (CCS), intraoperative hypotension (IOH), and a geriatric medicine consult index (GCI) with short-term mortality in hip fracture patients. A retrospective cohort study was conducted at a single institution over a 2-year period. Patients aged 65 years and older who sustained a hip fracture following a low-energy mechanism were identified using billing records and our orthopedic fracture registry. Medical records were reviewed to collect demographic data, fracture classification and operative records, calculation of CCS, intraoperative details including hypotension, and assessments recorded in the geriatric consult notes. The GCI was calculated using 30 dichotomous variables contained within the geriatric consult note. The index, ranging from 0 to 1, included markers for physical and cognitive function, as well as medications. A higher GCI score indicated more markers for frailty. One hundred eight patients met inclusion criteria. Sixty-four (59%) were females and the average age was 77.3 years. Thirty-five (32%) patients sustained femoral neck fractures, and 73 (68%) patients sustained inter-/pertrochanteric hip fractures. The 30-day mortality was 6%; the 90-day mortality was 13%. The mean GCI was 0.30 in the 30-day survivor group as compared to 0.52 in those who died. The mean GCI was 0.28 in patients who were alive at 90 days as compared to 0.46 in those who died. In contrast, the CCS and IOH were not associated with 30- or 90-day mortality. In our older hip fracture patients, an index calculated from information routinely obtained in the geriatric consult evaluation was associated with 30- and 90-day mortality, whereas the CCS and measures of IOH were not.

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COVID-19 pandemic and hip fractures: impact and lessons learned

Bone & Joint Open ◽

10.1302/2633-1462.19.bjo-2020-0116.r1 ◽

2020 ◽

Vol 1 (9) ◽

pp. 530-540

Author(s):

Mohamed Arafa ◽

Samia Nesar ◽

Hamza Abu-Jabeh ◽

Ma Odette Remelou Jayme ◽

Yegappan Kalairajah

Keyword(s):

Hip Fracture ◽

Hospital Stay ◽

Hip Fractures ◽

Care Service ◽

Health Concern ◽

Positive Group ◽

Fracture Care ◽

Significant Difference ◽

The Uk ◽

The Impact

Aims The coronavirus disease (COVID)-19 pandemic forced an unprecedented period of challenge to the NHS in the UK where hip fractures in the elderly population are a major public health concern. There are approximately 76,000 hip fractures in the UK each year which make up a substantial proportion of the trauma workload of an average orthopaedic unit. This study aims to assess the impact of the COVID-19 pandemic on hip fracture care service and the emerging lessons to withstand any future outbreaks. Methods Data were collected retrospectively on 157 hip fractures admitted from March to May 2019 and 2020. The 2020 group was further subdivided into COVID-positive and COVID-negative. Data including the four-hour target, timing to imaging, hours to operation, anaesthetic and operative details, intraoperative complications, postoperative reviews, COVID status, Key Performance Indicators (KPIs), length of stay, postoperative complications, and the 30-day mortality were compiled from computer records and our local National Hip Fracture Database (NHFD) export data. Results Hip fractures and inpatient falls significantly increased by 61.7% and 7.2% respectively in the 2020 group. A significant difference was found among the three groups regarding anaesthetic preparation time, anaesthetic time, and recovery time. The mortality rate in the 2020 COVID-positive group (36.8%) was significantly higher than both the 2020 COVID-negative and 2019 groups (11.5% and 11.7% respectively). The hospital stay was significantly higher in the COVID-positive group (mean of 24.21 days (SD 19.29)). Conclusion COVID-19 has had notable effects on the hip fracture care service: hip fracture rates increased significantly. There were inefficiencies in theatre processes for which we have recommended the use of alternate theatres. COVID-19 infection increased the 30-day mortality and hospital stay in hip fractures. More research needs to be done to reduce this risk. Cite this article: Bone Joint Open 2020;1-9:530–540.

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A SIMPLE SCREENING PROCEDURE COULD IDENTIFY INDIAN PATIENTS WITH EARLY COGNITIVE IMPAIRMENT AND ITS IMPLICATIONS FOR THE MANAGEMENT OF GERIATRIC HIP FRACTURES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i7.1322 ◽

2020 ◽

Vol 4 (7) ◽

Author(s):

Mrudev Gandhi ◽

Utsav Patel

Keyword(s):

Cognitive Impairment ◽

Hip Fracture ◽

Hip Fractures ◽

Treatment Modalities ◽

Wide Range ◽

Significant Difference ◽

Male Preponderance ◽

Geriatric Hip Fracture ◽

Asymptomatic Phase ◽

The Impact

Background: Dementia is one of the most common and cognitive impairments growing over the globe. It encompasses a wide range of other neurodegenerative disorders with the symptoms such as loss of memory, inability in carrying out everyday activities, a decline in the brain function activities, and perplexity. However, it has been identified that there is an absolute lack of treatment modalities for dementia, but the early diagnosis plays an important role in identifying the cognitive impairment in the asymptomatic phase itself. It helps in preventing the disease from reaching a further complicated stage Aim: To assess the impact of cognitive impairment screening on the management of geriatric hip fractures Methods: It was an observational study carried out at Shree Krishna Hospital, Karamsad; for a period of two years (June 2018 to May 2020). Two hundred sixty patients were included in the study. The patients were divided into three groups, namely hemiarthroplasty (HA), Total Hip Arthroplasty (THA), hemiarthroplasty in patients with known dementia (HAd). Result: The study showed male preponderance in the study, and the majority of the patients were above 80 years of age. There was a significant difference in the patients who can perform their grocery or medication independently and not independently with respect to MMSE. However, there was no statistically significant difference in Hip Harris Score. There was a statistically significant difference among the three groups regarding the intraoperative blood, operation duration, hospital stay, ICU postoperative, in-hospital details. Conclusion: In light of the above literature, it was found that hip fractures and cognitive impairment were closely related. There are many risk factors of hip fracture, which are aggravated due to the late diagnosis of cognitive impairment. The incidence of hip fracture among patients suffering from dementia was much higher as compared to normal patients. Keywords: multi-morbidity, cognitive impairment, geriatric hip fracture

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PSYCHOEDUCATION REDUCES ANXIETY IN ELDERLY WITH HYPERTENSION IN NAMBAKOR VILLAGE SARONGGI DISTRICT SUMENEP

Journal of Vocational Nursing ◽

10.20473/jovin.v2i2.30796 ◽

2021 ◽

Vol 2 (2) ◽

pp. 108

Author(s):

Emdat Suprayitno ◽

Zakiyah Yasin ◽

Istiqamatul Karamah ◽

Dian Ika Puspitasari

Keyword(s):

Sampling Technique ◽

The Elderly ◽

Anxiety Score ◽

Significant Difference ◽

Before And After ◽

Post Test ◽

The Mean ◽

Anxiety Depression ◽

The Impact ◽

Paired T Test

Introduction: The problems in hypertension will cause emotional or mental disorders, one of which is anxiety. Feelings arise due to the fear and ignorance of an individual about hypertension experienced and the impact that will occur in the future. Psychoeducation is the provision of information about disease management and individual psychological aspects. This study aims to determine the effect of psychoeducation on the anxiety level of elderly patients with hypertension in Nambakor Village, Saronggi District.Methods: This research method is pre-experimental with the research design is one group pre test post test. The sampling technique used is Random Sampling and the number of samples is 30 respondents. Data collection using a questionnaire on the level of anxiety Depression Anxiety and Stress Scale.Result: The results showed that the mean of the anxiety score before the psychoeducation intervention was 24,43±7,60 and the mean of the anxiety score after the psychoeducation intervention was was 23,23 ± 7,83. The results of the paired t test of anxiety score was p = 0.002, means that there is significant difference in anxiety scores before and after psychoeducation.Conclusion: There is an influence of psychoeducation on the level of anxiety in the elderly with hypertension. The conclusion obtained is that psychoeducation can increase knowledge in patients with hypertension so that it is expected to be one form of intervention that can be applied.

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P9 Impact of the relocation of a regional neuroscience service on major trauma patients

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.89 ◽

2019 ◽

Vol 90 (3) ◽

pp. e28.2-e28

Author(s):

C Cabaret ◽

M Nelson ◽

M Foroughi

Keyword(s):

Major Trauma ◽

Strong Association ◽

Trauma Centre ◽

Trauma Patients ◽

Major Trauma Centre ◽

Significant Difference ◽

Ct Head ◽

The Mean ◽

The Impact ◽

Mean Time

ObjectivesEvaluating the impact of relocating a regional neuroscience service on major trauma patients.DesignRetrospective analysis of prospectively collected data from 01/08/2013 to 31/07/2017.SubjectsPatients≥20 years with a TBI in the 2 years pre-relocation (cohort 1) and 2 years post-relocation (cohort 2).MethodsPatients were identified using the TARN registry. Comparison of the cohorts for demographics, type of neurosurgical input, site of first presentation and the times to first CT head and operation was conducted using cross-tabulation, percentages and statistical analysis (SPSS).Results30% of patients in cohort 1 (112 or 373) were admitted in neurosurgery. This increased to 40% of patients in cohort 2 (181 of 450). There was an increase in admissions for monitoring (70% vs 82%). Patients<60 years had a higher increment in admission (+16 points) than patients≥60 years (+8 points). A strong association was found between the relocation of the neuroscience service and the increase in proportion of patients first transported to the major trauma centre (63% vs 74%; p=0.037). There was a significant decrease in the mean time to operation (3.9 hour vs 2.0 hour; p=0.008) and no significant difference in the mean time to first CT head (1.3 hour vs 1.4 hour; p=0.689).ConclusionsThe relocation of neurosurgery has resulted in a significant increase in admission of patients<60 years with TBI in neurosurgery for monitoring, an increase in the proportion of patients first transported to the MTC and a reduction in the time to operation.

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Association Between Anthropometric Factors and Balance Among Elderly Fallers and Non-Fallers: A Cross-Sectional Study

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2021.2049 ◽

2021 ◽

Author(s):

Pothiraj Pitchai ◽

Reshma Gurav ◽

Srishti Chauhan

Keyword(s):

Risk Factors ◽

Negative Correlation ◽

Public Health Problem ◽

The Elderly ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Significant Difference ◽

The Mean ◽

The Impact

Purpose: Falls are an emerging public health problem causing a cascade of medical, functional, and socio-economic consequences. Apart from other widely explored risk factors affecting balance, anthropometric factors are also known to have an impact on balance. However, this relationship hasn’t been studied extensively in older adults. This study aimed to evaluate the relationship between the anthropometric factors such as Body Mass Index (BMI), Body Fat Mass (BFM), Waist-Hip Ratio (WHR), Lower Limb Length (LLL), Foot Length (FL) and balance in the elderly among fallers and non-fallers. Method: This cross-sectional study was performed on 100 fallers and 100 non-fallers, aged 60 years and above. These participants were recruited by a stratified random sampling technique from Navi Mumbai region. All the above anthropometric factors were measured and recorded. Each participant’s balance was assessed using the Mini-BESTest scale. Obtained scores were analysed in SPSS software; descriptive statistics, Spearman correlation coefficient, and Z scores were applied. Results: A sample size of 100 non-fallers, 50% male and 50% females, participated in this study. Among those participants classified as “fallers,” 56% were males and 44% were females. The mean age of the non-fallers was 66±5.01 and the mean age of the fallers was 67.72±6.73. In fallers, WHR showed good negative correlation (r= -.807), BFM as moderate (r= -.577) and BMI as fair (r= -.426) whereas in non-fallers, BMI showed moderate (r= -.546) and fair negative correlation for both WHR (r= -.303) and BFM (r= -.441). However, LLL and FL in both groups show little or no correlation. The Association of all anthropometric factors with the balance between fallers and non-fallers showed no-significant difference. It may be inter-group variance for age, gender and BMI, as participants were not matched for these variables during the recruiting phase. Additionally, the reason for the fall was not explored, thus adding to the limitations of our study. Conclusion: This study demonstrated the impact of increased WHR, BFM and BMI on balance in the elderly fallers and non-fallers. Thus, it is important to screen these factors while assessing biological risk factors for predicting falls. This study further recommends exploring the normative value for anthropometric factors in a healthy elderly population.

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HIP FRACTURES IN 5 YEARS AT HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2013.6.8 ◽

2014 ◽

pp. 47-50

Author(s):

Duy Binh Ho ◽

Nghi Thanh Nhan Le ◽

Maasalu Katre ◽

Koks Sulev ◽

Märtson Aare

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Hip Fractures ◽

Age Groups ◽

Femoral Fractures ◽

Femoral Neck Fractures ◽

University Hospital ◽

High Risk Population ◽

Intertrochanteric Fractures ◽

Significant Difference

Aim: This study aimed to review the clinical findings and surgical intervention of the hip fracture at the Hue University Hospital in Vietnam. Methods:The data of proximal femoral fractures was collected retrospectively. All patients, in a period of 5 years, from Jan 2008 to December 2012, suffered either from intertrochanteric or femoral neck fractures. The numbers of patients were gathered separately for each year, by age groups (under 40, 40-49, 50-59, 60-69, 70-79, older) and by sex. We analyzed what kind of treatment options were used for the hip fracture. Results:Of 224 patients (93 men and 131 women) studied, 71% patients are over 70 years old, 103 women and 56 men (p<0.05). For patients under 40 years, there were 1 woman and 11 men (p<0.05). There were 88 intertrochanteric and 136 femoral neck fractures. There was no significant difference in the two fractures between men and women. The numbers of hip fracture increased by each year, 29/224 cases in 2010, 63/224 cases in 2011, 76/224 cases in 2012. Treatment of 88 intertrochanteric fractures: 49 cases (55.7%) of dynamic hip screw (DHS), 14 cases of hemiarthroplasty (15.9%), 2 cases of total hip replacement (2.3%). Treatment of 136 femoral neck fractures: 48 cases of total replacement (35.3%), 43 cases of hemiarthroplasty (31.6%), 15 cases of screwing (11%). In cases of 40 patients (17.9%) hip fracture was managed conservatively, 23 were femoral neck fractures and 17 were intertrochanteric fractures. Conclusions: Hip fracture is growing challenge in Hue medical university hospital. The conservative approach is still high in people who could not be operable due to severe medical conditions as well as for patients with economic difficulties. Over 70% of the hip fractures in people 70+ are caused by osteoporosis. The number of hip fracture is increasing in the following years, most likely due to the increase in the prevalence of osteoporosis. Early detection and prevention of osteoporosis should be addressed, particularly in high risk population. More aggressive surgical approach should be implemented in order to improve the quality of life in patients with hip fractures. Key words:Hip fracture.

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