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

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

Trauma ◽

10.1177/1460408620949725 ◽

2021 ◽

pp. 146040862094972

Author(s):

Ahmed Fadulelmola ◽

Rob Gregory ◽

Gavin Gordon ◽

Fiona Smith ◽

Andrew Jennings

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Hospital Admissions ◽

The Elderly ◽

Primary Outcome Measure ◽

Time To Death ◽

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 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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Orthogeriatrics and Hip Fracture Care in the UK: Factors Driving Change to More Integrated Models of Care

Geriatrics ◽

10.3390/geriatrics3030055 ◽

2018 ◽

Vol 3 (3) ◽

pp. 55 ◽

Cited By ~ 2

Author(s):

Mark Middleton

Keyword(s):

Hip Fracture ◽

Financial Incentives ◽

Models Of Care ◽

Social Needs ◽

Medical Rehabilitation ◽

Integrated Models ◽

National Guidelines ◽

Fracture Care ◽

The Uk ◽

The Impact

In the United Kingdom (UK), approximately 80,000 hip fractures each year result in an estimated annual cost of two billion pounds in direct healthcare costs alone. Various models of care exist for collaboration between orthopaedic surgeons and geriatricians in response to the complex medical, rehabilitation, and social needs of this patient group. Mounting evidence suggests that more integrated models of orthogeriatric care result in superior quality of care indicators and clinical outcomes. Clinical governance through national guidelines, audit through the National Hip Fracture Database (NHFD), and financial incentives through the Best Practice Tariff (providing a £1335 bonus for each patient) have driven hip fracture care in the UK forward. The demanded improvement in quality indicators has increased the popularity of collaborative care models and particularly integrated orthogeriatric services. A significant fall in 30-day mortality has resulted nationally. Ongoing data collection by the NHFD will lead to greater understanding of the impact of all elements of hip fracture care including models of orthogeriatrics.

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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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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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30-day outcomes in hip fracture patients during the COVID-19 pandemic compared to the preceding year

Bone & Joint Open ◽

10.1302/2046-3758.17.bjo-2020-0077.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 415-419 ◽

Cited By ~ 1

Author(s):

Alistair R. M. Macey ◽

Joanna Butler ◽

Sean C. Martin ◽

Ting Yang Tan ◽

William J. Leach ◽

...

Keyword(s):

Intensive Care ◽

Venous Thromboembolism ◽

Hip Fracture ◽

Length Of Stay ◽

Hip Fractures ◽

Pulmonary Complications ◽

Intensive Care Admission ◽

Postoperative Intensive Care ◽

Significant Difference ◽

The Uk

Aims To establish if COVID-19 has worsened outcomes in patients with AO 31 A or B type hip fractures. Methods Retrospective analysis of prospectively collected data was performed for a five-week period from 20 March 2020 and the same time period in 2019. The primary outcome was mortality at 30 days. Secondary outcomes were COVID-19 infection, perioperative pulmonary complications, time to theatre, type of anaesthesia, operation, grade of surgeon, fracture type, postoperative intensive care admission, venous thromboembolism, dislocation, infection rates, and length of stay. Results In all, 76 patients with hip fractures were identified in each group. All patients had 30-day follow-up. There was no difference in age, sex, American Society of Anesthesiologists (ASA) classification or residence at time of injury. However, three in each group were not fit for surgery. No significant difference was found in 30-day mortality; ten patients (13%) in 2019 and 11 patients (14%) in 2020 (p = 0.341). In the 2020 cohort, ten patients tested positive for COVID-19, two (20%) of whom died. There was no significant increase in postoperative pulmonary complications. Median time to theatre was 20 hours (interquartile range (IQR) 16 to 25) in 2019 versus 23 hours (IQR 18 to 30) in 2020 (p = 0.130). Regional anaesthesia increased from 24 (33%) cases in 2019 to 46 (63%) cases in 2020, but ten (14%) required conversion to general anaesthesia. In both groups, 53 (70%) operations were done by trainees. Hemiarthroplasty for 31 B type fractures was the most common operation. No significant difference was found for intensive care admission or 30-day venous thromboembolism, dislocation or infection, or length of stay. Conclusion Little information exists on mortality and complications after hip fracture during the COVID-19 pandemic. At the time of writing, no other study of outcomes in the UK has been published. Cite this article: Bone Joint Open 2020;1-7:415–419.

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Demographic Study of Hip Fractures in the Maltese Islands

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318764772 ◽

2018 ◽

Vol 9 ◽

pp. 215145931876477 ◽

Cited By ~ 1

Author(s):

Mark Bugeja ◽

Simon Aquilina ◽

Charles Farrugia ◽

Ivan Esposito

Keyword(s):

Socioeconomic Status ◽

Hip Fracture ◽

Hospital Stay ◽

Low Socioeconomic Status ◽

Hip Fractures ◽

Surgical Intervention ◽

Average Delay ◽

Public Health Burden ◽

Maltese Islands ◽

The Impact

Introduction: Despite hip fractures being a great public health burden, only few studies have analyzed the relationship between hip fracture incidence and socioeconomic status. Many studies found an association; however, results are in part conflicting. Objective: To analyze the impact of regional-level socioeconomic status on the incidence of hip fractures in the Maltese Islands. Method: All individuals older than 50 years who presented to the acute care hospitals in Malta and Gozo with low-energy hip fractures between December 1, 2015, and November 30, 2016, were selected. Data on individual demographics, hip fracture type, surgical intervention, and hospital stay were collected. The percentage of hip fracture and socioeconomic status of each region in the Maltese Islands were calculated. These were then analyzed for any statistical association. Results: A moderate negative correlation ( r = −0.5987, N = 454, P < .05) was found between the socioeconomic status and the incidence of hip fracture in each region. There was 5.9% (n = 27) mortality rate posed by these hip fractures. The average duration of hospital stay was 14 days, with an average delay to surgical intervention of 2 days. Conclusion: Despite the Maltese Islands having a small population (429 344 people) and a free universal national health service, our results show that districts with low socioeconomic status had a higher incidence of hip fracture. Further studies using individual socioeconomic data and longer duration are required.

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Hip fracture litigation: A 10-year review of NHS Litigation Authority data and the effect of national guidelines

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0277 ◽

2017 ◽

Vol 99 (1) ◽

pp. 17-21 ◽

Cited By ~ 2

Author(s):

R Fanous ◽

S Sabharwal ◽

A Altaie ◽

CM Gupte ◽

P Reilly

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Best Practice ◽

Clinical Excellence ◽

Freedom Of Information ◽

National Guidelines ◽

Delay In Diagnosis ◽

Significant Difference ◽

Before And After ◽

The Uk

We present a review evaluating all litigation claims relating to hip fractures made in a 10-year period between 2005 and 2015. Data was obtained from the NHS Litigation Authority through a freedom of information request. All claims relating to hip fractures were reviewed. During the period analysed, 216 claims were made, of which 148 were successful (69%). The total cost of settling these claims was in excess of £5 million. The introduction of a best-practice tariff by the Department of Health in 2010 was designed to improve the quality of care for hip fracture patients. This was followed by guidance from the National Institute for Health and Clinical Excellence in 2011 and the British Orthopaedic Association in 2012. We analysed claims submitted before and after these guidelines were introduced and no significant difference in the number of claims was noted. The most common cause for litigation was a delay in diagnosis, which accounted for 86 claims in total (40%). Despite the presence of these guidelines and targets, there has not been a significant reduction in the number of claims or an improvement in diagnostic accuracy. This may be due to an increasing level of litigation in the UK but we must also question whether we are indeed providing best-practice care to our hip fracture patients and whether these guidelines need further review.

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30-day outcomes in hip fracture patients during the COVID-19 pandemic compared to the preceding year

Bone & Joint Open ◽

10.1302/2633-1462.17.bjo-2020-0077.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 415-419 ◽

Cited By ~ 4

Author(s):

Alistair R. M. Macey ◽

Joanna Butler ◽

Sean C. Martin ◽

Ting Yang Tan ◽

William J. Leach ◽

...

Keyword(s):

Intensive Care ◽

Venous Thromboembolism ◽

Hip Fracture ◽

Length Of Stay ◽

Hip Fractures ◽

Pulmonary Complications ◽

Intensive Care Admission ◽

Postoperative Intensive Care ◽

Significant Difference ◽

The Uk

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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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Prior Admissions as a Risk Factor for Readmission in Patients Surgically Treated for Femur Fractures: Implications for a Potential Hip Fracture Bundle

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459321996169 ◽

2021 ◽

Vol 12 ◽

pp. 215145932199616

Author(s):

Robert Erlichman ◽

Nicholas Kolodychuk ◽

Joseph N. Gabra ◽

Harshitha Dudipala ◽

Brook Maxhimer ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Hip Fracture ◽

Logistic Regression Analysis ◽

Hip Fractures ◽

Surgical Procedure ◽

Hospital Admissions ◽

Fracture Care ◽

Increased Risk ◽

Payment Models

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.

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