Coronavirus in HIP Fractures CHIP 2: Is Vitamin D Deficiency Associated with Increased Mortality from COVID-19 Infections in A Hip Fracture Population?

Purpose: There is controversy as to whether vitamin D deficiency is associated with increased mortality from coronavirus infection. The aim of the study was to assess the relationship between vitamin D levels and 30-day mortality in hip fracture patients co-infected with COVID-19. Methods: This was a national observational audit conducted between 23 March 2020 (start of UK lockdown) and 31st December 2020. The cohort consisted of patients aged >60 years presenting with a hip fracture. Patients were included if they had a vitamin D level done during the admission episode, diagnosis of COVID-19 infection via a viral reverse transcriptase PCR swab, and a hip fracture. There were 517 patients included in the study from 43 different hospital trusts. The primary outcome measure was 30-day mortality. Secondary outcomes were the percentage of patients who had vitamin D deficiency, the percentage of patients who were prescribed Vitamin D, and the impact of vitamin D prescribing on mortality Results: Vitamin D deficiency was not associated with a higher 30-day mortality. Low serum vitamin D was observed in 56% of the patients on admission. Vitamin D was prescribed prior to admission in 28% and during admission in a further 49%. Pre-hospital vitamin D therapy reduced the chance of vitamin D deficiency. Starting vitamin D before or on admission did not affect the mortality rates. Conclusion: Vitamin D deficiency was common, but not associated with a higher 30-day mortality in the hip fracture population co-infected with COVID-19.

The mortality burden in patients with hip fractures and dementia

Purpose Dementia is strongly associated with postoperative death in patients subjected to hip fracture surgery. Nevertheless, there is a distinct lack of research investigating the cause of postoperative mortality in patients with dementia. This study aims to investigate the distribution and the risk of cause-specific postoperative mortality in patients with dementia compared to the general hip fracture population. Methods All adults who underwent emergency hip fracture surgery in Sweden between 1/1/2008 and 31/12/2017 were considered for inclusion. Pathological, conservatively managed fractures, and reoperations were excluded. The database was retrieved by cross-referencing the Swedish National Quality Registry for Hip Fracture patients with the Swedish National Board of Health and Welfare quality registers. A Poisson regression model was used to determine the association between dementia and all-cause as well as cause-specific 30-day postoperative mortality. Results 134,915 cases met the inclusion criteria, of which 20% had dementia at the time of surgery. The adjusted risk of all-cause 30-day postoperative mortality was 67% higher in patients with dementia after hip fracture surgery compared to patients without dementia [adj. IRR (95% CI): 1.67 (1.60–1.75), p < 0.001]. The risk of cause-specific mortality was also higher in patients with dementia, with up to a sevenfold increase in the risk cerebrovascular mortality [adj. IRR (95% CI): 7.43 (4.99–11.07), p < 0.001]. Conclusions Hip fracture patients with dementia have a higher risk of death in the first 30 days postoperatively, with a substantially higher risk of mortality due to cardiovascular, respiratory, and cerebrovascular events, compared to patients without dementia.

The Correlation Between Timing of Surgery and the Need for RBC Transfusions in the Geriatric Intertrochanteric Fracture Population

Objective: To identify whether the timing of surgery affects red blood cell (RBC) transfusion requirements in the elderly with intertrochanteric fractures. Methods: We retrospectively studied all patients undergoing surgical fixation of their intertrochanteric fractures in our hospital between January 2009 and December 2018 and analyzed the relationship between the timing of surgery and RBC transfusion. Results: A total of 679 patients were included in this study. The need for RBC transfusion was lower in the patients who underwent surgery within 12 h after admission (timing of surgery <12 h, <12 h group) than those who underwent surgery over 12 h after admission (timing of surgery >12 h, >12 h group) (P = 0.046); lower in the the patients who underwent surgery within 24 h after admission (timing of surgery <24 h, <24 h group) than in those who underwent surgery over 24 h after admission (timing of surgery >24 h, >24 h group) (P = 0.008), and lower in the <24 h group compared to the patients who underwent surgery within 48 h after admission (timing of surgery <48 h, <48 h group) (P = 0.035). Moreover, the need for RBC transfusion was lower in the <24 h group (in the first 24 h from admission to surgery) than in the 24-48 h group (in the second 24 h from admission to surgery) (P = 0.016), and also lower in the <24 h group compared to the 48-72 h group (in the third 24 h from admission to surgery) (P = 0.047). However, there were no differences between the <12 h group and 12-24 h group, between the <12 h group and <24 h group, and between the 12-24 h group and <24 h group, respectively. Conclusion: Timing of surgery within 24 h contributes to the reduction of RBC transfusion in the elderly with intertrochanteric fractures.

Excess deaths in the fragility fracture population during the first wave of the COVID-19 pandemic due to altered care pathways

This study of fragility fracture patients demonstrated non-COVID-19 related mortality was significantly higher during the pandemic period (14.7% n=728) than in controls (10.2%; HR=1.86; 95%CI 1.41-2.45; p<0.0001 n=1014). This is associated with a significant decrease in length of stay, both for the whole group and for the hip fracture subgroup. Altered care-pathways and aggressive discharge criteria during the pandemic are likely responsible for the increase in excess deaths.

Prevalence of Swallowing and Eating Difficulties in an Elderly Postoperative Hip Fracture Population—A Multi-Center-Based Pilot Study

Elderly patients operated for hip fracture are characterized by high age and high degree of comorbidity and need of care, factors previously found to be associated with swallowing and eating difficulties. The aim of this study was to investigate the prevalence of swallowing and eating difficulties in an elderly postoperative hip fracture population and to identify factors associated with swallowing and eating difficulties. A cross-sectional multi-center pilot study was performed, including patients ≥65 years, operated for hip fracture, and able to participate in a swallowing and eating assessment. A clinical assessment was conducted using Danish versions of the standardized tools Volume-Viscosity Swallow Test and Minimal Eating Observation Form-version II. Demographic data and clinical characteristics were examined. A total of 78 patients (mean age 81.4 years (SD 7.8), 30.8% male) were included. Swallowing and eating difficulties were present in 60 patients (77%). Swallowing and eating difficulties were significantly associated with living in a nursing home before hospital admission (p = 0.014), low habitual New Mobility Score (p = 0.018), and absence of cardiac comorbidity (p = 0.023). The results underline the importance of focusing on swallowing and eating difficulties in elderly patients operated for hip fracture to ensure effectivity and safety and optimize the prognosis for the patient.