Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study

Journal of Orthopaedics and Traumatology

Massimo Franceschini¹  Giovanni Zatti²  Alessandro Massè³  Fabrizio Rivera⁴  Alberto Momoli⁵  Alessandro Casiraghi⁶  Federico Bove⁷  Flavio Ravasi⁸  Nicola Guindani⁹  Claudio Carlo Castelli⁹  Mario Mosconi^1,10  Fabio Catani^1,11  Fabio D’Angelo^1,12  Luigi Zagra^1,13  Rocco D’Apolito^1,13  Pietro Cimatti^1,14  Dante Dallari^1,14 

[1] ASST Gaetano Pini- CTO, Piazza A. Ferrari 1, 20122, Milan, Italy;Department of Orthopaedic Surgery ASST di Monza, Università Milano Bicocca, Via Pergolesi 33, 20900, Monza, Italy;Department of Orthopaedic Surgery Ospedale Città Della Salute e Della Scienza, Università di Torino, Via G. Zuretti 29, 10126, Turin, Italy;Department of Orthopaedic Surgery Ospedale SS Annunziata, Via Ospedali 14, 12038, Savigliano, Italy;Department of Orthopaedic Surgery Ospedale San Bortolo, Viale F. Rodolfi 37, 36100, Vicenza, Italy;Department of Orthopaedic Surgery, ASST Degli Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy;Department of Orthopaedic Surgery, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy;Department of Orthopaedic Surgery, ASST Melegnano Martesana-Ospedale di Vizzolo Predabissi, Via Pandina 1, 20077, Vizzolo Predabissi, Italy;Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy;Department of Orthopaedic Surgery, IRCCS Policlinico San Matteo di Pavia, Viale C. Golgi 19, 27100, Pavia, Italy;Department of Orthopaedic Surgery, Policlinico Universitario di Modena, Via del Pozzo 71, 41124, Modena, Italy;Division of Orthopaedics and Traumatology, ASST Dei Sette Laghi, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Viale L. Borri 57, 21100, Varese, Italy;IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy;Reconstructive Orthopaedic Surgery and Innovative Techniques–Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy;

关键词: Proximal femur;    Pertrochanteric fractures;    Neck of the femur;    Osteosynthesis;    Hip arthroplasty;    Cephalomedullary nail;    SARS-CoV-2;    Coronavirus;    COVID-19;   

DOI  :  10.1186/s10195-021-00577-9

来源: Springer

【 摘 要 】

BackgroundTreatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment.Materials and methodsFor this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C− group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month.ResultsOf the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C− group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group.ConclusionsHip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended.Level of evidenceTherapeutic study, level 4.

【 授权许可】

CC BY