by Elizabeth Hofheinz, M.P.H., M.Ed.
Several New York City institutions have banded together to get a clear picture of how hip fracture patients treated during the height of the COVID-19 pandemic in New York City have fared. Their work, which involved data from Hospital for Special Surgery (HSS) and NewYork-Presbyterian Queens, involved 59 consecutive hip fracture patients (average age 85 years, range: 65–100 years) treated over a 5-week period (March 20, 2020, to April 24, 2020).
Their study, “Hip Fracture Outcomes During the COVID-19 Pandemic: Early Results From New York,” and appears in the August 2020 edition of The Journal of Orthopaedic Trauma.
Asked why hip fracture in particular was selected, co-author Drake LeBrun, M.D., M.P.H of HSS told OSN, “In the very early phases of the pandemic in New York City, we noticed that geriatric patients with hip fractures who tested positive for COVID-19 tended to have worse outcomes in their hospitalization, with increased rates of pulmonary complications. This made some intuitive sense, given that older patients who sustain hip fractures often suffer from the same comorbidities that put people at risk for worse outcomes with COVID-19, such as diabetes, cardiac disease, and chronic obstructive pulmonary disease. Our goal was therefore to better understand how early outcomes differed among hip fracture patients in New York City who did vs. did not have COVID-19 and use that information to better inform clinical decision-making.”
Of the 59 patients, say the authors, 10 (15%) tested positive for COVID-19 or were presumed positive, 40 (68%) tested negative, and 9 (15%) were not tested in the primary hospitalization. While the American Society of Anesthesiologists’ scores were higher in the COVID+ group, the Charlson Comorbidity Index was similar between the study groups.
Overall, say the authors, “inpatient mortality was 11.9%. Five of the 9 tested COVID+ patients died, all of COVID-related disease. Four of the 5 were 85 years of age or older, and all had multiple comorbid diseases known to affect survival in COVID-positive patients. Two of the 5 died before operative intervention because of respiratory failure and were not intubated. Both patients had existing Do Not Resuscitate/ Do Not Intubate orders. The 3 other deaths in the COVID+ group occurred between postoperative days 8 and 21. All 3 of these patients were intubated for COVID-related lung disease between postoperative days 4 and 6 and ultimately died. The one presumed positive patient was 91 years old with dementia, hypertension, hyperlipidemia, and diabetes mellitus, became acutely hypotensive on postoperative day 1, and went into asystole later that day. Of the 4 surviving COVID+ patients, 2 were discharged on postoperative days 6 and 8 and 2 remained admitted.”
“One COVID-negative patient (not presumed positive), age 92 years, with comorbidities including coronary artery disease status post drug-eluting stent placement, atrial fibrillation with a pacemaker, hypertension, hyper-lipidemia, hypothyroidism, and chronic renal insufficiency had a cardiac arrest intraoperatively during hip hemi-arthroplasty treatment for his/her unstable femoral neck fracture under general anesthesia and died in the post- anesthesia care unit.”
Dr. LeBrun: “We found that geriatric hip fracture patients with concomitant COVID-19 had higher rates of inpatient mortality compared to those without COVID-19. What was partly surprising about this finding is that although 5 of 9 patients with concomitant COVID-19 expired, 4 of 9 had few, if any, symptoms related to COVID-19 and had an otherwise unremarkable hospital course.”
“Our study found that patients who sustained a hip fracture and had concomitant COVID-19 infection were more likely to expire during their hospitalization. Relative to patients who did not have COVID-19, those with concomitant COVID-19 infection were also more likely to be have low oxygen levels postoperatively, develop pneumonia, and require ICU admission during their hospitalization.”