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?:abstract
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BACKGROUND: Coronavirus disease 2019 (COVID-19) is a worldwide pandemic, with a case mortality ratio of approximately 6 4% at the time of writing (May 2020) Mortality increases in elderly patients with comorbidities Patients with hip fracture have an average age of 80 years, with an estimated 2 8 comorbidities per patient Evidence is lacking regarding the mortality rate of patients with hip fracture admitted during the COVID-19 pandemic Our aim was to investigate the mortality rate among patients with a proximal femoral fracture who were admitted to our hospital during the COVID-19 pandemic METHODS: We conducted a retrospective review of all patients with a proximal femoral fracture admitted to Southend University Hospital in the U K from March to April 2020 (during the COVID-19 pandemic) Data collected included demographics (patient age, body mass index, sex), comorbidities, and blood test values along with COVID-19 diagnosis (based on positive microbiological sample and clinical and radiographic findings) and operative characteristics (time to operation, length of stay, American Society of Anesthesiologists [ASA] classification, Nottingham Hip Fracture Score) The primary outcome was the 30-day mortality rate for patients with a hip fracture who were COVID-19 positive or negative Kaplan-Meier survival analysis was conducted along with Mann-Whitney U tests and Fisher exact tests RESULTS: Forty-one patients were included in the study, of whom 37 had an available SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) swab test result The overall 30-day mortality was 22% Eleven patients tested positive for COVID-19 There was a significant difference in the mortality rate between those who tested positive and those who tested negative (54 5% versus 7 69%, respectively;Fisher exact test, p = 0 004) and between the operative patients who tested positive and the operative patients who tested negative (37 5% versus 4 34%, respectively;Fisher exact test, p = 0 043) CONCLUSIONS: Patients with a proximal femoral fracture may be at higher risk for mortality during the COVID-19 pandemic We noted that patients with a proximal femoral fracture who tested positive for COVID-19 had a higher 30-day mortality rate compared with those who tested negative Additional research is required to ascertain the benefits of a reduction in time to operation LEVEL OF EVIDENCE: Prognostic Level III See Instructions for Authors for a complete description of levels of evidence
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