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A multi-institutional study of short-term mortality in COVID-positive patients undergoing hip fracture surgery: is survival better than expected?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Early reports of 30-day mortality in COVID-positive patients with hip fracture were often over 30% and were higher than historical rates of 10% in pre-COVID studies. We conducted a multi-institutional retrospective cohort study to determine whether the incidence of 30-day mortality and complications in COVID-positive patients undergoing hip fracture surgery is as high as initially reported.

Methods

A retrospective chart review was performed at 11 level I trauma centers from January 1, 2020 to May 1, 2022. Patients 50 years or older undergoing hip fracture surgery with a positive COVID test at the time of surgery were included. The primary outcome measurements were the incidence of 30-day mortality and complications. Post-operative outcomes were reported using proportions with 95% confidence interval (C.I.).

Results

Forty patients with a median age of 71.5 years (interquartile range, 50–87 years) met the criteria. Within 30-days, four patients (10%; 95% C.I. 3–24%) died, four developed pneumonia, three developed thromboembolism, and three remained intubated post-operatively. Increased age was a statistically significant predictor of 30-day mortality (p = 0.01), with all deaths occurring in patients over 80 years.

Conclusion

In this multi-institutional analysis of COVID-positive patients undergoing hip fracture surgery, 30-day mortality was 10%. The 95% C.I. did not include 30%, suggesting that survival may be better than initially reported. While COVID-positive patients with hip fractures have high short-term mortality, the clinical situation may not be as dire as initially described, which may reflect initial publication bias, selection bias introduced by testing, or other issues.

Levels of Evidence

Therapeutic Level III.

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Acknowledgements

The project described was supported by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

COVID-ORTHO Research Group

Chandler R. Sneed, MD (Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY), Daria L. Kinchelow, MD (Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY), Nicole G. Lemaster, PhD (Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY), Jarod T. Griffin, MD (Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY), David A. Zuelzer, MD (Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY), Paul E. Matuszewski, MD (Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY), Eric S. Moghadamian, MD (Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY), Raymond D. Wright, MD (Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY), Daniel D. Primm, MD (Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY), Clay A. Spitler, MD (Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL), David A. Patch, MD (Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL), Hassan R. Mir, MD, MBA (Florida Orthopaedic Institute, University of South Florida Morsani College of Medicine, Tampa, FL), Roy W. Sanders, MD (Florida Orthopaedic Institute, University of South Florida Morsani College of Medicine, Tampa, FL), Meghan K. McCaskey, MD (Florida Orthopaedic Institute, University of South Florida Morsani College of Medicine, Tampa, FL), Morgan R. Cardon, MS (Florida Orthopaedic Institute, University of South Florida Morsani College of Medicine, Tampa, FL), Randi Alexander, MPH (Florida Orthopaedic Institute, University of South Florida Morsani College of Medicine, Tampa, FL), Madhav Karunakar, MD (Atrium Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC), Mario Cuadra, MD (Atrium Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC), Christine Churchill, MA (Atrium Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC), Erica Grochowski, MPH (Atrium Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC ), Patrick F. Bergin, MD (Department of Orthopaedics, University of Mississippi Medical Center, Jackson, MS), Eldrin Bhanat, MD, MPH (Department of Orthopaedics, University of Mississippi Medical Center, Jackson, MS), Josny Thimothee, MD (Department of Orthopaedics, University of Mississippi Medical Center, Jackson, MS), Priyanka Nehete BDS, MPH (Department of Orthopaedics, University of Mississippi Medical Center, Jackson, MS), Jacqueline Serrano, DC (Department of Orthopaedics, University of Mississippi Medical Center, Jackson, MS), Jennifer L. Bruggers, MD (Resurgens Orthopaedics, Atlanta, GA), Stephen A. Kottmeier, MD (Department of Orthopaedics, Stony Brook University Hospital, Stony Brook, NY), Amanda C. Pawlak, MD (Department of Orthopaedics, Stony Brook University Hospital, Stony Brook, NY), Andrew J. Marcantonio, DO, MBA (Department of Orthopaedic Surgery, Lahey Hospital & Medical Center, Burlington, MA), Alexander J. Ment, BA (Department of Orthopaedic Surgery, Lahey Hospital & Medical Center, Burlington, MA), John Garfi, MS (Department of Orthopaedic Surgery, Lahey Hospital & Medical Center, Burlington, MA), Scott P. Ryan, MD (Department of Orthopaedics, Tufts Medical Center, Boston, MA), Gabriel S. Perrone, MD (Department of Orthopaedics, Tufts Medical Center, Boston, MA), Molly Clark, BS (Department of Orthopaedics, Tufts Medical Center, Boston, MA), Tristan J. Elias, BS (Department of Orthopaedics, Tufts Medical Center, Boston, MA), Ross K. Leighton, MD (Department of Orthopaedic Surgery, QEII Health Sciences Center, Halifax Infirmary, NS, Canada), Kelly Trask, MSc, BEng, CCRP (Department of Orthopaedic Surgery, QEII Health Sciences Center, Halifax Infirmary, NS, Canada), Shelley MacDonald (Department of Orthopaedic Surgery, QEII Health Sciences Center, Halifax Infirmary, NS, Canada), Michael T. Archdeacon, MD (Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH), Nihar S. Shah, MD (Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH), Kimberly Hasselfeld, MS, CCRP (Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH).

Funding

Financial Interests: Arun Aneja is a paid consultant for Depuy Synthes and Runatek and has received research or institutional support from Department of Defense, Orthopaedic Trauma Association, and AO Trauma North America. Arun Aneja or an immediate family member is a member of a speaker’s bureau or has made paid presentations on behalf of Depuy Synthes and AO Trauma North America. All remaining authors declare that they have no financial interests. Non-financial Interests: David C. Landy is an editorial or governing board member for the American Journal of Sports Medicine and is an associate editor for Clinical Orthopaedics and Related Research. Arun Aneja is a board or committee member for American Academy of Orthopaedic Surgeons and Orthopaedic Trauma Association. All remaining authors declare they have no non-financial interests.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA

    Jeffrey A. Foster, David C. Landy, Richard W. Pectol, Arun Aneja, Chandler R. Sneed, Daria L. Kinchelow, Nicole G. Lemaster, Jarod T. Griffin, David A. Zuelzer, Paul E. Matuszewski, Eric S. Moghadamian, Raymond D. Wright & Daniel D. Primm

  2. Department of Biomedical Engineering, University of Kentucky College of Engineering, Lexington, KY, USA

    Ramkumar T. Annamalai

  3. Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Clay A. Spitler & David A. Patch

  4. Florida Orthopaedic Institute, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Hassan R. Mir, Roy W. Sanders, Meghan K. McCaskey, Morgan R. Cardon & Randi Alexander

  5. Atrium Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC, USA

    Madhav Karunakar, Mario Cuadra, Christine Churchill & Erica Grochowski

  6. Department of Orthopaedics, University of Mississippi Medical Center, Jackson, MS, USA

    Patrick F. Bergin, Eldrin Bhanat, Josny Thimothee, Priyanka Nehete & Jacqueline Serrano

  7. Resurgens Orthopaedics, Atlanta, GA, USA

    Jennifer L. Bruggers

  8. Department of Orthopaedics, Stony Brook University Hospital, Stony Brook, NY, USA

    Stephen A. Kottmeier & Amanda C. Pawlak

  9. Department of Orthopaedic Surgery, Lahey Hospital & Medical Center, Burlington, MA, USA

    Andrew J. Marcantonio, Alexander J. Ment & John Garfi

  10. Department of Orthopaedics, Tufts Medical Center, Boston, MA, USA

    Scott P. Ryan, Gabriel S. Perrone, Molly Clark & Tristan J. Elias

  11. Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS, Canada

    Ross K. Leighton, Kelly Trask & Shelley MacDonald

  12. Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA

    Michael T. Archdeacon, Nihar S. Shah & Kimberly Hasselfeld

Authors
  1. Jeffrey A. Foster
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  2. David C. Landy
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  3. Richard W. Pectol
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  4. Ramkumar T. Annamalai
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  5. Arun Aneja
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Consortia

the “COVID-ORTHO” Research Group

  • Chandler R. Sneed
  • , Daria L. Kinchelow
  • , Nicole G. Lemaster
  • , Jarod T. Griffin
  • , David A. Zuelzer
  • , Paul E. Matuszewski
  • , Eric S. Moghadamian
  • , Raymond D. Wright
  • , Daniel D. Primm
  • , Clay A. Spitler
  • , David A. Patch
  • , Hassan R. Mir
  • , Roy W. Sanders
  • , Meghan K. McCaskey
  • , Morgan R. Cardon
  • , Randi Alexander
  • , Madhav Karunakar
  • , Mario Cuadra
  • , Christine Churchill
  • , Erica Grochowski
  • , Patrick F. Bergin
  • , Eldrin Bhanat
  • , Josny Thimothee
  • , Priyanka Nehete
  • , Jacqueline Serrano
  • , Jennifer L. Bruggers
  • , Stephen A. Kottmeier
  • , Amanda C. Pawlak
  • , Andrew J. Marcantonio
  • , Alexander J. Ment
  • , John Garfi
  • , Scott P. Ryan
  • , Gabriel S. Perrone
  • , Molly Clark
  • , Tristan J. Elias
  • , Ross K. Leighton
  • , Kelly Trask
  • , Shelley MacDonald
  • , Michael T. Archdeacon
  • , Nihar S. Shah
  •  & Kimberly Hasselfeld

Contributions

AA and DCL conceived the presented idea and research design. RWP and the “COVID-ORTHO” Research Group contributed toward the acquisition of data. AA and DCL performed the analysis and interpretation of data. JAF, RWP, and RTA wrote and revised the manuscript in consultation with the previously listed authors. All authors have read and approved the final submitted manuscript.

Corresponding author

Correspondence to Jeffrey A. Foster.

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The authors declare no conflicts of interest relevant to the submitted work.

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Foster, J.A., Landy, D.C., Pectol, R.W. et al. A multi-institutional study of short-term mortality in COVID-positive patients undergoing hip fracture surgery: is survival better than expected?. Eur J Orthop Surg Traumatol 34, 285–291 (2024). https://doi.org/10.1007/s00590-023-03620-z

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