IMPACT OF COVID-19 ON MORTALITY AND HOSPITALIZATION IN OLDER ADULTS WITH HIP FRACTURE

SANTOS, DIEGO DA SILVA; BARROS, EDIVANDO MOURA; HOSNI, NICOLE DITTRICH; SCATIGNA, BRUNO FRANCESCO; FALÓTICO, GUILHERME GUADAGNINI; TAKATA, EDMILSON TAKEHIRO

doi:10.1590/1413-785220223005e255298

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Acta Ortopédica Brasileira

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ORIGINAL ARTICLE, HIP • Acta ortop. bras. 30 (5) • 2022 • https://doi.org/10.1590/1413-785220223005e255298 copy

IMPACT OF COVID-19 ON MORTALITY AND HOSPITALIZATION IN OLDER ADULTS WITH HIP FRACTURE

IMPACTO DA COVID-19 NA MORTALIDADE E INTERNAÇÃO DE IDOSOS COM FRATURA DO QUADRIL

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the impact of the COVID-19 pandemic on hospital admission and mortality indicators in older adults with fractures of the proximal femur.

Methods:

Observational and retrospective study that took place from June 2016 to 2020. Patients of both genders who underwent surgical treatment for fractures of the proximal end of the femur, aged over 60 years, were included.

Results:

The population consisted of 379 patients, treated before (group 1; N = 278; 73.35%) and during the pandemic (group 2; N = 101; 26.65%). Higher mortality was observed in group 2 (N = 24; 23.8%) versus group 1 (N = 10; 3.6%), p < 0.001. The highest proportion of deaths in group 2 was maintained in patients aged 70-79 years (p = 0.011), 80-89 years (p ≤ 0.001) and > 90 years (p ≤ 0.001). In addition, the preoperative time and hospital stay were longer in group 2 compared to group 1 (p ≤ 0.001).

Conclusion:

The present study demonstrated that the pandemic period increased the mortality rate and the preoperative and hospitalization time in older patients with femur fractures. Thus, the pandemic has affected the care of fractures of the proximal femur in older adults, which reinforces the need to adopt measures to reduce complications and mortality. Level of Evidence II, Retrospective Study.

Keywords:
COVID-19; Fractures, Bone; Aged; Hospitalization; Mortality; Femur

	Group 1		Group 2		Total
	N	%	N	%	N	%
Variables	278	73.35	101	26.65	37	100	p
Age	78.98	SD:9.55	78.87	SD:10.23	78.95	9.728	0.9927#
Sex							0.9023*
Male	93	33.50	35	35.00	128	33.77%
Female	185	66.50	66	65.00	251	66.23%
Age group							0.488*
60-69 years	55	19.80	25	24.80	80	21.11%
70-79 years	73	26.30	23	22.80	96	25.33%
80-89 years	116	41.70	37	36.60	153	40.37%
> 90 years	34	12.20	16	15.80	50	13.19%
Type of Fracture							< 0.001*
Transtrochanteric	259	93.10	68	67.30	327	86.28%
Fracture of neck	19	6.90	33	32.70	52	13.72%

		Group 1		Group 2		p
		N	%	N	%
Sex	Death	278	73.35	101	26.65
Male						< 0.001
	No	92	98.92	26	74.29
	Yes	1	1.08	9	25.71
	Total	93	100.00	35	68.63
Female						< 0.001
	No	176	95.14	51	77.27
	Yes	9	4.86	15	22.73
	Total	185	100.00	66	100.00
Total						< 0.001
	No	268	96.40	77	76.24
	Yes	10	3.60	24	23.76
	Total	278	100.00	101	100.00

		Group 1		Group 2		p
		N	%	N	%
Age group	Death	278	73.35	101	26.65
60-69 years						0.053
	No	54	98.18	22	88.00
	Yes	1	1.82	3	12.00
	Total	55	100.00	25	100.00
70-79 years						0.011
	No	71	97.26	19	82.61
	Yes	2	2.74	4	17.39
	Total	73	100.00	23	100.00
80-89 years						< 0.001
	No	111	80.43	5	33.33
	Yes	27	19.57	10	66.67
	Total	138	100.00	15	33.33
> 90 years						< 0.001
	No	32	94.12	9	56.25
	Yes	2	5.88	7	43.75
	Total	34	100.00	16	100.00

	Group 1			Group 2			p
	N	%		N	%
Time (days)	278	73.35		101	26.65
	Mean	Median	SD	Mean	Median	SD
Preoperative	0.76	0.12	2.70	4.92	3.45	4.55	< 0.001
Hospital stay	4.97	2.5	6.14	12.7	9.31	10.5	< 0.001

	Group 1		Group 2
	N	%		N
Causes of death	278	73.35		101
CRP secondary to hydroelectrolytic disorder	2	17.60	3	12.00
CRP of undetermined cause	2	17.60	8	36.00
CRP secondary to upper gastrointestinal bleeding	0	0.00	2	8.00
Urinary focal sepsis	2	17.60	0	0.00
Pulmonary focal sepsis	1	14.70	6	24.00
Sepsis; focus, indeterminate	0	0.00	3	12.00
IRA secondary to COVID	0	0.00	2	8.00
Other causes*	3	32.00	0	0.00
Causes of the increase in hospitalization time
Waiting until clinical stabilization	194	70.00	32	32.10
Waiting for cardiologist evaluation	55	20.00	47	46.40
Delay for material arrival	0	0.00	14	14.20
Lack of ICU	2	0.90	4	3.60
Waiting for exam	0	0.00	3	3.50
Other causes#	27	10.00	0	0.00

	COVID-19 CRP
	Negative		Positive		Total
	N	%	N	%	N	%	p
Death							1.000
No	60	80.00	3	75.00	63	79.75
Yes	15	20.00	1	25.00	16	20.25
Total	75	100.00	4	100.00	79	100.00

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[1] Correspondence: Diego da Silva Santos. Rua Frei Caneca, 750, apt 3122, São Paulo, SP, Brazil, 01307000. diegos-santos@hotmail.com