Early mortality outcomes of patients with fragility hip fracture and concurrent SARS-CoV-2 infection: a systematic review and meta-analysis

Alcock, H.; Moppett, E.; Moppett, I.

Abstract

Aims
Hip fracture is a common condition of the older, frailer person. This population is also at risk from SARS-CoV-2 infection. It is important to understand the impact of coexistent hip fracture and SARS-CoV-2 for informed decision-making at patient and service levels.

Methods
We undertook a systematic review and meta-analysis of observational studies of older (> 60 years) people with fragility hip fractures and outcomes with and without SARS-CoV-2 infection during the first wave of the COVID-19 pandemic. The primary outcome was early (30-day or in-hospital) mortality. Secondary outcomes included length of hospital stay and key clinical characteristics known to be associated with outcomes after hip fracture.

Results
A total of 14 cohort and five case series studies were included (692 SARS-CoV-2 positive, 2,585 SARS-CoV-2 negative). SARS-CoV-2 infection was associated with an overall risk ratio (RR) for early mortality of 4.42 (95% confidence interval (CI) 3.42 to 5.82). Early mortality was 34% (95% CI 30% to 38%) and 9% (95% CI 8% to 10%) in the infected and noninfected groups respectively. Length of stay was increased in SARS-CoV-2 infected patients (mean difference (MD) 5.2 days (3.2 to 7.2)). Age (MD 1.6 years (0.3 to 2.9)); female sex (RR 0.83 (95% CI 0.65 to 1.05)); admission from home (RR 0.51 (95% CI 0.26 to 1.00)); presence of dementia (RR 1.13 (95% CI 0.94 to 1.43)); and intracapsular fracture (RR 0.89 (95% CI 0.71 to 1.11)) were not associated with SARS-CoV-2 infection. There were statistically, but not clinically, significantly greater Nottingham Hip Fracture Scores in infected compared with non-infected patients (MD 0.7 (0.4 to 0.9)).

Conclusion
SARS-CoV-2 infection is associated with worse outcomes after hip fracture. This is not explained by differences in patient characteristics. These data can be used to support informed decision-making and may help track the impact of widespread adoption of system-level and therapeutic changes in management of the COVID-19 pandemic.

Citation

Alcock, H., Moppett, E., & Moppett, I. (2021). Early mortality outcomes of patients with fragility hip fracture and concurrent SARS-CoV-2 infection: a systematic review and meta-analysis. Bone & Joint Open, 2(5), 314-322. https://doi.org/10.1302/2633-1462.25.BJO-2020-0183.R1

• Journal Article Type: Article
• Acceptance Date: Jan 22, 2021
• Online Publication Date: May 18, 2021
• Publication Date: May 1, 2021
• Deposit Date: Feb 3, 2021
• Publicly Available Date: May 1, 2021
• Journal: Bone & Joint Open
• Print ISSN: 2633-1462
• Electronic ISSN: 2633-1462
• Publisher: British Editorial Society of Bone and Joint Surgery
• Peer Reviewed: Peer Reviewed
• Volume: 2
• Issue: 5
• Pages: 314-322
• DOI: https://doi.org/10.1302/2633-1462.25.BJO-2020-0183.R1
• Keywords: Hip fracture; COVID-19; mortality; complications
• Public URL: https://nottingham-repository.worktribe.com/output/5289696
• Publisher URL: https://online.boneandjoint.org.uk/doi/full/10.1302/2633-1462.25.BJO-2020-0183.R1#d3002e1