The COVID-19 pandemic has been shown to have caused a significant strain on the healthcare system and resources in the United States. However, data regarding the impact of the virus on hip fractures, primarily seen in elderly patients, is lacking.
Researchers at Hospital for Special Surgery (HSS) sought to compare characteristics and outcomes of hip fracture patients admitted during the COVID-19 outbreak to patients admitted before the outbreak. They also examined characteristics and outcomes of hip fracture patients with and without the virus. Their findings were presented at the 2021 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting.1
"Studying this topic is important because events that stress the healthcare system, like this pandemic, allow us to gain rare insights into what happens to medical care when resources become scarce," said principal investigator Stavros Memtsoudis, MD, PhD, MBA, an anesthesiologist at HSS.
Dr. Memtsoudis and colleagues compared patient and healthcare characteristics, COVID-19 diagnoses and outcomes for hip-fracture patients from March to April 2019 and March to April 2020. Observed outcomes included length of hospital stay, admission to an intensive care unit (ICU), use of mechanical ventilation, 30-day readmission, discharge disposition and postoperative complications.
The number of hip fracture cases during the COVID-19 surge decreased by 50% compared with the same time period during the previous year. "One of the major takeaways from this study was we saw that fractures were more commonly treated nonoperatively, and how outcomes differed," Dr. Memtsoudis noted. During the pandemic, hip fracture patients were discharged earlier and were less likely to be admitted to the ICU.
Other factors did not differ before and after COVID-19, including in-hospital mortality rate, 30-day readmission rate, use of mechanical ventilation, and complication rate.
Hip-fracture patients with COVID-19 stayed in the hospital longer, had higher rates of complications during surgery, increased rates of mortality, and more frequently received nonsurgical treatment.
These results show two main considerations for hospitals. As society begins to return to more normal activities, rates of hip fracture are likely to increase back to pre-COVID-19 levels. Hospitals should be prepared and have plans for treating hip fracture patients with COVID-19, as well as protecting non-COVID-19 patients from exposure.
Additionally, findings that demonstrate shorter length of stay in the hospital, less use of the ICU, and earlier home discharge did not compromise outcomes and deserve further study. This raises the question of whether the strategies of care for hip fracture patients used before the pandemic should be adjusted.
"These results should make us reevaluate our practice going forward to make sure we do not waste resources but also affirm interventions that truly are beneficial," Dr. Memtsoudis concluded.
1. Haoyan Zhong MPA, Jashvant Poeran MD PhD, Jiabin Liu MD PhD, Lauren A. Wilson MPH, Stavros G. Memtsoudis MD PhD MBA FCCP. "Hip Fracture Characteristics and Outcomes During COVID 19: A Large Retrospective National Database Review." Presented at: 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), May 13-15, 2021; Orlando, FL.
HSS is the world's leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 11th consecutive year), No. 4 in rheumatology by U.S. News & World Report (2020-2021), and named a leader in pediatric orthopedics by U.S. News & World Report "Best Children's Hospitals" list (2020-2021). HSS is ranked world #1 in orthopedics by Newsweek (2020-2021). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. http://www.