COVID-19 and proximal femur fracture in older adults – A lethal combination? An analysis of the Registry for Geriatric Trauma (ATR-DGU)

Pass, Bastian; Vajna, Elvira; Knauf, Tom; Rascher, Katherine; Aigner, Rene; Eschbach, Daphne; Lendemans, Sven; Knobe, Matthias; Schoeneberg, Carsten

Objectives COVID-19 can be a life-threatening illness, especially for older patients. The COVID-19 outbreak created a dramatic organizational challenge in treating infected patients requiring surgical treatment, like those suffering a proximal femur fracture, in a pandemic setting. We investigate the impact of a COVID-19 infection in patients with a proximal femur fracture not only on mortality but also on quality of life (QoL), length of stay, and discharge target. Design Retrospective cohort analysis from July 1, 2020, to December 31, 2020. The Registry for Geriatric Trauma collected the data prospectively. Patient groups with and without COVID-19 infection were compared using linear and logistic regression models. Setting and Participants Retrospective multicenter registry study including patients aged 70 years or above with proximal femur fracture requiring surgery from 107 certified Centers for Geriatric Trauma in Germany, Austria, and Switzerland. Measures The occurrence and impact of COVID-19 infection in patients suffering a proximal femur fracture were measured regarding in-house mortality, length of stay, and discharge location. Moreover, QoL was measured by the validated EQ-5D-3L questionnaire. Results 3,733 patients were included in our study. Of them, 123 patients tested COVID-19 positive at admission. A COVID-19 infection resulted in a 5.95-fold higher mortality risk (odds ratio (OR) 5.95, p < 0.001), a length of stay prolonged by 4.21 days (regression coefficient (ß) 4.21, p < 0.001), a reduced QoL (ß -0.13, p = 0.001), and a change in discharge target, more likely to their home instead of another inpatient facility like a rehabilitation clinic (p = 0.013). Conclusions and Implications The impact of a COVID-19 infection in patients suffering a proximal femur fracture is tremendous. The infected patients presented a dramatic rise in mortality rate, were significantly less likely to be discharged to a rehabilitation facility, had a longer in-hospital stay and a reduced QoL.