Mortality escalates in patients of proximal femoral fractures with COVID-19: A systematic review and meta-analysis of 35 studies on 4225 patients

Patralekh, Mohit Kumar; Jain, Vijay Kumar; Iyengar, Karthikeyan P.; Upadhyaya, Gaurav Kumar; Vaishya, Raju

BACKGROUND: Concerns have been raised about the escalated mortality in patients of proximal femoral fractures (PPFs) with COVID-19. A meta-analysis to evaluate mortality in patients with PPFs managed during the current COVID-19 pandemic was conducted. METHODS: A systematic review and meta-analysis of all published studies were conducted with a search on PubMed, Scopus, Web of Science, and Cochrane Library databases using appropriate keywords from January 01, 2020 to January 29, 2021. RESULTS: 35 relevant studies reporting 3979 patients with hip fracture in the current ongoing pandemic, out of which 692 patients were COVID -19 positive. Twenty studies reported mortality and other relevant statistics on hip fracture patients with and without COVID 19 (4123 hip fracture patients in the year 2020–21, out of which 560 had or were suspected of having COVID -19). A meta-analysis of mortality statistics in patients with and without COVID revealed increased odds of mortality among COVID patients [odds ratio (OR) 6.31, 95% confidence interval (CI) [5.09, 7.83] and meta-analysis on the subgroup of surgically treated patients also showed markedly increased mortality risk among those with COVID-19 (OR) 5.99, 95% CI [3.88,9.24]. CONCLUSION: The mortality risk is markedly increased in hip fracture with concomitant COVID -19 compared to those without it. This increased risk persisted in those managed surgically. It could be due to the inflammation induced by the fracture or surgery for fracture fixation, further exacerbating inflammation, leading to cytokine storm. It is imperative that such patients are informed regarding increased mortality risk during the consent and shared decision-making process.