Perioperative mortality and morbidity of hip fracture among COVID-19 infected and non-infected patients: A systematic review and meta-analysis

Tripathy, Sujit Kumar; Varghese, Paulson; Panigrahi, Sibasish; Panda, Bijnya Birajita; Srinivasan, Anand; Sen, Ramesh Kumar

PURPOSE: Hip fractures among elderly patients are surgical emergencies. During COVID-19 pandemic time, many such patients could not be operated at early time because of the limitation of the medical resources, the risk of infection and redirection of medical attention to a severe infective health problem. METHODS: A search of electronic databases (PubMed, Medline, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials) with keywords "COVID", "COVID-19", “SARS-COV-2”, “Corona”, "pandemic", "hip fracture", "trochanteric fracture" and "neck femur fracture" revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time. After screening, 7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected (COVID-19 +) and non-infected (COVID-19 −) patients. The 30-day mortality rate, inpatient mortality rate, critical care/special care need, readmission rate and complications rate in both groups were evaluated. Data were analyzed using Review Manager (RevMan) V.5.3. RESULTS: There were significantly increased risks of 30-day mortality (32.23% COVID-19 + death vs. 8.85% COVID-19 − death) and inpatient mortality (29.33% vs. 2.62%) among COVID-19 + patients with odds ratio (OR) of 4.84 (95% CI: 3.13-7.47, p < 0.00001) and 15.12 (95% CI: 6.12-37.37, p < 0.00001), respectively. The COVID-19 + patients needed more critical care admission (OR = 5.34, 95% CI: 3.41-8.38, p < 0.00001) and they remain admitted for a longer time in the hospital (MD = 3.6, 95% CI: 1.74-5.45, p = 0.0001); but there was no difference in readmission rate between these 2 groups. The risks of overall complications (OR = 17.22), development of pneumonia (OR = 21.02), and acute respiratory distress syndrome/acute respiratory failure (OR = 32.96) was significantly high among COVID-19 + patients compared to COVID-19 − patients. CONCLUSIONS: There are increased risks of the 30-day mortality, inpatient mortality and critical care admission among hip fracture patients who are COVID-19 +. The chances of developing pneumonia and acute respiratory failure are more in these patients than in COVID-19 ‒ patients.