Summary

To review 30 day mortality rate, mortality related to covid infected neck of femur fracture patients, if we are following NICE guidelines for management of neck of femur fracture patients during the pandemic

Abstract

Covid-19 has had a profound impact on the NHS.
•In addition, Hip fractures still form a significant proportion of admissions during the national lockdown period in 2020.
•Since 2007 the NHFD has reported a progressive improvement in 30 day mortality after hip fracture and this trend continues with just 6.1% dying in 2018, against 6.9% in 2017.(1)
•Covid-19 has increased the mortality especially in elderly population who commonly present with fragility hip fractures.(2)
•Various early studies show increased mortality in paientswith hip fracture with concurrent covid-19 infection.
National Institute of Clinical Excellence (NICE) clinical guidance (CG124) states that patients should have definitive surgery on the day of, or the day after diagnosis, along with other criteria, aiming to reduce mortality and morbidity.(8)

Objectives

To review the 30 day mortality rate (30 days from fracture diagnosis) in patients with NOFs and PPs during the pandemic.
•To determine mortality in NOF patients with concurrent covid-19 infection.
•To assess if we are following the NICE guidelines of time to surgery for NOF patients during the covidpandemic.

Study Design & Methods

Retrospective study of all patients with NOFs and peri-prosthetic hip and knee fractures admitted during the period of 01/03/2019 to 24/05/2019 and 01/03/2020 to 24/05/2020.
•Data collection using eTrauma, ICE and PACS.

Results

Admissions-
1)There were 86 NOFs in 2019 and 8 PPs in 2019 (94 patients).
2)There were 95 NOFs in 2020 and 9 PPs in 2020 (104 patients).
•Deaths-
1)There were 3 NOF and 1PP deaths in 2019 (4.25%).
2)There were 18NOF deaths and 0 PP deathsin 2020 (17.3%).
•Covid status-
1)Among the 95 NOFs in 2020, 15 were covid positive, of which 7 died.
2)Among the 9 PPs in 2020, there were 2 were covid positive, of which none died.
(38.8% of deaths in 2020 were covid positive)
•Time to surgery for all patients (in 2019 and 2020) was <24 hours.

Conclusions

Mortality rate in 2019 was 4.25% which increased to 17.3% in 2020 which is opposite to the recent yearly decreasing NHFD trend (6.8% prior to pandemic) but similar to NW study (32.8%).
•Of the 2020 deaths, 38.8% were covid-19 positive which is similar torecent UK study of 16,749 patients admitted to hospital with COVID-19 reports a mortality rate of 31%.(9)
•Time to surgery was <24 hours in both 2019 and 2020 showing that we are following NICE guideline.