Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

COVIDSurg Collaborative

doi:10.1136/bmjopen-2021-050830

Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

COVIDSurg Collaborative

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

64 Downloads (Pure)

Abstract

OBJECTIVES: Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.

SETTING: Prospective, international, multicentre, observational cohort study.

PARTICIPANTS: Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).

PRIMARY OUTCOME: 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.

RESULTS: This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).

CONCLUSIONS: Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.

TRIAL REGISTRATION NUMBER: NCT04323644.

Original language	English
Article number	e050830
Number of pages	10
Journal	BMJ open
Volume	11
Issue number	11
DOIs	https://doi.org/10.1136/bmjopen-2021-050830
Publication status	Published - 30 Nov 2021

Bibliographical note

Funding Information:
Funding This work was supported by a National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 16.136.79), the Association of Coloproctology of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons, Bowel Disease Research Foundation, Yorkshire Cancer Research, Sarcoma UK, the British Association of Surgical Oncology, the Vascular Society for Great Britain and Ireland and the European Society of Coloproctology.

Publisher Copyright:
© 2021 Author(s). Published by BMJ.

Keywords

Aged, 80 and over
COVID-19
Cohort Studies
Femoral Fractures
Hip Fractures
Humans
Male
Prospective Studies
SARS-CoV-2

ASJC Scopus subject areas

General Medicine

Access to Document

10.1136/bmjopen-2021-050830Licence: Creative Commons: Attribution (CC BY)

COVIDSurgCollaborative2021OutcomesFinal published version, 531 KBLicence: Creative Commons: Attribution (CC BY)

Cite this

@article{39a19c78d55e4469a1468a5c66570b80,

title = "Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study",

abstract = "OBJECTIVES: Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SETTING: Prospective, international, multicentre, observational cohort study.PARTICIPANTS: Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).PRIMARY OUTCOME: 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.RESULTS: This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).CONCLUSIONS: Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.TRIAL REGISTRATION NUMBER: NCT04323644.",

keywords = "Aged, 80 and over, COVID-19, Cohort Studies, Femoral Fractures, Hip Fractures, Humans, Male, Prospective Studies, SARS-CoV-2",

author = "{COVIDSurg Collaborative} and Paul Nankivell and Elizabeth Li",

note = "Funding Information: Funding This work was supported by a National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 16.136.79), the Association of Coloproctology of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons, Bowel Disease Research Foundation, Yorkshire Cancer Research, Sarcoma UK, the British Association of Surgical Oncology, the Vascular Society for Great Britain and Ireland and the European Society of Coloproctology. Publisher Copyright: {\textcopyright} 2021 Author(s). Published by BMJ.",

year = "2021",

month = nov,

day = "30",

doi = "10.1136/bmjopen-2021-050830",

language = "English",

volume = "11",

journal = "BMJ open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "11",

}

TY - JOUR

T1 - Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures

T2 - an international cohort study

AU - COVIDSurg Collaborative

AU - Nankivell, Paul

AU - Li, Elizabeth

N1 - Funding Information: Funding This work was supported by a National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 16.136.79), the Association of Coloproctology of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons, Bowel Disease Research Foundation, Yorkshire Cancer Research, Sarcoma UK, the British Association of Surgical Oncology, the Vascular Society for Great Britain and Ireland and the European Society of Coloproctology. Publisher Copyright: © 2021 Author(s). Published by BMJ.

PY - 2021/11/30

Y1 - 2021/11/30

N2 - OBJECTIVES: Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SETTING: Prospective, international, multicentre, observational cohort study.PARTICIPANTS: Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).PRIMARY OUTCOME: 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.RESULTS: This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).CONCLUSIONS: Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.TRIAL REGISTRATION NUMBER: NCT04323644.

AB - OBJECTIVES: Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SETTING: Prospective, international, multicentre, observational cohort study.PARTICIPANTS: Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).PRIMARY OUTCOME: 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.RESULTS: This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).CONCLUSIONS: Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.TRIAL REGISTRATION NUMBER: NCT04323644.

KW - Aged, 80 and over

KW - COVID-19

KW - Cohort Studies

KW - Femoral Fractures

KW - Hip Fractures

KW - Humans

KW - Male

KW - Prospective Studies

KW - SARS-CoV-2

UR - http://www.scopus.com/inward/record.url?scp=85121269167&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2021-050830

DO - 10.1136/bmjopen-2021-050830

M3 - Article

C2 - 34848515

SN - 2044-6055

VL - 11

JO - BMJ open

JF - BMJ open

IS - 11

M1 - e050830

ER -

Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

Access to Document

Fingerprint

Cite this