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

COVIDSurg Collaborative

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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 languageEnglish
Article numbere050830
Number of pages10
JournalBMJ open
Volume11
Issue number11
DOIs
Publication statusPublished - 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

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