COVID-19大流行期间的髋部骨折治疗结果：来自纽约的早期结果
Hip Fracture Outcomes During the COVID-19 Pandemic: Early Results From New York.
作者信息
LeBrun Drake G, Konnaris Maxwell A, Ghahramani Gregory C, Premkumar Ajay, DeFrancesco Chris J, Gruskay Jordan A, Dvorzhinskiy Aleksey, Sandhu Milan S, Goldwyn Elan M, Mendias Christopher L, Ricci William M
机构信息
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
HSS Research Institute, Hospital for Special Surgery, New York, NY.
出版信息
J Orthop Trauma. 2020 Aug;34(8):403-410. doi: 10.1097/BOT.0000000000001849.
OBJECTIVE
To evaluate inpatient outcomes among patients with hip fracture treated during the COVID-19 pandemic in New York City.
DESIGN
Multicenter retrospective cohort study.
SETTING
One Level 1 trauma center and one orthopaedic specialty hospital in New York City.
PATIENTS/PARTICIPANTS: Fifty-nine consecutive patients (average age 85 years, range: 65-100 years) treated for a hip fracture (OTA/AO 31, 32.1) over a 5-week period, March 20, 2020, to April 24, 2020, during the height of the COVID-19 crisis.
MAIN OUTCOME MEASUREMENTS
COVID-19 infection status was used to stratify patients. The primary outcome was inpatient mortality. Secondary outcomes were admission to the intensive care unit, unexpected intubation, pneumonia, deep vein thrombosis, pulmonary embolus, myocardial infarction, cerebrovascular accident, urinary tract infection, and transfusion. Baseline demographics, comorbidities, treatment characteristics, and COVID-related symptomatology were also evaluated.
RESULTS
Ten patients (15%) tested positive for COVID-19 (COVID+) (n = 9; 7 preoperatively and 2 postoperatively) or were presumed positive (n = 1), 40 (68%) patients tested negative, and 9 (15%) patients were not tested in the primary hospitalization. American Society of Anesthesiologists' scores were higher in the COVID+ group (d = -0.83; P = 0.04); however, the Charlson Comorbidity Index was similar between the study groups (d = -0.17; P = 0.63). Inpatient mortality was significantly increased in the COVID+ cohort (56% vs. 4%; odds ratio 30.0, 95% confidence interval 4.3-207; P = 0.001). Including the one presumed positive case in the COVID+ cohort increased this difference (60% vs. 2%; odds ratio 72.0, 95% confidence interval 7.9-754; P < 0.001).
CONCLUSIONS
Hip fracture patients with concomitant COVID-19 infection had worse American Society of Anesthesiologists' scores but similar baseline comorbidities with significantly higher rates of inpatient mortality compared with those without concomitant COVID-19 infection.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
目的
评估纽约市在2019冠状病毒病大流行期间接受治疗的髋部骨折患者的住院结局。
设计
多中心回顾性队列研究。
地点
纽约市的一家一级创伤中心和一家骨科专科医院。
患者/参与者：2020年3月20日至2020年4月24日，在2019冠状病毒病危机高峰期的5周内，连续59例接受髋部骨折（OTA/AO 31、32.1）治疗的患者（平均年龄85岁，范围：65 - 100岁）。
主要结局测量指标
使用2019冠状病毒病感染状况对患者进行分层。主要结局是住院死亡率。次要结局包括入住重症监护病房、意外插管、肺炎、深静脉血栓形成、肺栓塞、心肌梗死、脑血管意外、尿路感染和输血。还评估了基线人口统计学、合并症、治疗特征和与2019冠状病毒病相关的症状。
结果
10例患者（15%）2019冠状病毒病检测呈阳性（COVID+）（9例；7例术前阳性，2例术后阳性）或被推测为阳性（1例），40例（68%）患者检测呈阴性，9例（15%）患者在首次住院期间未进行检测。COVID+组的美国麻醉医师协会评分较高（d = -0.83；P = 0.04）；然而，研究组之间的Charlson合并症指数相似（d = -0.17；P = 0.63）。COVID+队列中的住院死亡率显著增加（56%对4%；比值比30.0，95%置信区间4.3 - 207；P = 0.001）。将1例推测为阳性的病例纳入COVID+队列会增加这种差异（60%对2%；比值比72.0，95%置信区间7.9 - 754；P < 0.001）。
结论
与未合并2019冠状病毒病感染的患者相比，合并2019冠状病毒病感染的髋部骨折患者的美国麻醉医师协会评分更差，但基线合并症相似，住院死亡率显著更高。
证据水平
预后性III级。有关证据水平的完整描述，请参阅作者指南。
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