De Chiranjit, Wignall Alice, Giannoudis Vasileios, Jimenez Andrea, Sturdee Simon, Aderinto Joseph, Pandit Hemant, Palan Jeya, Gulati Aashish
Sandwell and West Birmingham Hospitals HNS Trust, West Bromwich, UK.
Leeds General Infirmary, Leeds, UK.
Indian J Orthop. 2020 Oct 9;54(Suppl 2):386-396. doi: 10.1007/s43465-020-00272-7. eCollection 2020 Dec.
This UK based multi-centre study reports clinical characteristics, early outcomes and predictors of mortality in 34 consecutive COVID-19-positive hip fractures so that the lessons learnt could be utilised in other parts of World who are at a different phase of the pandemic.
This study analysed patient admitted with hip fractures with COVID positive swabs, between March and May'2020 in three large hospitals covering a population of nearly two million. Data was collected on demographic profile, peri-operative variables, post-operative complications and mortality. The specific aim was to identify any variables, which could predict high 30-day mortality.
Overall, 12% of hip fractures were COVID positive with the mortality rate of 41.2%. The higher age ( = 0.036) and male gender ( = 0.025) was significantly associated with mortality and most of the deaths were between American Society of Anaesthesiologists (ASA) grade 3 and 4 patients. The patients having intramedullary (IM) nailing were more likely to die ( = 0.02). There was no difference in laboratory parameters but there was significant difference in findings on chest radiographs ( < 0.001), post-operative oxygen requirements ( = 0.006) and early respiratory complications ( = 0.006).
This study suggests that the mortality following surgery for a hip fracture in COVID-positive patients is strikingly high and is associated with higher age and male gender. Higher mortality has been observed for extracapsular fracture operated with intramedullary nailing. In the immediate post-operative period, rapid deterioration of chest imaging, higher oxygen requirement and early pulmonary complications can serve as warning signs and predicting factors for higher mortality.
这项基于英国的多中心研究报告了34例连续的新冠病毒19阳性髋部骨折患者的临床特征、早期结局和死亡率预测因素，以便在处于疫情不同阶段的世界其他地区借鉴所吸取的经验教训。
本研究分析了2020年3月至5月期间在三家大型医院收治的新冠病毒检测呈阳性拭子的髋部骨折患者，这些医院覆盖人口近200万。收集了人口统计学资料、围手术期变量、术后并发症和死亡率的数据。具体目的是确定任何可预测30天高死亡率的变量。
总体而言，12%的髋部骨折新冠病毒检测呈阳性，死亡率为41.2%。较高年龄（P = 0.036）和男性（P = 0.025）与死亡率显著相关，且大多数死亡发生在美国麻醉医师协会（ASA）3级和4级患者之间。接受髓内钉固定的患者死亡可能性更大（P = 0.02）。实验室参数无差异，但胸部X光片检查结果（P < 0.001）、术后氧气需求（P = 0.006）和早期呼吸并发症（P = 0.006）存在显著差异。
本研究表明，新冠病毒阳性患者髋部骨折手术后的死亡率极高，且与较高年龄和男性性别相关。髓内钉固定治疗的囊外骨折死亡率较高。在术后即刻，胸部影像学快速恶化、较高的氧气需求和早期肺部并发症可作为高死亡率的警示信号和预测因素。
