Wright Esther Victoria, Musbahi Omar, Singh Abhinav, Somashekar Naresh, Huber Christopher P, Wiik Anatole Vilhelm
The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK.
Imperial College London, London, UK.
Patient Saf Surg. 2021 Jan 10;15(1):8. doi: 10.1186/s13037-020-00279-x.
The coronavirus disease 19 (COVID-19) pandemic has presented modern healthcare with an unprecedented challenge. At the peak of the pandemic, trauma and orthopaedic services at our institutions undertook internal restructuring, diverting resources to frontline medical care. Consequently, we sought to assess the impact on the elderly and comorbid patients presenting with femoral neck fractures, with a particular focus on 30-day mortality, length of stay, multidisciplinary team involvement and departmental structuring.
A retrospective analysis of patients presenting with femoral neck fractures at three separate West London NHS Trusts was undertaken between March 11, 2020, to April 30, 2020. Length of stay, 30-day mortality and adherence to parameters constituting the best care evidence-based practice tariffs were compared between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and negative patients. A similar comparison was also conducted between our cohort and the equivalent period in 2018 using data from the National Hip Fracture Database.
A total of 68 patients presenting with femoral neck fractures were identified, mean age 81 (range 38-98), 73% female. There were 10 confirmed/suspected cases of COVID-19 on admission and a further seven confirmed as inpatients. The 30-day mortality within our cohort was 11.76% compared to 6% nationally in 2018 (p = 0.045). Orthogeriatric reviews occurred within 72 h in 71% of cases compared to 88% in the equivalent 2018 period. Within the cohort, mean length of stay was 17.13 days (SD 5.6, range 8-27 days) for SARS-CoV-2 positive patients compared to 10 days (SD 8.7, range 1-53 days) for negative patients (p < 0.05). Thirty-two patients (47%) required increased packages of care on discharge or rehabilitation.
The increase in 30-day mortality for SARS-CoV-2 positive patients presenting with femoral neck fractures is multifactorial, resulting from a combination of the direct effects of COVID-19 pneumonia as well as changes to the delivery of orthopaedic services. The provision of multidisciplinary care was directly affected by staff redeployment, particularly reorganisation of orthogeriatric services and lack of continuity of ward based clinical care. Our experiences have re-directed efforts towards the management of theatre teams, patient services and staffing, should we be faced with either a resurgence of COVID-19 or a future pandemic.
2019冠状病毒病（COVID-19）大流行给现代医疗保健带来了前所未有的挑战。在大流行高峰期，我们机构的创伤和骨科服务进行了内部重组，将资源转移到一线医疗护理。因此，我们试图评估对股骨颈骨折的老年患者和合并症患者的影响，特别关注30天死亡率、住院时间、多学科团队参与情况和科室结构。
对2020年3月11日至2020年4月30日期间在伦敦西部三个不同的国民保健服务信托基金就诊的股骨颈骨折患者进行回顾性分析。比较了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）阳性和阴性患者的住院时间、30天死亡率以及对构成最佳护理循证实践收费标准参数的遵守情况。我们还使用国家髋部骨折数据库的数据，将我们的队列与2018年同期进行了类似比较。
共确定68例股骨颈骨折患者，平均年龄81岁（范围38 - 98岁），73%为女性。入院时有10例确诊/疑似COVID-19病例，另有7例住院期间确诊。我们队列中的30天死亡率为11.76%，而2018年全国为6%（p = 0.045）。71%的病例在72小时内进行了骨科老年病学评估，而2018年同期为88%。在队列中，SARS-CoV-2阳性患者的平均住院时间为17.13天（标准差5.6，范围8 - 27天），阴性患者为10天（标准差8.7，范围1 - 53天）（p < 0.05）。32例患者（47%）出院或康复时需要增加护理套餐。
SARS-CoV-2阳性的股骨颈骨折患者30天死亡率增加是多因素的，是COVID-19肺炎的直接影响以及骨科服务提供方式改变共同作用的结果。多学科护理的提供直接受到人员重新部署的影响，特别是骨科老年病学服务的重组以及病房临床护理缺乏连续性。我们的经验已将工作重点重新导向手术室团队管理、患者服务和人员配置，以防我们面临COVID-19卷土重来或未来的大流行。
