COVID-19 对股骨近端骨折患者管理和结局的影响：一项 580 例患者的多中心研究。
The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients.
机构信息
Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Huddersfield Royal Infirmary, Huddersfield, UK.
出版信息
J Orthop Surg Res. 2021 Feb 24;16(1):155. doi: 10.1186/s13018-021-02301-z.
BACKGROUND
On the 11th March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. Multiple new guidelines were proposed and existing models of social, domestic and hospital care altered. Most healthcare systems were largely unprepared for this, and the pandemic has tested their adaptability. This study aimed to assess the impact of COVID-19 on the demographics, presentation, clinical management and outcomes of patients with proximal femoral (hip) fractures comparing them to a similar cohort of patients admitted a year earlier.
METHODS
This retrospective multi-centre cohort study compared all patients admitted with hip fractures between 1st March and 30th May 2019 (group PC: pre-COVID-19) with hip fracture patients admitted over the same time period during the pandemic in 2020 (group C: COVID-19). The data was obtained from the hospitals' local and National Hip Fracture Databases. Mortality data was checked with the Office for National Statistics (ONS). Primary outcomes were time to theatre, in-patient length of stay and 30-day mortality.
RESULTS
A total of 580 patients were included (304 group PC, 276 group C). Patient demographics including Charlson Comorbidity Index and Nottingham Hip Fracture Scores were broadly similar across the two cohorts. There was a significant reduction in the percentage of total hip replacements (11 to 5%, p = 0.006) in group C. There was an increase in conservative management (1 to 5%, p = 0.002) in group C. Time to theatre was significantly delayed in group C (43.7 h) vs group PC (34.6 h) (p ≤ 0.001). The overall length of hospital stay was significantly longer in group PC (16.6 days) vs group C (15 days) (p = 0.025). The 30-day mortality rate in group C was 9.8% compared to 8.2% in group PC (p = 0.746), but for COVID-19 (+) patients, it was significantly higher at 38.2% vs 5.8% in COVID-19 (-) patients (p < 0.001).
CONCLUSION
This is one of the largest multi-centre comparative cohort study in the literature to date examining the impact of the COVID-19 pandemic on the management of hip fracture patients. Whilst mortality rates were similar in both groups, COVID-19-positive patients were almost seven times more likely to die, reflecting the seriousness of the COVID-19 infection and its sequelae in such elderly, vulnerable patients.
背景
2020 年 3 月 11 日，世界卫生组织宣布 COVID-19 疫情为大流行。提出了多项新指南，并改变了现有的社会、国内和医院护理模式。大多数医疗保健系统对此准备不足，大流行检验了它们的适应性。本研究旨在评估 COVID-19 对股骨近端（髋关节）骨折患者的人口统计学、表现、临床管理和结局的影响，并将其与一年前相似的髋关节骨折患者进行比较。
方法
这是一项回顾性多中心队列研究，比较了 2019 年 3 月 1 日至 5 月 30 日期间（PC 组：COVID-19 前）所有因髋部骨折入院的患者，以及 2020 年同期大流行期间因髋部骨折入院的患者（C 组：COVID-19）。数据来自医院的当地和国家髋关节骨折数据库。通过国家统计局（ONS）检查死亡率数据。主要结局指标是手术时间、住院时间和 30 天死亡率。
结果
共纳入 580 例患者（PC 组 304 例，C 组 276 例）。两组患者的人口统计学特征，包括 Charlson 合并症指数和诺丁汉髋关节骨折评分，基本相似。C 组全髋关节置换术的比例显著下降（11%降至 5%，p=0.006）。C 组保守治疗的比例增加（1%至 5%，p=0.002）。C 组手术时间明显延迟（43.7 小时）vs PC 组（34.6 小时）（p≤0.001）。PC 组的总住院时间明显长于 C 组（16.6 天）vs C 组（15 天）（p=0.025）。C 组 30 天死亡率为 9.8%，PC 组为 8.2%（p=0.746），但 COVID-19（+）患者的死亡率明显更高，为 38.2%，而 COVID-19（-）患者为 5.8%（p<0.001）。
结论
这是迄今为止文献中最大的多中心对照队列研究之一，研究了 COVID-19 大流行对髋部骨折患者管理的影响。尽管两组死亡率相似，但 COVID-19 阳性患者的死亡风险几乎高出七倍，反映出 COVID-19 感染及其在这些老年、脆弱患者中的后遗症的严重性。
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