The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK.
Department of Trauma and Orthopaedics, Leicester Royal Infirmary, Balmoral Building, Infirmary Square, Leicester, LE1 5WW, UK.
Sci Rep. 2021 May 12;11(1):10157. doi: 10.1038/s41598-021-89617-2.
Incidence of hip fractures has remained unchanged during the pandemic with overlapping vulnerabilities observed in patients with hip fractures and those infected with COVID-19. We aimed to investigate the independent impact of COVID-19 infection on the mortality of these patients. Healthcare databases were systematically searched over 2-weeks from 1st-14th November 2020 to identify eligible studies assessing the impact of COVID-19 on hip fracture patients. Meta-analysis of proportion was performed to obtain pooled values of prevalence, incidence and case fatality rate of hip fracture patients with COVID-19 infection. 30-day mortality, excess mortality and all-cause mortality were analysed using a mixed-effects model. 22 studies reporting 4015 patients were identified out of which 2651 (66%) were assessed during the pandemic. An excess mortality of 10% was seen for hip fractures treated during the pandemic (OR 2.00, p = 0.007), in comparison to the pre-pandemic controls (5%). Estimated mortality of COVID-19 positive hip fracture patients was four-fold (RR 4.59, p < 0.0001) and 30-day mortality was 38.0% (HR 4.73, p < 0.0001). The case fatality rate for COVID-19 positive patients was 34.74%. Between-study heterogeneity for the pooled analysis was minimal (I = 0.00) whereas, random effects metaregression identified subgroup heterogeneity for male gender (p < 0.001), diabetes (p = 0.002), dementia (p = 0.001) and extracapsular fractures (p = 0.01) increased risk of mortality in COVID-19 positive patients.
在大流行期间,髋部骨折的发病率保持不变,同时观察到髋部骨折患者和 COVID-19 感染患者存在重叠的脆弱性。我们旨在研究 COVID-19 感染对这些患者死亡率的独立影响。在 2020 年 11 月 1 日至 14 日的两周内,系统地从医疗保健数据库中搜索了符合条件的研究,以评估 COVID-19 对髋部骨折患者的影响。进行了荟萃分析,以获得 COVID-19 感染髋部骨折患者的患病率、发病率和病死率的合并值。使用混合效应模型分析 30 天死亡率、超额死亡率和全因死亡率。从 22 项研究中确定了 4015 名患者,其中 2651 名(66%)是在大流行期间评估的。与大流行前的对照组(5%)相比,大流行期间治疗的髋部骨折患者的死亡率过高(OR 2.00,p=0.007)。估计 COVID-19 阳性髋部骨折患者的死亡率为四倍(RR 4.59,p<0.0001),30 天死亡率为 38.0%(HR 4.73,p<0.0001)。COVID-19 阳性患者的病死率为 34.74%。荟萃分析的组间异质性很小(I=0.00),而随机效应荟萃回归确定了男性(p<0.001)、糖尿病(p=0.002)、痴呆症(p=0.001)和囊外骨折(p=0.01)的亚组异质性,这些因素增加了 COVID-19 阳性患者的死亡率风险。