Sadiq Salman, Lipski Caroline, Hanif Umar-Khetaab, Arshad Faizan, Chaudary Muhammad, Chaudhry Fouad
Russells Hall Hospital, Dudley, UK.
Bone Jt Open. 2021 Dec;2(12):1017-1026. doi: 10.1302/2633-1462.212.BJO-2021-0102.R1.
This study assessed the impact of COVID-19 on hip and distal femur fracture patient outcomes across three successive UK lockdown periods over one year.
A single-centre retrospective cohort study was performed at an acute NHS Trust. Hip and distal femur fracture patients admitted within the first month from each of the three starting dates of each national lockdown were included and compared to a control group in March 2019. Data were collected as per the best practice tariff outcomes including additional outcomes as required. Data collection included COVID-19 status, time to theatre, 30-day mortality, presence of acute kidney injury (AKI) and pneumonia, and do not attempt cardiopulmonary resuscitation (DNACPR) status. Data were analyzed using an independent-samples -test or chi-squared test with Fisher's exact test where applicable. A p-value of < 0.05 was considered statistically significant.
A total of 95 patients during the pandemic were included and 20 were COVID-positive. Patients experienced a statistically significant increase in time to theatre in Lockdown 1 compared to 2019 (p = 0.039) with a decrease with successive lockdown periods by Lockdown 3. The 30-day mortality increased from 8.8% in 2019 to 10.0% to 14.8% in all lockdown periods. COVID-positive patient mortality was 30.0% (p = 0.063, odds ratio (OR) = 4.43 vs 2019). The rates of AKI and pneumonia experienced were higher for patients during the pandemic. The highest rates were experienced in COVID-positive patients, with 45.0% of patients with AKI versus 27.0% in 2019 (p = 0.38, OR = 1.80), and 50.0% of patients diagnosed with pneumonia versus 16.2% in 2019 (p = 0.0012, OR = 5.17). The percentage of patients with a DNACPR increased from 30.0% in 2019 to 60.7% by Lockdown 3 (p = 0.034, OR = 3.61).
COVID-positive hip and distal femur fracture patients are at a higher risk of mortality due to AKI and pneumonia. Patient outcomes have improved with successive lockdowns to pre-pandemic levels. Cite this article: 2021;2(12):1017-1026.
本研究评估了在英国连续三个为期一年的封锁期内，新冠疫情对髋部和股骨远端骨折患者治疗结果的影响。
在一家NHS急性信托机构开展了一项单中心回顾性队列研究。纳入在每次全国封锁的三个起始日期中的每个日期的第一个月内入院的髋部和股骨远端骨折患者，并与2019年3月的对照组进行比较。按照最佳实践收费标准收集数据，并根据需要收集其他结果数据。数据收集包括新冠病毒感染状况、手术时间、30天死亡率、急性肾损伤（AKI）和肺炎的发生情况，以及不进行心肺复苏（DNACPR）状态。在适用的情况下，使用独立样本t检验或卡方检验及费舍尔精确检验对数据进行分析。p值<0.05被认为具有统计学意义。
疫情期间共纳入95例患者，其中20例新冠病毒检测呈阳性。与2019年相比，封锁1期患者的手术时间在统计学上显著增加（p = 0.039），而到封锁3期，随着后续封锁期手术时间减少。30天死亡率从2019年的8.8%增加到所有封锁期的10.0%至14.8%。新冠病毒检测呈阳性患者的死亡率为30.0%（p = 0.063，比值比（OR）= 4.43，与2019年相比）。疫情期间患者发生AKI和肺炎的比率更高。新冠病毒检测呈阳性患者的发生率最高，45.0%的患者发生AKI，而2019年为27.0%（p = 0.38，OR =
