Andritsos Loukas, Thomas Owain, Pallikadavath Susil, Kirmani Sayyied, Sambwhani Sharan
Trauma and Orthopaedics, Northampton General Hospital, Northampton, GBR.
Cardiology, Leicester General Hospital, Leicester, GBR.
Cureus. 2021 Dec 8;13(12):e20262. doi: 10.7759/cureus.20262. eCollection 2021 Dec.
Neck of femur (NOF) fracture patients have significant 30-day mortality. The incidence of NOF fractures remained high during the coronavirus disease 2019 (COVID-19) pandemic in the United Kingdom. Consequently, numerous cases were complicated with concurrent severe acute respiratory syndrome coronavirus 2 infection. We performed a systematic review and meta-analysis of all studies from the United Kingdom related to NOF fractures and 30-day mortality outcomes during the pandemic. A systematic review and meta-analysis was performed and reported as per the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two reviewers independently searched on Medline for studies that were published between the 1st of March 2020 and the 1st of November 2020 in the United Kingdom. The following outcomes were compared: 30-day mortality, time to surgery, and anaesthetic risk. A total of five articles were included in this review. In total, 286 patients with NOF fractures and COVID-19 infection were identified, with 30-day mortality ranging from 30.5% to 50% (odds ratio = 6.02; 95% confidence interval = 4.10-8.85; χ = 4.82; I = 58%). Increased time to surgery due to COVID-19-related delays was also noted for the majority of patients in some studies. Mortality scores (Charlson Comorbidity Index, Nottingham Hip Fracture Score) failed to accurately predict the mortality risk. Concurrent infection of COVID-19 in patients with NOF fractures increases the 30-day mortality sixfold compared to the COVID-19-negative group. Efforts should be made to optimise time to surgery as well as consideration of postoperative care in higher dependency units. Future updates in mortality predicting scores should include COVID-19 infection as a significant factor.
股骨颈（NOF）骨折患者30天死亡率较高。在英国，2019年冠状病毒病（COVID-19）大流行期间，NOF骨折的发病率依然居高不下。因此，众多病例并发了严重急性呼吸综合征冠状病毒2感染。我们对英国所有与大流行期间NOF骨折及30天死亡率结果相关的研究进行了系统评价和荟萃分析。
按照系统评价和荟萃分析的首选报告项目指南进行了系统评价和荟萃分析。两名评价者独立在Medline上检索2020年3月1日至2020年11月1日期间在英国发表的研究。比较了以下结果：30天死亡率、手术时间和麻醉风险。
本评价共纳入五篇文章。总共识别出286例患有NOF骨折和COVID-19感染的患者，30天死亡率在30.5%至50%之间（比值比=6.02；95%置信区间=4.10-8.85；χ=4.82；I=58%）。一些研究中还指出，大多数患者因COVID-19相关延误导致手术时间增加。死亡率评分（查尔森合并症指数、诺丁汉髋部骨折评分）未能准确预测死亡风险。与COVID-19阴性组相比，NOF骨折患者并发COVID-19感染使30天死亡率增加了六倍。应努力优化手术时间，并考虑在更高依赖程度的病房进行术后护理。未来死亡率预测评分的更新应将COVID-19感染作为一个重要因素纳入。
