Department of Orthopaedic Surgery, University of Kentucky, 740 South Limestone, Suite K413, Lexington, KY, 40536-0284, USA.
University of Pittsburgh, Pittsburgh, PA, USA.
Eur J Orthop Surg Traumatol. 2023 May;33(4):927-935. doi: 10.1007/s00590-022-03228-9. Epub 2022 Feb 23.
The extent to which concomitant COVID-19 infection increases short-term mortality following hip fracture is not fully understood. A systemic review and meta-analysis of COVID-19 positive hip fracture patients (CPHFPs) undergoing surgery was conducted to explore the association of COVID-19 with short-term mortality.
Review of the literature identified reports of short-term 30-day postoperative mortality in CPHFPs. For studies including a contemporary control group of COVID-19 negative patients, odds ratios of the association between COVID-19 infection and short-term mortality were calculated. Short-term mortality and the association between COVID-19 infection and short-term mortality were meta-analyzed and stratified by hospital screening type using random effects models.
Seventeen reports were identified. The short-term mortality in CPHFPs was 34% (95% C.I., 30-39%). Short-term mortality differed slightly across studies that screened all patients, 30% (95% C.I., 22-39%), compared to studies that conditionally screened patients, 36% (95% C.I., 31-42%), (P = 0.22). The association between COVID-19 infection and short-term mortality produced an odds ratio of 7.16 (95% C.I., 4.99-10.27), and this was lower for studies that screened all patients, 4.08 (95% C.I., 2.31-7.22), compared to studies that conditionally screened patients, 8.32 (95% C.I., 5.68-12.18), (P = 0.04).
CPHFPs have a short-term mortality rate of 34%. The odds ratio of short-term mortality was significantly higher in studies that screened patients conditionally than in studies that screened all hip fracture patients. This suggests mortality prognostication should consider how COVID-19 infection was identified as asymptomatic patients may fare slightly better.
COVID-19 感染是否会增加髋部骨折后短期死亡率尚不完全清楚。对接受手术的 COVID-19 阳性髋部骨折患者（CPHFPs）进行了系统回顾和荟萃分析，以探讨 COVID-19 与短期死亡率的关系。
对文献进行回顾，确定了 CPHFPs 短期 30 天术后死亡率的报告。对于包括 COVID-19 阴性患者当代对照组的研究，计算了 COVID-19 感染与短期死亡率之间关联的优势比。使用随机效应模型对短期死亡率和 COVID-19 感染与短期死亡率之间的关联进行荟萃分析，并按医院筛查类型进行分层。
确定了 17 份报告。CPHFPs 的短期死亡率为 34%（95%置信区间，30-39%）。与所有患者进行筛查的研究相比，条件性筛查患者的短期死亡率略有不同，分别为 30%（95%置信区间，22-39%）和 36%（95%置信区间，31-42%）（P=0.22）。COVID-19 感染与短期死亡率之间的关联产生的优势比为 7.16（95%置信区间，4.99-10.27），而对所有患者进行筛查的研究的优势比为 4.08（95%置信区间，2.31-7.22），而对条件性筛查患者的研究的优势比为 8.32（95%置信区间，5.68-12.18）（P=0.04）。
CPHFPs 的短期死亡率为 34%。与对所有髋部骨折患者进行筛查的研究相比，对患者进行条件性筛查的研究中，短期死亡率的优势比显著更高。这表明，在进行死亡率预测时，应考虑 COVID-19 感染的识别方式，因为无症状患者的预后可能稍好。
