Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
ZESBO - Center for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany.
Orthopadie (Heidelb). 2022 Jul;51(7):573-579. doi: 10.1007/s00132-022-04268-z. Epub 2022 Jun 13.
The medical challenges caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) pose a tremendous burden on the healthcare system. This study aimed to analyze the effects of a SARS-CoV‑2 infections or disease progression on inpatient mortality of geriatric patients after proximal femoral fracture surgery.
A retrospective analysis was conducted in all patients with a proximal femoral fracture surgically treated in an urban regional trauma center from 01/01/2020 to 01/31/2021. According to PCR test results detecting SARS-CoV‑2, the patients were divided into two groups (SARS-CoV‑2 positive vs. SARS-CoV‑2 negative). Patient data, disease progression data, and treatment-related information were evaluated for all patients. Statistical data analysis was performed using unpaired Student's t test or non-parametric Mann-Whitney U test.
A total of 311 patients (women: 70.4%, age: 82.0 ± 11.0 years) were included in this study. Of these 3.9% (12/311) had a positive test result for SARS-CoV‑2. Significantly more deceased patients were found in the group tested positive for SARS-CoV‑2 (SARS-CoV‑2 positive: 41.7%, SARS-CoV‑2 negative: 5.4%, p < 0.001). In addition, the number of proximal femoral fracture associated deaths correlated with the number of positive test results performed in the Clinic. The length of stay of SARS-CoV‑2 COVID-19 survivors tended to be greater than in those who were tested negative (SARS-CoV‑2 COVID-19 positive: 15.6 ± 13.1 days, SARS-CoV‑2 COVID-19 negative: 11.5 ± 6.5 days, p = 0.683). Furthermore, a significant difference in age was found in SARS-CoV‑2 survivors and SARS-CoV‑2 decedents (deceased: 95.5 ± 7.5 years, alive: 83.5 ± 7.3 years, p = 0.020).
The study was conducted before the introduction of SARS-CoV‑2 vaccination. The results therefore refer to immune naive (unvaccinated) patients. In our study, more than 40% of all patients with proximal femoral fractures who tested positive for SARS-CoV‑2 died during hospitalization. An additional, critical factor in this respect was the age of the infected patients. Nonetheless, a positive correlation was demonstrated between the mortality rate and the number of positive SARS-CoV‑2 detections. Regarding the greater length of stay of patients tested positive for SARS-CoV‑2, the limited transfer options (further rehabilitation, skilled nursing facility) of the infected ones can be considered as causal. Particularly the vulnerable older patients are increasingly endangered by a combination of proximal femoral fracture and SARS-CoV‑2.
严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 引起的医学挑战给医疗系统带来了巨大负担。本研究旨在分析 SARS-CoV-2 感染或疾病进展对老年股骨近端骨折患者住院病死率的影响。
对 2020 年 1 月 1 日至 2021 年 1 月 31 日在城市区域性创伤中心接受股骨近端骨折手术治疗的所有患者进行回顾性分析。根据 SARS-CoV-2 的 PCR 检测结果，将患者分为两组(SARS-CoV-2 阳性组与 SARS-CoV-2 阴性组)。评估所有患者的患者数据、疾病进展数据和治疗相关信息。使用未配对的学生 t 检验或非参数曼-惠特尼 U 检验进行统计数据分析。
本研究共纳入 311 例患者(女性占 70.4%，年龄：82.0±11.0 岁)。其中 3.9%(12/311)的患者 SARS-CoV-2 检测结果为阳性。SARS-CoV-2 检测阳性组的死亡患者明显多于 SARS-CoV-2 检测阴性组(SARS-CoV-2 阳性：41.7%，SARS-CoV-2 阴性：5.4%，p<0.001)。此外，与 SARS-CoV-2 相关的股骨近端骨折死亡人数与诊所进行的阳性检测次数相关。SARS-CoV-2 COVID-19 幸存者的住院时间往往长于检测结果为阴性的患者(SARS-CoV-2 COVID-19 阳性：15.6±13.1 天，SARS-CoV-2 COVID-19 阴性：11.5±6.5 天，p=0.683)。此外，SARS-CoV-2 幸存者和 SARS-CoV-2 死亡者的年龄差异有统计学意义(死亡者：95.5±7.5 岁，存活者：83.5±7.3 岁，p=0.020)。
本研究在 SARS-CoV-2 疫苗接种前进行。因此，研究结果针对的是免疫原性未受影响的(未接种疫苗的)患者。在我们的研究中，超过 40%的 SARS-CoV-2 检测阳性股骨近端骨折患者在住院期间死亡。在这方面，另一个关键因素是感染患者的年龄。尽管如此，死亡率与 SARS-CoV-2 阳性检测数量之间存在正相关关系。关于 SARS-CoV-2 检测阳性患者的住院时间延长，感染患者的有限转移选择(进一步康复、熟练护理机构)可被视为原因。特别是脆弱的老年患者因股骨近端骨折和 SARS-CoV-2 的结合而面临越来越大的威胁。
