The Health Foundation, London, UK
University Hospital of Wales and Cardiff University School of Medicine, Cardiff, UK.
BMJ Qual Saf. 2023 May;32(5):264-273. doi: 10.1136/bmjqs-2022-014896. Epub 2022 Aug 1.
Hip fracture is a leading cause of disability and mortality among older people. During the COVID-19 pandemic, orthopaedic care pathways in the National Health Service in England were restructured to manage pressures on hospital capacity. We examined the indirect consequences of the pandemic for hospital mortality among older patients with hip fracture, admitted from care homes or the community.
Retrospective analysis of linked care home and hospital inpatient data for patients with hip fracture aged 65 years and over admitted to hospitals in England during the first year of the pandemic (1 March 2020 to 28 February 2021) or during the previous year. We performed survival analysis, adjusting for case mix and COVID-19 infection, and considered live discharge as a competing risk. We present cause-specific hazard ratios (HR) for the effect of admission year on hospital mortality risk.
During the first year of the pandemic, there were 55 648 hip fracture admissions: a 5.2% decrease on the previous year. 9.5% of patients had confirmed or suspected COVID-19. Hospital stays were substantially shorter (p<0.05), and there was a higher daily chance of discharge (HR 1.40, 95% CI 1.38 to 1.41). Overall hip fracture inpatient mortality increased (7.2% in 2020/2021 vs 6.4% in 2019/2020), but patients without concomitant COVID-19 infection had lower mortality rates compared with the year before (5.3%). Admission during the pandemic was associated with a 11% increase in the daily risk of hospital death for patients with hip fracture (HR 1.11, 95% CI 1.05 to 1.16).
Although COVID-19 infections led to increases in hospital mortality, overall hospital mortality risk for older patients with hip fracture remained largely stable during the first year of the pandemic.
髋部骨折是老年人残疾和死亡的主要原因。在 COVID-19 大流行期间，英国国民保健制度中的骨科护理途径进行了重组，以应对医院容量的压力。我们研究了大流行对从养老院或社区入院的老年髋部骨折患者的医院死亡率的间接影响。
对 2020 年 3 月 1 日至 2021 年 2 月 28 日期间或前一年期间在英格兰医院入院的 65 岁及以上髋部骨折患者的养老院和医院住院数据进行回顾性分析。我们进行了生存分析，调整了病例组合和 COVID-19 感染，并将存活出院视为竞争风险。我们报告了入院年份对医院死亡率风险的特定原因危害比（HR）。
在大流行的第一年，有 55648 例髋部骨折入院：比前一年减少了 5.2%。9.5%的患者有确诊或疑似 COVID-19。住院时间明显缩短（p<0.05），每日出院的机会更高（HR 1.40，95%CI 1.38 至 1.41）。髋部骨折住院患者的总体死亡率上升（2020/2021 年为 7.2%，而 2019/2020 年为 6.4%），但无合并 COVID-19 感染的患者的死亡率低于前一年（5.3%）。大流行期间入院与髋部骨折患者每日住院死亡风险增加 11%相关（HR 1.11，95%CI 1.05 至 1.16）。
尽管 COVID-19 感染导致医院死亡率上升，但在大流行的第一年，老年髋部骨折患者的总体医院死亡率风险基本保持稳定。
