Public Health England, London, UK.
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Bone Joint J. 2022 Oct;104-B(10):1156-1167. doi: 10.1302/0301-620X.104B10.BJJ-2022-0082.R1.
Hip fracture commonly affects the frailest patients, of whom many are care-dependent, with a disproportionate risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England.
We conducted a cohort study of patients with hip fracture recorded in the National Hip Fracture Database between 1 February 2019 and 31 October 2020 in England. Data were linked to Hospital Episode Statistics to quantify patient characteristics and comorbidities, Office for National Statistics mortality data, and Public Health England's SARS-CoV-2 testing results. Multivariable Cox regression examined determinants of 90-day mortality. Excess mortality attributable to COVID-19 was quantified using Quasi-Poisson models.
Analysis of 102,900 hip fractures (42,630 occurring during the pandemic) revealed that among those with COVID-19 infection at presentation (n = 1,120) there was a doubling of 90-day mortality; hazard ratio (HR) 2.09 (95% confidence interval (CI) 1.89 to 2.31), while the HR for infections arising between eight and 30 days after presentation (n = 1,644) the figure was greater at 2.51 (95% CI 2.31 to 2.73). Malnutrition (1.45 (95% CI 1.19 to 1.77)) and nonoperative treatment (2.94 (95% CI 2.18 to 3.95)) were the only modifiable risk factors for death in COVID-19-positive patients. Patients who had tested positive for COVID-19 more than two weeks prior to hip fracture initially had better survival compared to those who contracted COVID-19 around the time of their hip fracture; however, survival rapidly declined and by 365 days the combination of hip fracture and COVID-19 infection was associated with a 50% mortality rate. Between 1 January and 30 June 2020, 1,273 (99.7% CI 1,077 to 1,465) excess deaths occurred within 90 days of hip fracture, representing an excess mortality of 23% (99.7% CI 20% to 26%), with most deaths occurring within 30 days.
COVID-19 infection more than doubles the rate of early hip fracture mortality. Those contracting infection between 8 and 30 days after initial presentation are at even higher mortality risk, signalling the potential for targeted interventions during this period to improve survival.Cite this article: 2022;104-B(10):1156-1167.
髋部骨折通常影响最脆弱的患者，其中许多患者需要依赖护理，感染 COVID-19 的风险不成比例。我们研究了 COVID-19 感染对英格兰髋部骨折死亡率的影响。
我们对 2019 年 2 月 1 日至 2020 年 10 月 31 日期间在英格兰国家髋部骨折数据库中记录的髋部骨折患者进行了队列研究。数据与医院发病统计数据、国家统计局死亡率数据以及英格兰公共卫生署的 SARS-CoV-2 检测结果相关联。多变量 Cox 回归分析了 90 天死亡率的决定因素。使用拟泊松模型量化了归因于 COVID-19 的超额死亡率。
对 102900 例髋部骨折（其中 42630 例发生在大流行期间）的分析显示，在就诊时患有 COVID-19 感染的患者（n=1120）中，90 天死亡率增加了一倍；风险比（HR）为 2.09（95%置信区间（CI）为 1.89 至 2.31），而在发病后 8 至 30 天之间发生感染的患者（n=1644）的 HR 更高，为 2.51（95%CI 为 2.31 至 2.73）。营养不良（1.45（95%CI 1.19 至 1.77））和非手术治疗（2.94（95%CI 2.18 至 3.95））是 COVID-19 阳性患者死亡的唯一可改变的危险因素。最初检测出 COVID-19 呈阳性且比髋部骨折早两周的患者最初的生存率高于在髋部骨折时感染 COVID-19 的患者；然而，生存率迅速下降，到 365 天时，髋部骨折和 COVID-19 感染的结合与 50%的死亡率相关。2020 年 1 月 1 日至 6 月 30 日期间，在髋部骨折后 90 天内有 1273 例（99.7%CI 1077 至 1465）超额死亡，代表超额死亡率为 23%（99.7%CI 20%至 26%），大多数死亡发生在 30 天内。
COVID-19 感染使髋部骨折早期死亡率增加一倍以上。在初次就诊后 8 至 30 天之间感染的患者死亡率更高，这表明在此期间可能需要有针对性的干预措施来提高生存率。
引用：2022;104-B(10):1156-1167.
