Selçuk Eşref, Erem Murat, Selçuk Emine Gökçen, Mercan Oğuz
Department of Orthopaedics and Traumatology, School of Medicine, Trakya University, Edirne, Turkey.
Department of Public Health, School of Medicine, Trakya University, Edirne, Turkey.
Geriatr Orthop Surg Rehabil. 2024 Aug 13;15:21514593241273124. doi: 10.1177/21514593241273124. eCollection 2024.
The COVID-19 pandemic has profoundly impacted global healthcare systems, necessitating substantial shifts in patient care strategies. The pandemic's onset led to drastic operational changes in hospitals, including reduced bed capacity and staffing levels, which could have further influenced the mortality outcomes for geriatric patients. The study aimed to assess the impact of the COVID-19 pandemic on 1-year mortality rates of surgically treated geriatric hip fractures.
This retrospective, single-center cohort study included 346 participants aged 65 and above who underwent surgical treatment for hip fractures. We compared mortality rates between the pre-COVID and COVID eras. Data included demographics, treatment, complications, and COVID-19 status. The independent samples test and Chi-square tests (or Fisher's exact test) were used for comparisons for era cohorts. Survival probabilities were assessed using Kaplan-Meier, while multivariate analysis identified mortality predictors.
175 patients were included in the pre-COVID era, and 171 patients were included in the COVID era. During the COVID era, the 30-day mortality rate was 11.7% (compared to 13.7% in the pre-COVID era, p = 0.573), and the 1-year mortality rate was 43.9% (compared to 49.1% in the pre-COVID era, p = 0.325). The overall 1-year mortality rate was 46.5%. Patients who underwent surgery within 48 hours had a higher 1-year survival rate (60.5%) compared to those with delayed surgery (51.2%), p = 0.031. Additionally, patients not admitted to the ICU had a higher 1-year survival rate (74.7%) than those who were admitted (44.9%), p < 0.001. 70.1% of the total deaths occurred within the first 90 days.
Elderly patients with hip fractures experienced high mortality rates before and during the pandemic. This study demonstrates that the 1-year mortality rates of geriatric hip fractures were not significantly affected by the pandemic. The findings emphasize the importance of pandemic preparedness and prompt surgeries and attentive ICU care in reducing mortality rates.
新冠疫情对全球医疗系统产生了深远影响，促使患者护理策略发生重大转变。疫情的爆发导致医院运营发生巨大变化，包括床位容量和人员配备水平降低，这可能进一步影响老年患者的死亡率。本研究旨在评估新冠疫情对接受手术治疗的老年髋部骨折患者1年死亡率的影响。
这项回顾性单中心队列研究纳入了346名年龄在65岁及以上接受髋部骨折手术治疗的参与者。我们比较了新冠疫情前和疫情期间的死亡率。数据包括人口统计学、治疗、并发症和新冠病毒感染状况。采用独立样本t检验和卡方检验（或费舍尔精确检验）对不同时期的队列进行比较。使用Kaplan-Meier法评估生存概率，同时进行多变量分析以确定死亡率预测因素。
新冠疫情前时期纳入175例患者，疫情期间纳入171例患者。在疫情期间，30天死亡率为11.7%（新冠疫情前时期为13.7%，p = 0.573），1年死亡率为43.9%（新冠疫情前时期为49.1%，p = 0.325）。总体1年死亡率为46.5%。与延迟手术的患者（51.2%）相比，48小时内接受手术的患者1年生存率更高（60.5%），p = 0.031。此外，未入住重症监护病房的患者1年生存率（74.7%）高于入住的患者（44.9%），p < 0.001。总死亡病例的70.1%发生在最初90天内。
老年髋部骨折患者在疫情之前和期间死亡率都很高。本研究表明，新冠疫情对老年髋部骨折患者的1年死亡率没有显著影响。研究结果强调了疫情防范、及时手术和精心的重症监护在降低死亡率方面的重要性。
