Preoperative COVID-19 infection status negatively impacts postoperative outcomes of geriatric hip fracture surgery

Objectives: Compare outcomes for patients with recently diagnosed COVID-19 infection to those without COVID19 infection undergoing operative treatment of hip fractures using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Design: Retrospective propensity score matched cohort. Methods: Patients who received surgery for an acute hip fracture (intramedullary nail (IMN), open reduction internal fixation (ORIF) or hemiarthroplasty) in 2021 were identified from the NSQIP database. Propensity score matching was implemented using patient demographics and preoperative medical conditions to compare outcomes for COVID-19-positive and COVID-19-negative cohorts. Results: After matching, COVID-19-positive patients exhibited a higher risk of 30-day mortality (Odds ratio (OR) 1.48, 95 % confidence interval (CI) 1.01 - 2.04), pneumonia (OR 2.90, 95 % CI: 1.91 - 4.33), unplanned intubation (OR 2.53, 95 % CI: 1.39 - 4.39), and septic shock (OR 2.51, 95 % CI: 1.10 - 4.67). COVID-19-positive patients were also more likely to have a longer length of hospital stay (Hazard Ratio 1.3, 95 % CI: 1.20 - 1.41) and were more likely to be discharged to an acute care hospital (OR 1.90, 95 % CI: 1.03 - 3.06). Conclusions: Active COVID-19 infection is an independent risk factor for complications as well as increased resource utilization in patients undergoing surgical treatment of acute hip fracture. Using the results of this multicenter study, quantification of these risks can help inform practice and treatment protocols for this population. Level of Evidence: III.

Automated summary

A retrospective propensity score matched cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to compare outcomes for patients with recently diagnosed COVID-19 infection and those without COVID-19 infection undergoing operative treatment of hip fractures. The results showed that COVID-19-positive patients had a higher risk of 30-day mortality, pneumonia, unplanned intubation, septic shock, longer length of hospital stay, and discharge to an acute care hospital. Active COVID-19 infection is an independent risk factor for complications and increased resource utilization in these patients.