Published online Jan 18, 2021. doi: 10.5312/wjo.v12.i1.35
Peer-review started: November 24, 2020
First decision: December 3, 2020
Revised: December 5, 2020
Accepted: December 23, 2020
Article in press: December 23, 2020
Published online: January 18, 2021
During the coronavirus disease 2019 (COVID-19) pandemic time, the attention of the whole of the medical fraternity was diverted to the infective viral severe acute respiratory syndrome coronavirus-2 infection. There was a huge risk of infection among the medical staffs and patients coming to the hospital for other serious problems. Limitations of the operation theatre and medical staff were other hurdles in tackling life-threatening emergency surgeries. Although the mandatory lockdown policy might have reduced the incidence of the road traffic accident, the incidence of fragility fractures remained unaltered. Hip fracture is a surgical emergency and needs urgent surgical intervention to reduce morbidity and mortality. The impact of the COVID-19 infection on hip fracture management has been studied by a few researchers.
This systematic review and meta-analysis were designed to look for the impact of COVID-19 infection on hip fracture management and outcome.
The objectives of this meta-analysis were to compare the 30-d mortality and complications of hip fracture management during COVID-19 pandemic time and pre-pandemic time.
The search of electronic databases was performed to retrieve studies related to hip fracture management during COVID-19 pandemic and pre-pandemic times. A total of 45 studies were identified, of which eight studies were eligible for quantitative and qualitative analysis of data.
The pooled data of eight studies with 1586 patients showed no significant difference in 30-d mortality rate between the hip fracture patients treated during the pandemic and pre-pandemic periods [9.63% vs 6.33%; odds ratio (OR), 0.62; 95%CI, 0.33, 1.17; P = 0.14]. Even there was no difference in the 30-d mortality rate between COVID-19 − patients managed during the pandemic time vs all hip fracture patients managed during the pre-pandemic period (OR, 1.03; 95%CI, 0.61, 1.75; P = 0.91). A significant difference in mortality rate was observed between COVID-19 positive and COVID-19 negative patients (OR, 6.99; 95%CI, 3.45, 14.16; P < 0.00001). There was no difference in the duration of hospital stay (OR, −1.52; 95%CI, −3.85, 0.81; P = 0.20), overall complications (OR, 1.62; P = 0.15) and pulmonary complications (OR, 1.46; P = 0.38) in these two-time frames. Nevertheless, the preoperative morbidity was more severe, and there was less use of general anesthesia during the pandemic time.
There was no difference in 30-d mortality rate between hip fracture patients treated during the pandemic and pre-pandemic periods. However, the mortality risk was higher in COVID-19 positive patients compared to COVID-19 negative patients. There was no difference in time to surgery, complications and hospitalization time between these two time periods.
This meta-analysis showed that the COVID-19 infected patients with a hip fracture had a higher mortality rate, but the non-infected patients received the same level of care and they had similar mortality to that of hip fracture patient managed during the pre-pandemic period. The orthopedic trauma surgeons have learnt the ways to tackle the orthopedic emergency during the epidemic time.