Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study.
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Authors
COVIDSurg Collaborative
Publication Date
2021-11-30Journal Title
BMJ Open
ISSN
2044-6055
Publisher
BMJ
Volume
11
Issue
11
Number
ARTN e050830
Pages
e050830
Type
Article
This Version
VoR
Physical Medium
Electronic
Metadata
Show full item recordCitation
COVIDSurg Collaborative. (2021). Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study.. BMJ Open, 11 (11. ARTN e050830), e050830. https://doi.org/10.1136/bmjopen-2021-050830
Abstract
OBJECTIVES: Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis. SETTING: Prospective, international, multicentre, observational cohort study. PARTICIPANTS: Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative). PRIMARY OUTCOME: 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality. RESULTS: This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787). CONCLUSIONS: Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups. TRIAL REGISTRATION NUMBER: NCT04323644.
Keywords
COVID-19, hip, trauma management, Aged, 80 and over, COVID-19, Cohort Studies, Femoral Fractures, Hip Fractures, Humans, Male, Prospective Studies, SARS-CoV-2
Identifiers
External DOI: https://doi.org/10.1136/bmjopen-2021-050830
This record's URL: https://www.repository.cam.ac.uk/handle/1810/332962
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