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dc.contributor.authorCOVIDSurg Collaborative
dc.date.accessioned2022-01-28T00:30:09Z
dc.date.available2022-01-28T00:30:09Z
dc.date.issued2021-11-30
dc.identifier.issn2044-6055
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/332962
dc.description.abstractOBJECTIVES: 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.
dc.format.mediumElectronic
dc.publisherBMJ
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectCOVID-19
dc.subjecthip
dc.subjecttrauma management
dc.subjectAged, 80 and over
dc.subjectCOVID-19
dc.subjectCohort Studies
dc.subjectFemoral Fractures
dc.subjectHip Fractures
dc.subjectHumans
dc.subjectMale
dc.subjectProspective Studies
dc.subjectSARS-CoV-2
dc.titleOutcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study.
dc.typeArticle
dc.date.updated2022-01-22T20:18:26Z
prism.issueIdentifier11
prism.numberARTN e050830
prism.publicationDate2021
prism.publicationNameBMJ Open
prism.startingPagee050830
prism.volume11
dc.identifier.doi10.17863/CAM.80386
rioxxterms.versionofrecord10.1136/bmjopen-2021-050830
rioxxterms.versionVoR
dc.identifier.eissn2044-6055
rioxxterms.typeJournal Article/Review
cam.issuedOnline2021-11-30
cam.depositDate2022-01-22
pubs.licence-identifierapollo-deposit-licence-2-1
pubs.licence-display-nameApollo Repository Deposit Licence Agreement


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International