Are Hospitals Safe? A Prospective Study on SARS-CoV-2 Prevalence and Outcome on Surgical Fracture Patients: A Closer Look at Hip Fracture Patients

J Orthop Trauma. 2020 Oct;34(10):e371-e376. doi: 10.1097/BOT.0000000000001899.


Objectives: To describe clinical characteristics of fracture patients, including a closer look to hip fracture patients, and determine how epidemiological variables may have influenced on a higher vulnerability to SARS-CoV-2 infection, as the basis for the considerations needed to reintroduce elective surgery during the pandemic.

Design: Longitudinal prospective cohort study.

Setting: Level I Trauma Center in the East of Spain.

Patients/participants: One hundred forty-four consecutive fracture patients 18 years or older admitted for surgery.

Intervention: Patients were tested for SARS-CoV-2 with either molecular and/or serological techniques and screened for presentation of COVID-19.

Main outcome measurements: Patients were interviewed and charts reviewed for demographic, epidemiological, clinical, and surgical characteristics.

Results: We interviewed all patients and tested 137 (95.7%) of them. Three positive patients for SARS-CoV-2 were identified (2.1%). One was asymptomatic and the other 2 required admission due to COVID-19-related symptoms. Mortality for the whole cohort was 13 patients (9%). Significant association was found between infection by SARS-CoV-2 and epidemiological variables including: intimate exposure to respiratory symptomatic patients (P = 0.025) and intimate exposure to SARS-CoV-2-positive patients (P = 0.013). No association was found when crowding above 50 people was tested individually (P = 0.187). When comparing the 2020 and 2019 hip fracture cohorts we found them to be similar, including 30-day mortality. A significant increase in surgical delay from 1.5 to 1.8 days was observed on the 2020 patients (P = 0.034).

Conclusions: Patients may be treated safely at hospitals if strict recommendations are followed. Both cohorts of hip fracture patients had similar 30-day mortality.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / epidemiology
  • Female
  • Follow-Up Studies
  • Fracture Fixation / standards*
  • Hip Fractures / complications*
  • Hip Fractures / epidemiology*
  • Hip Fractures / surgery
  • Hospitals / standards*
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Patient Safety*
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / epidemiology
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Spain / epidemiology
  • Survival Rate / trends
  • Treatment Outcome
  • Young Adult