Risk of Mortality for Proximal Femoral Fracture in Patients With and Without COVID-19. A Retrospective Cohort Study

Ashley Holub; Montsant Jornet-Gibert; Jill Ruppenkamp; Chantal E Holy; Juan Daccach; Pere Torner; Pedro Caba-Doussoux; Josep Maria Muñoz Vives

doi:10.1177/21514593221138656

Risk of Mortality for Proximal Femoral Fracture in Patients With and Without COVID-19. A Retrospective Cohort Study

Geriatr Orthop Surg Rehabil. 2022 Nov 10:13:21514593221138656. doi: 10.1177/21514593221138656. eCollection 2022.

Authors

Ashley Holub¹, Montsant Jornet-Gibert², Jill Ruppenkamp¹, Chantal E Holy¹, Juan Daccach³, Pere Torner², Pedro Caba-Doussoux⁴, Josep Maria Muñoz Vives⁵

Affiliations

¹ Epidemiology & Real-World Data Sciences, Johnson & Johnson MedTech, New Brunswick, NJ, USA.
² Department of Orthopaedic Surgery and Traumatology, Hospital Clinic de Barcelona, Barcelona, Spain.
³ Medical Safety, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ, USA.
⁴ Department of Orthopaedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
⁵ Department of Orthopaedic Surgery and Traumatology, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain.

Abstract

Background: SARS-CoV-2 (COVID-19) has resulted in a widespread loss of lives, morbidity, and major disruptions to the healthcare system. Hip fractures are an emergent condition which require early intervention to reduce increased risk of mortality and morbidity. Infection of SARS-CoV-2 may contribute to increased mortality due to the role of infection and immune response. This study investigated the impact of COVID-19 infection (defined by clinical symptoms) on mortality following proximal femoral fracture (PFF) repair procedures.

Methods: This study was a retrospective cohort study. Data from the Premier Healthcare Database^® was extracted for patients presenting for PFF during 2019 for control, and February 2020-September 2020 to represent a COVID time-period.

Results: A total of N = 73 953 subjects were enrolled for the 2019 period, and a total of N = 34 842 subjects were enrolled for the COVID period. For the 2019 period, subjects who had a PFF procedure and who had flu/COVID-like illness had 2.47 (CI:2.11, 2.88) times the odds of mortality compared to those who did not have flu/COVID-like illness. Subjects who had a PFF procedure and who had flu/COVID-like illness during the COVID period had 2.85 times (CI:2.36, 3.42) the odds of mortality compared to those who did not have flu/COVID-like illness. For the COVID period, within subjects who did not have a PFF procedure, those with flu/COVID-like illness had increased odds of mortality compared to those who did not have flu/COVID-like illness (OR:2.26, CI:1.57, 3.21).

Conclusions: Hip fractures present high risk for mortality and morbidity, where timely intervention is critical to improved outcomes. Presence of infection such as flu/COVID-like illness may influence mortality in patients undergoing hip fracture repair procedures. Consideration of infection status as a comorbidity is important to proper management and achieving optimal outcomes.

Keywords: COVID-19; SARS-cov-2; hip fracture; mortality; proximal femoral fracture; real world data.