Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

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doi:10.1136/bmjopen-2021-050830

ObjectivesStudies 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.SettingProspective, international, multicentre, observational cohort study.ParticipantsPatients 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 outcome30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.ResultsThis 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).ConclusionsPatients 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 numberNCT04323644

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[10.1136/bmjopen-2021-050830]

Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

Chetan Khatri;A E Ward;D Nepogodiev;I Ahmed;D Chaudhry;F Dhaif;B Bankhad-Kendall;H Kaafarani;C Bretherton;A Mahmood;L Marais;N Parsons;A Bhangu;Andrew Metcalfe;K Siaw-Acheampong;D Chaudhry;B E Dawson;J P Evans;J C Glasbey;R R Gujjuri;E Heritage;C S Jones;S K Kamarajah;J M Keatley;S Lawday;E Li;S C Mckay;D Nepogodiev;G Pellino;A Tiwari;J F F Simoes;I M Trout;M L Venn;R J W Wilkin;A Bhangu;A O Ademuyiwa;A Agarwal;E Al Ameer;D Alderson;O Alser;A P Arnaud;K M Augestad;B Bankhead-Kendall;R A Benson;S Chakrabortee;R Blanco-Colino;A Brar;A Minaya Bravo;K A Breen;I Lima Buarque;E Caruana;M F Cunha;G H Davidson;A Desai;S Di Saverio;J Edwards;M Elhadi;S Farik;M Fiore;J E Fitzgerald;S Ford;G Gallo;D Ghosh;G M A Gomes;E Griffiths;C Halkias;E M Harrison;P Hutchinson;A Isik;H Kaafarani;A Kolias;I Lawani;H Lederhuber;S Leventoglu;M W Loffler;J Martin;H Mashbari;D Mazingi;H Mohan;R Moore;D Moszkowicz;J S Ng-Kamstra;S Metallidis;S Moug;M Niquen;F Ntirenganya;O Outani;F Pata;T D Pinkney;P Pockney;D Radenkovic;A Ramos-De la Medina;K Roberts;I Santos;A Schache;A Schnitzbauer;G D Stewart;R Shaw;S Shu;K Soreide;A Spinelli;S Sundar;S Tabiri;P Townend;G Tsoulfas;G van Ramshorst;R Vidya;D Vimalachandran;N Wright;J F F Simoes;Mak JKC;R Kulkarni;N Sharma;P Nankivell;F Tirotta;A Parente;O Breik;A Kisiel;LD Cato;S Saeed;A Bhangu;E Griffiths;AM Pathanki;S Ford;A Desai;M Almond;M Kamal;A Chebaro;K Lecolle;S Truant;M El Amrani;P Zerbib;FR Pruvot;D Mathieu;E Surmei;L Mattei;H Marin;J Dudek;T Singhal;S El-Hasani;D Nehra;A Walters;J Cuschieri;GH Davidson;M Ho;RG Wade;J Johnstone;G Bourke;A Brunelli;H Elkadi;M Otify;C Pompili;JR Burke;E Bagouri;M Chowdhury;Z Abual-Rub;A Kaufmann;S Munot;T Lo;A Young;M Kowal;J Wall;A Peckham-Cooper;SC Winter;E Belcher;D Stavroulias;F Di Chiara;K Wallwork;A Qureishi;M Lami;S Sravanam;S Mastoridis;K Shah;S Chidambaram;R Smillie;AV Shaw;S Bandyopadhyay;C Cernei;C Bretherton;D Jeyaretna;M Ganau;RJ Piper;E Duck;S Brown;C Jelley;SC Tucker;G Bond-Smith;XL Griffin;GD Tebala;N Neal;M Vatish;TM Noton;H Ghattaura;M Maher;H Fu;OBF Risk;H Soleymani majd;S Sinha;S Shankar;A Aggarwal;H Kharkar;K Lakhoo;C Verberne;S Mastoridis;A Senent-Boza;A Sánchez-Arteaga;I Benítez-Linero;F Manresa-Manresa;L Tallón-Aguilar;L Melero-Cortés;MR Fernández-Marín;VM Durán-Muñoz-Cruzado;I Ramallo-Solís;P Beltrán-Miranda;F Pareja-Ciuró;BT Antón-Eguía;AC Dawson;A Drane;F Oliva Mompean;J Gomez-Rosado;J Reguera-Rosal;J Valdes-Hernandez;L Capitan-Morales;del Toro Lopez;M Patel;A Shabana;A Alanbuki;O Usman;A Tang;AJ Beamish;C Price;D Bosanquet;D Magowan;F Solari;G Williams;H Nassa;L Smith;L Elliott;G Mccabe;D Holroyd;NB Jamieson;N. 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Mahvi;C Reinke;S Ross;K Thompson;D Manning;R Perkins;A Volpe;S Merola;A Ssentongo;P Ssentongo;Oh JS;J Hazelton;J Maines;N Gusani;M Garner;S Horvath;RCG Martin;N Bhutiani;R Choron;G Peck;F Soliman;S Rehman;A Abbas;A Soliman;B Kim;C Jones;MD E Dauer;E Renza-Stingone;E Hernandez;E Gokcen;E Kropf;H Sufrin;H Hirsch;H Ross;J Engel;J Sewards;J Diaz;J Poggio;K Sanserino;L Rae;M Philp;M Metro;P McNelis;R Petrov;S Rehman;T Pazionis;M Quintana;H Jackson;DB Lumenta;SP Nischwitz;E Richtig;M Pau;P Srekl-Filzmaier;N Eibinger;B Michelitsch;M Fediuk;A Papinutti;G Seidel;J Kahn;TU Cohnert;E Kantor;J Kahiu;N Hossain;S Hosny;A Sultana;M Taggarsi;L Vitone;J Lambert;OP Vaz;I Sarantitis;D Shrestha;S Timbrell;A Shugaba;GP Jones;A Gardner;SS Tripathi;MS Greenhalgh;H Emerson;K Vejsbjerg;L Pearce;W McCormick;A Fisher;K Singisetti;Y Aawsaj;C Barry;J Blanco;R Vanker;M Ghobrial;G Jones;S Kanthasamy;H Fawi;M Awadallah;F Chen;J Cheung;S Tingle;F Abbadessa;A Sachdeva;B Rai;CD Chan;I McPherson;K Booth;F Mahmoud Ali;S Pandanaboyana;T Grainger;S Nandhra;A Patience;A Rogers;C Roy;T Williams;N Dawe;C McCaffer;J Riches;S Bhattacharya;J Moir;NS Kalson;H Elamin Ahmed;C Mellor;C Saleh;RM Koshy;J Hammond;L Sanderson;S Wahed;AW Phillips;K Ghosh;LJ Rogers;PL Labib;D Miller;G Minto;N Hope;A Marchbank;K Emslie;P Panahi;B Ho;C Perkins;E Clough;H Roy;I Enemosah;R Campbell;J Natale;K Gohil;M Rela;N Raza;C Menakaya;JI Webb;M Antar;N Modi;R Sofat;J Noel;R Nunn;S Adegbola;F Eriberto;V Sharma;R Tanna;S Lodhia;L Carvalho;C Osório;J Antunes;S Lourenço;P Balau;M Godinho;A Pereira;Deborah S Keller;and Neil J Smart

2021

Abstract

ObjectivesStudies 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.SettingProspective, international, multicentre, observational cohort study.ParticipantsPatients 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 outcome30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.ResultsThis 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).ConclusionsPatients 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 numberNCT04323644

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	Parole chiave
	
			COVID-19; hip; trauma management; Aged, 80 and over; Cohort Studies; Humans; Male; Prospective Studies; SARS-CoV-2; COVID-19; Femoral Fractures; Hip Fractures
		
	Settori scientifico-disciplinari dell'articolo
	
			Settore MED/10 - Malattie dell'Apparato Respiratorio
		
	Data di pubblicazione
	
			2021
		
	Rivista in ANCE
	
			BMJ OPEN
		
	DOI
	
			https://dx.doi.org/10.1136/bmjopen-2021-050830
		
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/889977

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