Authors (including presenting author) :
Lo CK (1), Wong YC (1)
Affiliation :
(1) Department of Orthopaedics and traumatology, Yan Chai Hospital
Introduction :
Geriatric hip fracture accounted for substantial workload in orthopaedics departments; with more than 14,000 cases managed in Hong Kong each year. Extensive studies had demonstrated the importance of early operation to reduce mortality and morbidity of geriatric hip fracture patients. With the marked cutback of orthopaedic service during COVID-19 pandemic, overseas studies demonstrated a delay in time to surgery and potential increased complications. In the strictest lockdown period between March and May 2020, our orthopaedic operative sessions were reduced by 60 percent. Our department therefore decided to prioritise urgent cases while delaying elective operations by focusing our resources on three disease categories: (1) acute fracture, (2) musculoskeletal infection and (3) disease causing neurovascular compromise.
Objectives :
The aim of this study was to identify the impact of COVID-19 pandemic on the treatment and early outcome of geriatric hip fracture patients.
Methodology :
This was a retrospective cohort study conducted in a single Hospital Authority (HA) hospital. All patients aged over 65 admitted through the Accident and Emergency Department and received hip fracture operation in the strictest lockdown period between March 2020 and May 2020 were studied. Data collected from patients who received geriatric hip fracture operation from March 2019 to May 2019 was used as control. Hip fracture was defined as trochanteric fracture and neck of femur fracture. Periprosthetic femoral fracture and polytrauma patients were excluded. All patient identities were anonymised for analysis. Demographic data, treatment and outcome data were retrieved retrospectively from the Clinical Management System of HA. Demographic data included age, sex and type of fracture. Type of operation and time from admission to surgery (TTS) were identified. Postoperative outcomes were assessed by postoperative complications, return to theatre, 30-day mortality and length of hospital stay (LOS). Continuous variables were presented as mean and compared using Student’s t-test. Categorical variables were presented as absolute number and compared using Chi-squared test. A P-value of ≤0.05 was considered statistically significant
Result & Outcome :
A total of 98 patients were reviewed in this study. The number of geriatric hip patients operated in the pandemic period was 46 compared to 52 in 2019. There was no significant difference in patient demographics, type of operation, TTS, postoperative complications among the study and control group. None of the studied patients required return to theatre or died within 30 days after operation. The mean LOS was 5.81 days shorter in the pandemic period (p=0.045). In our institute, hip fracture patients were sent to the rehabilitation service within our hospital immediately after operation. The shortened LOS was explained by the effort made by our rehabilitation team to facilitate early discharge to avoid in-hospital transmission of COVID-19. Our study showed that by prioritizing urgent orthopaedic cases while delaying elective operations, we were able to maintain the standard of care for geriatric hip fracture patients. Emphasis on expediting discharge resulted in shorted LOS in the COVID-19 pandemic.
