Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2021; 12(1): 35-50
Published online Jan 18, 2021. doi: 10.5312/wjo.v12.i1.35
Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: A systematic review and meta-analysis
Sujit Kumar Tripathy, Paulson Varghese, Sibasish Panigrahi, Bijnya Birajita Panda, Sandeep Velagada, Samrat Smrutiranjan Sahoo, Monappa A Naik, Sharath K Rao
Sujit Kumar Tripathy, Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
Paulson Varghese, Sibasish Panigrahi, Sandeep Velagada, Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, India
Bijnya Birajita Panda, Department of Ophthalmology, SCB Medical College, Cuttack 753007, India
Samrat Smrutiranjan Sahoo, Department of Orthopedics, All India Institute of Medical Sciences, Nagpur 441108, India
Monappa A Naik, Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576104, India
Sharath K Rao, Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, Manipal 576104, India
Author contributions: Tripathy SK, Varghese P, Panigrahi S and Panda BB designed the study, searched the literature and screened the articles; Tripathy SK, Panda BB, Velagada S and Naik MA assessed the quality of the studies and the statistical analysis; Tripathy SK, Sahoo SS and Velagada S wrote the manuscript; Tripathy SK and Rao SK provided intellectual content; all authors read the manuscript and approved the final manuscript for publication.
Conflict-of-interest statement: The authors of this manuscript declare that they have no conflicts of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sujit Kumar Tripathy, DNB, MBBS, MS, Additional Professor, Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar 751019, India. sujitortho@yahoo.co.in
Received: November 24, 2020
Peer-review started: November 24, 2020
First decision: December 3, 2020
Revised: December 5, 2020
Accepted: December 23, 2020
Article in press: December 23, 2020
Published online: January 18, 2021
Processing time: 45 Days and 11 Hours
Abstract
BACKGROUND

Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality. However, limitations of the resources, risk of disease transmission and redirection of medical attention to a more severe infective health problem during coronavirus disease 2019 (COVID-19) pandemic period have affected the quality of care even in a surgical emergency.

AIM

To compare the 30-d mortality rate and complications of hip fracture patients treated during COVID-19 pandemic and pre-pandemic times.

METHODS

The search of electronic databases on 1st August 2020 revealed 45 studies related to mortality of hip fracture during the COVID-19 pandemic and pre-pandemic times. After careful screening, eight studies were eligible for quantitative and qualitative analysis of data.

RESULTS

The pooled data of eight studies (n = 1586) revealed no significant difference in 30-d mortality rate between the hip fracture patients treated during the pandemic and pre-pandemic periods [9.63% vs 6.33%; odds ratio (OR), 0.62; 95%CI, 0.33, 1.17; P = 0.14]. Even the 30-d mortality rate was not different between COVID-19 non-infected patients who were treated during the pandemic time, and all hip fracture patients treated during the pre-pandemic period (OR, 1.03; 95%CI, 0.61, 1.75; P = 0.91). A significant difference in mortality rate was observed between COVID-19 positive and COVID-19 negative patients (OR, 6.99; 95%CI, 3.45, 14.16; P < 0.00001). There was no difference in the duration of hospital stay (OR, -1.52, 95%CI, -3.85, 0.81; P = 0.20), overall complications (OR, 1.62; P = 0.15) and incidence of pulmonary complications (OR, 1.46; P = 0.38) in these two-time frames. Nevertheless, the preoperative morbidity was more severe, and there was less use of general anesthesia during the pandemic time.

CONCLUSION

There was no difference in 30-d mortality rate between hip fracture patients treated during the pandemic and pre-pandemic periods. However, the mortality risk was higher in COVID-19 positive patients compared to COVID-19 negative patients. There was no difference in time to surgery, complications and hospitalization time between these two time periods.

Keywords: Hip fracture; Femur neck fracture; Trochanter fracture; Mortality; Pandemic; COVID-19

Core Tip: Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality. However, limitations of the resources, risk of disease transmission and redirection of medical attention to a more severe infective health problem during coronavirus disease 2019 (COVID-19) pandemic period have affected the quality of care even in a surgical emergency. This meta-analysis and systematic review compared the 30-d mortality rate and complications of hip fracture patients treated during COVID-19 pandemic and pre-pandemic times. The findings of the meta-analysis revealed whether the delay in surgery for hip fracture patients affected the outcome or not.