Delayed surgery versus nonoperative treatment for hip fractures in post-COVID-19 arena: a retrospective study of 145 patients

Bobin Mi; Lang Chen; Dake Tong; Adriana C Panayi; Fang Ji; Junfei Guo; Zhiyong Hou; Yingze Zhang; Yuan Xiong; Guohui Liu

doi:10.1080/17453674.2020.1816617

Authors

Bobin Mi Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Lang Chen Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Dake Tong Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Adriana C Panayi Department of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical College, Boston, USA
Fang Ji Department of Orthopedics, Changhai Hospital, Shanghai, China
Junfei Guo Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
Zhiyong Hou Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
Yingze Zhang Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
Yuan Xiong Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Guohui Liu Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

DOI:

https://doi.org/10.1080/17453674.2020.1816617

Abstract

Background and purpose — Following the outbreak of COVID-19 in December 2019, in China, many hip fracture patients were unable to gain timely admission and surgery. We assessed whether delayed surgery improves hip joint function and reduces major complications better than nonoperative therapy.

Patients and methods — In this retrospective observational study, we collected data from 24 different hospitals from January 1, 2020, to July 20, 2020. 145 patients with hip fractures aged 65 years or older were eligible. Clinical data was extracted from electronic medical records. The primary outcomes were visual analogue scale (VAS) score and Harris Hip Score. Major complications, including deep
venous thrombosis (DVT) and pneumonia within 1 month and 3 months, were collected for further analysis.

Results — Of the 145 hip fracture patients 108 (median age 72; 70 females) received delayed surgery and 37 (median age 74; 20 females) received nonoperative therapy. The median time from hip fracture injury to surgery was 33 days (IQR 24–48) in the delayed surgery group. Hypertension, in about half of the patients in both groups, and cerebral infarction, in around a quarter of patients in both groups, were the most common comorbidities. Both VAS score and Harris Hip Score were superior in the delayed surgery group. At the 3-month follow-up, the median VAS score was 1 in the delayed surgery group and 2.5 in the nonoperative group (p< 0.001). Also, the percentage of complications was higher in the nonoperative group (p = 0.004 for DVT, p < 0.001 for pulmonary infection).

Interpretation — In hip fracture patients, delayed surgery compared with nonoperative therapy significantly improved hip function and reduced various major complications.