6 research outputs found
COVID-19 during the index hospital admission confers a 'double-hit' effect on hip fracture patients and is associated with a two-fold increase in 1-year mortality risk
PURPOSE: The aims were to: (1) determine 1âyear mortality rates for hip fracture patients during the first UK COVIDâ19 wave, and (2) assess mortality risk associated with COVIDâ19. METHODS: A nationwide multicentre cohort study was conducted of all patients presenting to 17 hospitals in MarchâApril 2020. Followâup data were collected one year after initial hip fracture (âindexâ) admission, including: COVIDâ19 status, readmissions, mortality, and cause of death. RESULTS: Data were available for 788/833 (94.6%) patients. Oneâyear mortality was 242/788 (30.7%), and the prevalence of COVIDâ19 within 365 days of admission was 142/788 (18.0%). Oneâyear mortality was higher for patients with COVIDâ19 (46.5% vs. 27.2%; p < 0.001), and highest for those COVIDâpositive during index admission versus after discharge (54.7% vs. 39.7%; p = 0.025). Anytime COVIDâ19 was independently associated with 50% increased mortality risk within a year of injury (HR 1.50, p = 0.006); adjusted mortality risk doubled (HR 2.03, p < 0.001) for patients COVIDâpositive during index admission. No independent association was observed between mortality risk and COVIDâ19 diagnosed following discharge (HR 1.16, p = 0.462). Most deaths (56/66; 84.8%) in COVIDâpositive patients occurred within 30 days of COVIDâ19 diagnosis (median 11.0 days). Most cases diagnosed following discharge from the admission hospital occurred in downstream hospitals. CONCLUSION: Almost half the patients that had COVIDâ19 within 365 days of fracture had died within one year of injury versus 27.2% of COVIDânegative patients. Only COVIDâ19 diagnosed during the index admission was associated independently with an increased likelihood of death, indicating that infection during this time may represent a âdoubleâhitâ insult, and most COVIDârelated deaths occurred within 30 days of diagnosis