The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures A MULTICENTRE COHORT STUDY
The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures A MULTICENTRE COHORT STUDY
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DOI：
10.1302/0301-620x.102b9.bjj-2020-1127.r1
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发表时间：
2020-09-01
影响因子：
4.6
通讯作者：
Haddad, F. S.
中科院分区：
文献类型：
--
作者：
Kayani, B.;Onochie, E.;Haddad, F. S.
目标在 COVID-19 大流行期间，许多患者仍然需要因髋部骨折进行紧急手术。然而，COVID-19 对这些高危患者围手术期结局的影响仍不清楚。本研究的目的是确定 COVID-19 对围手术期发病率和死亡率的影响，并确定接受髋部骨折手术的 COVID-19 患者死亡率增加的任何危险因素。方法这项多中心队列研究包括英国大伦敦地区 9 家 NHS 医院接受髋部骨折手术治疗的 340 名 COVID-19 阴性患者和 82 名接受髋部骨折手术治疗的 82 名 COVID-19 阳性患者。两个治疗组的患者在年龄、性别、体重指数、骨折形态和所进行的手术类型方面具有可比性。在术后 30 天内记录预定的围手术期结果。采用单变量和多变量分析来确定与死亡风险增加相关的危险因素。结果与 COVID-19 阴性患者相比，COVID-19 阳性患者术后死亡率增加（分别为 30.5%（25/82）和 10.3%（35/340），p < 0.001）。接受手术的 COVID-19 患者死亡率增加的危险因素包括阳性吸烟状况（风险比 (HR) 15.4（95% 置信区间 (CI) 4.55 至 52.2；p < 0.001）和超过 3 种合并症（HR 13.5（95% CI 2.82 至 66.0，p < 0.001））。COVID-19 阳性患者术后并发症的风险增加（分别为 89.0% (73/82) vs 35.0% (119/340)；p < 0.001），入院重症监护病房的人数增加（分别为 61.0% (50/82) vs 18.2% (62/340)；p < 0.001），住院时间增加（平均 13.8 天 (SD 4.6) vs 6.7 天 (SD与 COVID-19 阴性患者相比，分别为 2.5；p < 0.001。 结论 与 COVID-19 阴性患者相比，COVID-19 阳性患者的髋部骨折手术与住院时间延长、入住重症监护病房的次数增加、围手术期并发症风险更高以及死亡率增加有关。接受手术的 COVID-19 患者死亡率增加的危险因素包括阳性吸烟状况和多种（超过 3 种）合并症。
AimsDuring the COVID-19 pandemic, many patients continue to require urgent surgery for hip fractures. However, the impact of COVID-19 on perioperative outcomes in these high-risk patients remains unknown. The objectives of this study were to establish the effects of COVID-19 on perioperative morbidity and mortality, and determine any risk factors for increased mortality in patients with COVID-19 undergoing hip fracture surgery.MethodsThis multicentre cohort study included 340 COVID-19-negative patients versus 82 COVID-19-positive patients undergoing surgical treatment for hip fractures across nine NHS hospitals in Greater London, UK. Patients in both treatment groups were comparable for age, sex, body mass index, fracture configuration, and type of surgery performed. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariate and multivariate analysis were used to identify risk factors associated with increased risk of mortality.ResultsCOVID-19-positive patients had increased postoperative mortality rates (30.5% (25/82) vs 10.3% (35/340) respectively, p < 0.001) compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status (hazard ratio (HR) 15.4 (95% confidence interval (CI) 4.55 to 52.2; p < 0.001) and greater than three comorbidities (HR 13.5 (95% CI 2.82 to 66.0, p < 0.001). COVID-19-positive patients had increased risk of postoperative complications (89.0% (73/82) vs 35.0% (119/340) respectively; p < 0.001), more critical care unit admissions (61.0% (50/82) vs 18.2% (62/340) respectively; p < 0.001), and increased length of hospital stay (mean 13.8 days (SD 4.6) vs 6.7 days (SD 2.5) respectively; p < 0.001), compared to COVID-19-negative patients.ConclusionHip fracture surgery in COVID-19-positive patients was associated with increased length of hospital stay, more admissions to the critical care unit, higher risk of perioperative complications, and increased mortality rates compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status and multiple (greater than three) comorbidities.