Open AccessIncreased Comorbidity Burden Among Hip Fracture Patients During the COVID-19 Pandemic in New York City
Author(s) -
Drake G. LeBrun,
Maxwell A. Konnaris,
Gregory Ghahramani,
Ajay Premkumar,
Chris J. Defrancesco,
Jordan A. Gruskay,
Aleksey Dvorzhinskiy,
Milan S. Sandhu,
Elan M Goldwyn,
Christopher L. Mendias,
William M. Ricci
Publication year - 2021
Publication title -
geriatric orthopaedic surgery and rehabilitation
Language(s) - English
Resource type - Journals
eISSN - 2151-4593
pISSN - 2151-4585
DOI - 10.1177/21514593211040611
Subject(s) - medicine , comorbidity , hip fracture , pandemic , cohort , retrospective cohort study , covid-19 , emergency medicine , demographics , cohort study , disease , osteoporosis , demography , sociology , infectious disease (medical specialty)
Background The coronavirus disease 19 (COVID-19) pandemic had a devastating effect on New York City in the spring of 2020. Several global reports suggested worse early outcomes among COVID-positive patients with hip fractures. However, there is limited data comparing baseline comorbidities among patients treated during the pandemic relative to those treated in non-pandemic conditions.Materials and Methods A multicenter retrospective cohort study was performed at two Level 1 Trauma centers and one orthopedic specialty hospital to assess demographics, comorbidities, and outcomes among 67 hip fracture patients treated (OTA/AO 31, 32.1) during the peak of the COVID-19 pandemic in New York City (March 20, 2020 to April 24, 2020), including 9 who were diagnosed with COVID-19. These patients were compared to a cohort of 76 hip fracture patients treated 1 year prior (March 20, 2019 to April 24, 2019). Baseline demographics, comorbidities, treatment characteristics, and respiratory symptomatology were evaluated. The primary outcome was inpatient mortality.Results Relative to patients treated in 2019, patients with hip fractures during the pandemic had worse Charlson Comorbidity Indices (median 5.0 vs 6.0, P = .03) and American Society of Anesthesiologists (ASA) scores (mean 2.4 vs 2.7, P = .04). Patients during the COVID-19 pandemic were more likely to have decreased ambulatory status ( P<.01) and a smoking history ( P = .04). Patients in 2020 had longer inpatient stays (median 5 vs 7 days, P = .01), and were more likely to be discharged home (61% vs 9%, P<.01). Inpatient mortality was significantly increased during the COVID-19 pandemic (12% vs 0%, P = .002).Conclusions Patients with hip fractures during the COVID-19 pandemic had worse comorbidity profiles and decreased functional status compared to patients treated the year prior. This information may be relevant in negotiations regarding reimbursement for cost of care of hip fracture patients with COVID-19, as these patients may require more expensive care.