IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit: Lessons from an international multicentre study of 7, 090 patients conducted in 14 nations during the COVID-19 pandemic. Issue 6 (December 2022)

• Record Type: Journal Article
• Authors: Hall, Andrew J.; Clement, Nicholas D.; Ojeda-Thies, Cristina; MacLullich, Alasdair MJ.; Toro, Giuseppe; Johansen, Antony; White, Tim O.; Duckworth, Andrew D.; Abdul-Jabar, Hani; Abu-Rajab, Rashid; Abugarja, Ahmed; Adam, Karen; Aguado Hernández, Héctor J.; Améstica Lazcano, Gedeón; Anderson, Sarah; Ansar, Mahmood; Antrobus, Jonathan; Aragón Achig, Esteban Javier; Archunan, Maheswaran; Arrieta Salinas, Mirentxu; Ashford–Wilson, Sarah; Assens Gibert, Cristina; Athanasopoulou, Katerina; Awadelkarim, Mohamed; Baird, Stuart; Bajada, Stefan; Balakrishnan, Shobana; Balasubramanian, Sathishkumar; Ballantyne, James A.; Bárcena Goitiandia, Leopoldo; Barkham, Benjamin; Barmpagianni, Christina; Barres-Carsi, Mariano; Barrett, Sarah; Baskaran, Dinnish; Bell, Jean; Bell, Katrina; Bell, Stuart; Bellelli, Giuseppe; Benchimol, Javier Alberto; Boietti, Bruno Rafael; Boswell, Sally; Braile, Adriano; Brennan, Caitlin; Brent, Louise; Brooke, Ben; Bruno, Gaetano; Burahee, Abdus; Burns, Shirley; Calabrò, Giampiero; Campbell, Lucy; Carabelli, Guido Sebastian; Carnegie, Carol; Carretero Cristobal, Guillermo; Caruana, Ethan; Cassinello Ogea, M.a Concepción; Castellanos Robles, Juan; Castillon, Pablo; Chakrabarti, Anil; Cecere, Antonio Benedetto; Chen, Ping; Clarke, Jon V.; Collins, Grace; Corrales Cardenal, Jorge E.; Corsi, Maurizio; Cózar Adelantado, Gara María; Craxford, Simon; Crooks, Melissa; Cuarental-García, Javier; Cuthbert, Rory; Dall, Graham; Daskalakis, Ioannis; De Cicco, Annalisa; de la Fuente de Dios, Diana; Demaria, Pablo; Dereix, John; Díaz Jiménez, Julian; Dinamarca Montecinos, José Luis; Do Le, Ha Phuong; Donoso Coppa, Juan Pablo; Drosos, Georgios; Duffy, Andrew; East, Jamie; Eastwood, Deborah; Elbahari, Hassan; Elias de Molins Peña, Carmen; Elmamoun, Mamoun; Emmerson, Ben; Escobar Sánchez, Daniel; Faimali, Martina; Farré-Mercadé, Maria Victòria; Farrow, Luke; Fayez, Almari; Fell, Adam; Fenner, Christopher; Ferguson, David; Finlayson, Louise; Flores Gómez, Aldo; Freeman, Nicholas; French, Jonathan; Gabardo Calvo, Santiago; Gagliardo, Nicola; Garcia Albiñana, Joan; García Cruz, Guillermo; García de Cortázar Antolín, Unai; García Virto, Virginia; Gealy, Sophie; Gil Caballero, Sandra Marcela; Gill, Moneet; González González, María Soledad; Gopireddy, Rajesh; Guntley, Diane; Gurung, Binay; Guzmán Rosales, Guadalupe; Haddad, Nedaa; Hafeez, Mahum; Haller, Petra; Halligan, Emer; Hardie, John; Hawker, Imogen; Helal, Amr; Herrera Cruz, Mariana; Herreros Ruiz-Valdepeñas, Ruben; Horton, James; Howells, Sean; Howieson, Alan; Hughes, Luke; Hünicken Torrez, Flavia Lorena; Hurtado Ortega, Ana; Huxley, Peter; Hamid, Hytham K.S.; Ilahi, Nida; Iliadis, Alexis; Inman, Dominic; Jadhao, Piyush; Jandoo, Rajan; Jawad, Lucy; Jayatilaka, Malwattage Lara Tania; Jenkins, Paul J.; Jeyapalan, Rathan; Johnson, David; Johnston, Andrew; Joseph, Sarah; Kapoor, Siddhant; Karagiannidis, Georgios; Karanam, Krishna Saga; Kattakayam, Freddy; Konarski, Alastair; Kontakis, Georgios; Labrador Hernández, Gregorio; Lancaster, Victoria; Landi, Giovanni; Le, Brian; Liew, Ignatius; Logishetty, Kartik; Lopez Marquez, Andrew Carlomaria Daniel; Lopez, Judit; Lum, Joann; Macpherson, Gavin J.; Madan, Suvira; Mahroof, Sabreena; Malik-Tabassum, Khalid; Mallina, Ravi; Maqsood, Afnan; Marson, Ben; Martin Legorburo, M. José; Martin-Perez, Encarna; Martínez Jiménez, Tania; Martinez Martin, Javier; Mayne, Alistair; Mayor, Amy; McAlinden, Gavan; McLean, Lucille; McDonald, Lorna; McIntyre, Joshua; McKay, Pamela; McKean, Greg; McShane, Heather; Medici, Antonio; Meeke, Chelsea; Meldrum, Evonne; Mendez, Mijail; Mercer, Scott; Merino Perez, Josu; Mesa-Lampré, María-Pilar; Mighton, Shuna; Milne, Kirsty; Mohamed Yaseen, Muhammed; Moppett, Iain; Mora, Jesus; Morales-Zumel, Sira; Moreno Fenoll, Irene Blanca; Mousa, Adham; Murray, Alastair W.; Murray, Elspeth V.; Nair, Radhika; Neary, Fiona; Negri, Giacomo; Negus, Oliver; Newham-Harvey, Fiona; Ng, Nigel; Nightingale, Jess; Noor Mohamed Anver, Sumiya; Nunag, Perrico; O'Hare, Matthew; Ollivere, Ben; Ortés Gómez, Raquel; Owens, AnneMarie; Page, Siobhan; Palloni, Valentina; Panagiotopoulos, Andreas; Panagiotopoulos, Elias; Panesar, Paul; Papadopoulos, Antonios; Spyridon, Papagiannis; Pareja Sierra, Teresa; Park, Chang; Parwaiz, Hammad; Paterson-Byrne, Paul; Patton, Sam; Pearce, Jack; Porter, Marina; Pellegrino, Achille; Pèrez Cuellar, Arturo; Pezzella, Raffaele; Phadnis, Ashish; Pinder, Charlotte; Piper, Danielle; Powell-Bowns, Matilda; Prieto Martín, Rocío; Probert, Annabel; Ramesh, Ashwanth; Ramírez de Arellano, Manuel Vicente Mejía; Renton, Duncan; Rickman, Stephen; Robertson, Alastair; Roche Albero, Adrian; Rodrigo Verguizas, José Alberto; Rodríguez Couso, Myriam; Rooney, Joanna; Sáez-López, Pilar; Saldaña-Díaz, Andres; Santulli, Adriano; Sanz Pérez, Marta Isabel; Sarraf, Khaled M.; Scarsbrook, Christine; Scott, Chloe E.H.; Scott, Jennifer; Shah, Sachi; Sharaf, Sharief; Sharma, Sidharth; Shirley, Denise; Siano, Antonio; Simpson, James; Singh, Abhinav; Singh, Amit; Sinnett, Tim; Sisodia, Gurudatt; Smith, Philomena; Sophena Bert, Eugenia; Steel, Michael; Stewart, Avril; Stewart, Claire; Sugand, Kapil; Sullivan, Niall; Sweeting, Lauren; Symes, Michael; Tan, Dylan Jun Hao; Tancredi, Francesco; Tatani, Irini; Thomas, Philip; Thomson, Fraser; Toner, Niamh S.; Tong, Anna; Toro, Antonio; Tosounidis, Theodoros; Tottas, Stylianos; Trinidad Leo, Andrea; Tucker, Damien; Vemulapalli, Krishna; Ventura Garces, Diego; Vernon, Olivia Katherine; Viveros Garcia, Juan Carlos; Ward, Alex; Ward, Kirsty; Watson, Kate; Weerasuriya, Thisara; Wickramanayake, Udara; Wilkinson, Hannah; Windley, Joseph; Wood, Janet; Wynell-Mayow, William; Zatti, Giovanni; Zeiton, Moez; Zurrón Lobato, Miriam;
• Is Part Of: Surgeon. Volume 20:Issue 6(2022)
• Page Start: e429
• Page End: e446
• Publication Date: 2022-12
• Subjects: Hip fracture -- Frailty -- Trauma -- Orthopaedic -- Geriatric -- Risk -- Prognosis -- Outcomes -- Reporting standards -- COVID-19 -- Nosocomial -- Communicable disease -- Infection -- Audit -- Meta-audit; Surgery -- Periodicals; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617
• DOI: 10.1016/j.surge.2022.02.009
• Languages: English
• ISSNs: 1479-666X

Abstract

Abstract: Aims: This international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients. Methods: A multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1st March-31st May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded. Results: A total of 7090 patients were included, with a mean age of 82.2 (range 50–104) years and 4959 (69.9%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) were positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p = 0.001), residential care (OR 2.15, p < 0.001), inpatient fall (OR 2.23, p = 0.003), cancer (OR 0.63, p = 0.009), ASA grades 4 (OR 1.59, p = 0.008) or 5 (OR 8.28, p < 0.001), and longer admission (OR 1.06 for each increasing day, p < 0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p < 0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p < 0.001). Increasing age (HR 1.03, p = 0.028), male sex (HR 2.35, p < 0.001), renal disease (HR 1.53, p = 0.017), and pulmonary disease (HR 1.45, p = 0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders. Conclusion: The prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality risk. Among COVID-19-positive patients, those who were older, male, with renal or pulmonary disease had a significantly higher 30-day mortality risk. Highlights: IMPACT-Global is the largest multicentre observational study undertaken solely in T&O Prevalence of COVID-19 in hip fracture patients was ten times higher than background COVID-19 was independently associated with a 3x increased 30-day mortality risk Nosocomial transmission likely had significant role in COVID-19 prevalence & mortality Lessons applicable to audit and practice in future communicable disease outbreaks