Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study
Objectives: Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.
Setting: Prospective, international, multicentre, observational cohort study.
Participants: Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).
Primary outcome: 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.
Results: This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).
Conclusions: Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.
Trial registration number: NCT04323644.
Funding
National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 16.136.79)
Association of Coloproctology of Great Britain and Ireland
Association of Upper Gastrointestinal Surgeons
Bowel Disease Research Foundation
Yorkshire Cancer Research
Sarcoma UK
British Association of Surgical Oncology
Vascular Society for Great Britain and Ireland
European Society of Coloproctology
History
Data Availability Statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary informationComments
The original article is available at https://bmjopen.bmj.com/Published Citation
COVIDSurg Collaborative. Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study. BMJ Open. 2021;11(11):e050830.Publication Date
30 November 2021External DOI
PubMed ID
34848515Department/Unit
- Beaumont Hospital
- Surgery
Research Area
- Surgical Science and Practice
- Cancer
Publisher
BMJVersion
- Published Version (Version of Record)