Delayed surgery versus nonoperative treatment for hip fractures in post-COVID-19 arena: a retrospective study of 145 patients

Figures & data

Figure 1. Flow chart of study design.

Table 1. Demographics, clinical characteristics, and treatment of elderly hip fracture patients during the COVID-19 pandemic

	All patients	Surgery	Nonoperative therapy
Factor	n = 145	n = 108	n = 37	p-value
Demographics
Female sex	90	70	20	0.2
Age, mean	72	72	74	0.2
range	66–81	65–79	66–85
Chronic comorbidity
Hypertension	81	62	19	0.5
Diabetes	29	18	11	0.09
Cerebral infarction	40	29	11	0.7
Coronary heart disease	23	15	8	0.3
Osteoporosis	10	9	1	0.4
Prior medical history
Smoking	20	15	5	1.0
Alcohol	16	12	4	1.0
Other clinical characteristics
Simple fall	118	88	30	1.0
Traffic accident	15	11	4	1.0
Fall from height	6	4	2	1.0
Sprain	6	5	1	1.0
Femoral fracture type
Neck	105	88	17	< 0.001
Intertrochanteric	36	17	19	< 0.001
Subtrochanteric	4	3	1	1.0
Brain injury	5	4	1	1.0
Treatment
Traction	41	32	9	0.5
Analgesics	116	86	30	0.8
Antibiotics	68	56	12	0.04

Table 2. Intraoperative data of 108 surgical patients

	All	Plate fixation	Dynamic hip screw	Proximal antirotation nail	Hip replacement	Hollow screw fixation
	n = 108	n = 12	n = 6	n = 15	n = 68	n = 7
Femoral fracture typ, n
neck	88	7	5	2	67	7
intertrochanteric	17	5	0	11	1	0
subtrochanteric	3	0	1	2	0	0
Days from injury to surgery	33	32	45	29	37	23
IQR	24–48	25–58	26–71	22–44	25–49	21–38
Surgery time, minutes	90	133	95	90	80	90
IQR	60–120	60–173	80–110	60–135	60–120	40–120
Intraoperative blood loss, mL	200	150	225	200	200	50
IQR	100–300	100–400	118–425	100–400	120–300	30–100

Table 4. 1-month follow-up results of 145 elderly hip fracture patients during the pandemic of COVID-19

	All patients	Surgery	Nonoperative therapy
Items	n = 145	n = 108	n = 37	p-value
Deep venous thrombosis, n	20	11	9	0.03
Pulmonary infection, n	24	14	10	0.03
VAS score (0–10)	3.0	3.0	5.0	< 0.001
IQR	2.0–4.0	1.3–4.0	3.0–6.5
Harris Hip Score (0–100)	69	71	66	0.04
IQR	57–82	60–84	55–82

Figure 2. Kaplan–Meier curves of survival. Gehan–Breslow–Wilcoxon test p-value = 0.003; hazard ratio, surgery versus nonoperative therapy group = 0.06 (95% confidence interval 0.01–0.38).

Table 5. 3-month follow-up results of 133 elderly hip fracture patients during the COVID-19 pandemic

	All patients	Surgery	Nonoperative therapy
Items	n = 133	n = 99	n = 34	p-value ^a
Deep venous thrombosis, n	25	13	12	0.004
Pulmonary infection, n	31	15	16	< 0.001
VAS score (0–10)	1.0	1.0	2.5	< 0.001
IQR	0.0–3.0	0.0–2.0	1.0–5.0
Harris Hip Score (0–100)	71	73	70	0.04
IQR	63–85	66–86	58–84
Dead	5	1	4	0.02

^a Mann–Whitney U-test or chi-square test was selected to compare differences between surgery and conservative therapy where appropriate.

Table 6. Demographics, clinical characteristics, and causes of death of 6 dead elderly hip fracture patients during the COVID-19 pandemic

Patient	Therapy	Sex	Age	Hyper- tension	Dia- betes	Cerebral infarction	Other chronic comorbidity	Cause of death	Days from admission to death
1	surgical	female	84	+	+	+	Chronic obstructive pulmonary disease	Pulmonary infection	78
2	nonoperative	male	80	–	–	+	Pleural effusion, arrhythmia, atrial fibrillation	Heart failure	18
3	nonoperative	male	87	–	–	–	Pulmonary infection, pulmonary tuberculosis, pulmonary embolism	Pulmonary embolism	27
4	nonoperative	female	71	+	–	+	Coronary heart disease, arrhythmia	Heart failure	69
5	nonoperative	male	73	+	+	+	Coronary heart disease	Heart failure	88
6	nonoperative	male	85	+	+	–	Renal failure	Renal failure	169