Incidence, Quality of Care, and Mortality in Hip Fracture Patients in the Course of the COVID Pandemic: A Population-Based Cohort Study.

BACKGROUND: We assessed the incidence, quality of in-hospital care, and mortality for hip fracture (HF) patients in Denmark before and during the coronavirus disease (COVID) pandemic. METHODS: We obtained data from the Danish registries in the COVID period (March 11, 2020 to January 27, 2021, overall and in 5 periods) and compared it to a pre-COVID period (March 13, 2019 to March 10, 2020). We calculated the proportion of patients (%) that have fulfilled all the relevant quality indicators (a composite score of 100%) and adjusted hazard ratios (HR) with a 95% confidence interval (CI) for 30-day mortality. RESULTS: The incidence of HF was 5.7 per 1 000 person-years both in pre-COVID and COVID periods. About 35% of patients had a composite score of 100% in the COVID period compared to 28% in the pre-COVID period (proportion ratio 1.23 [95% CI: 1.17-1.30]). Fulfillment of all individual quality indicators was similar or higher in the COVID period. 30-day mortality was 9.5% in pre-COVID period, compared to 10.8% in the COVID period (HR 1.15 [95% CI: 1.02-1.30]). HRs varied from 1.07 (95% CI: 0.89-1.29) to 1.31 (95% CI: 1.06-1.62) in 5 COVID periods. In-hospital mortality was 4% in pre-COVID versus 4.4% in COVID period. CONCLUSIONS: The incidence of HF in Denmark remained unchanged. The quality of in-hospital care was higher in the COVID compared to pre-COVID period. Unfortunately, 30-day mortality was also higher, highlighting the importance of recognizing diversity of social networks, home support, and digital health intervention after discharge for outcome of HF patients.

[Fatal outcome for a patient in treatment with dabigatran suffering a subtrochanteric femoral fracture]. / Fatal blødning ved operation for hoftenær fraktur hos en patient i behandling med dabigatran

An 82-year-old woman in treatment with the thrombin inhibitor dabigatran etexilate (a new oral anticoagulant (NOAC)) was admitted with a subtrochanteric femoral fracture and surgery was initiated 15 hours after admittance. She had a blood loss of 6,000 ml and died the next morning from multi-organ failure. In 2013 1.8% of hip fracture patients in Funen received NOACs. Surgery is recommended within 24 hours for hip fracture patients to reduce mortality, but patients in treatment with NOACs should wait at least 48 hours before major surgery. Care should be taken when prescribing NOACs to patients with high risk of falling.