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AIMS: Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients. METHODS: All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality. RESULTS: Overall, 132 patients were included. Of these, 34.8% (n = 46) were diagnosed with COVID-19. Bacterial pneumonia was observed at a significantly higher rate in those patients with COVID-19 (56.5% vs 15.1%; p =< 0.000). Non respiratory complications such as acute kidney injury (30.4% vs 9.3%; p =0.002) and urinary tract infection (10.9% vs 3.5%; p =0.126) were also more common in those patients with COVID-19. Length of stay was increased by a median of 21.5 days in patients diagnosed with COVID-19 (p < 0.000). 30-day mortality was significantly higher in patients with COVID-19 (37.0%) when compared to those without (10.5%; p <0.000). CONCLUSION: This study has shown that patients with a neck of femur fracture have a high rate of mortality and complications such as bacterial pneumonia and acute kidney injury when diagnosed with COVID-19 within the perioperative period. We have demonstrated the high risk of in hospital transmission of COVID-19 and the association between the infection and an increased length of stay for the patients affected.Cite this article: Bone Joint Open 2020;1-11:669-675.
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BACKGROUND/OBJECTIVES: The very elderly constitute a subgroup of elderly who may respond differently than the younger elderly to medical intervention. This possibility has not previously been investigated. Our study investigates whether successful rehabilitation of the very elderly is possible within the current processes of care and also whether factors that help predict successful rehabilitation in all age elderly are applicable to the oldest old. METHODS: A retrospective case note analysis of all very elderly people (>or=90 years old) treated within in-patient elderly person rehabilitation facilities at the Northern General Hospital, Sheffield. Potential predictive factors analysed: Barthel index, main presenting illness, number of co-morbid conditions, number of regular prescribed medications, abbreviated mental test score, prior formal social services input, previous hospital admission within 1 year and serum albumin (g/l). Outcome measures reflecting success of rehabilitation: duration of rehabilitation (days), discharge destination to the same ('good outcome') or increased ('poor outcome') level of social and/or nursing care, readmission to hospital within 30 days of discharge and death during rehabilitation or within 120 days of discharge. RESULTS: Of 230 nonagenarians admitted to inpatient elderly rehabilitation 47% required no increase in social support following their admission and 76% of those admitted from their own home were able to return there. Barthel index and the number of co-morbid conditions were the most influential predictors of success, with Barthel index predicting length of stay (p < 0.001), discharge destination (p < 0.001) and in-hospital mortality (p < 0.01) and co-morbidity predicting readmission to hospital (p = 0.05), in-hospital mortality (p = 0.04) and survival (p = 0.05). On multi-variate analysis all other predictive factors analysed, except for presenting illness, were associated with at least one outcome measure (p < 0.05). CONCLUSION: Successful inpatient rehabilitation of the very elderly is possible. Factors that predict the success of rehabilitation of nonagenarians are similar to those associated with success in the younger elderly. The factors that most broadly predict success are Barthel index and the number of co-morbid conditions identified at admission to rehabilitation. Main presenting illness did not emerge as a predictor within this group.