The Impact of COVID-19 on the Prevalence, Mortality, and Associated Risk Factors for Mortality in Patients with Hip Fractures: A Meta-Analysis.

ABSTRACT

OBJECTIVE: This study aimed to assess (1) the prevalence of COVID-19 in patients with hip fracture; (2) the mortality rate of patients with hip fracture associated with COVID-19; (3) risk factors associated with mortality in patients with hip fracture; and (4) the effects of COVID-19 on surgical outcomes of patients with hip fracture. DESIGN: Meta-analysis. SETTING AND PARTICIPANTS: Patients with hip fractures during COVID-19. METHODS: PubMed, Web of Science, and Embase were systematically reviewed. The outcomes included the prevalence of COVID-19, case fatality rate, 30-day mortality, cause of death, risk factors associated with the mortality of patients with hip fracture, time to surgery, surgical time, and length of hospitalization. Risk ratio or weight mean difference with 95% confidence intervals were used to pool the estimates. RESULTS: A total of 60 studies were included in this meta-analysis. The pooled estimate showed that the prevalence of COVID-19 was 21% in patents with hip fractures. Patients with hip fracture with COVID-19 had an increased 30-day mortality risk compared with those without the infection. The main causes of death were respiratory failure, COVID-19-associated pneumonia, multiorgan failure, and non-COVID-19 pneumonia. The hospitalization was longer in patients with COVID-19 when compared with those without the infection, but was shorter in patients during the pandemic period. The surgery time and time to surgery were not significantly different between patients during or before the pandemic period and in those with or without COVID-19. CONCLUSIONS AND IMPLICATIONS The 30-day mortality rate was significantly higher in patients with hip fracture with COVID-19 infection than those without. Patients with COVID-19 had a higher all-cause mortality rate than those without. This information can be used by the medical community to guide the management of patients with hip fracture with COVID-19.