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Introduction The primary aim of our study was to evaluate the impact of coronavirus disease 2019 (COVID-19) vaccination on mortality in patients with hip fractures by comparing it to those who are unvaccinated. Our secondary objective was to compare the impact on postoperative morbidity parameters like length of hospital stay and complications. Methods A total of 619 hip fractures were divided into the 'Vaccinated group' consisting of 300 patients who had COVID-19 vaccination and the 'Unvaccinated group' consisting of 319 patients who were not vaccinated. Patient demographic variables, Nottingham hip fracture score, American Society of Anesthesiologists (ASA) grade, type of anaesthesia used, and Charlson Comorbidity Index were collected. Our primary outcome measures were 30- and 90-day mortality. Secondary outcome measures included postoperative complications like thromboembolic complications, cardiac, and respiratory complications, etc. Mortality among the COVID-positive patients was also compared between the groups. Results Thirty-day postoperative mortality was higher in the unvaccinated group at 13.2% than in the vaccinated group at 5.3%. A similar increase in 90-day mortality was also observed in the unvaccinated group at 24.8% when compared to 14.7% in the vaccinated group(p<0.001). Despite having a higher baseline prevalence of cardiac comorbidities, the Vaccinated group had fewer post-operative cardiac, thromboembolic, and neurological complications (p>0.05). Moreover, electrolyte imbalance and AKI were also seen in fewer patients in the vaccinated group compared to the control group (p<0.05). Furthermore, it was found that among the vaccinated patients who did have perioperative COVID-19 infection, the 30-day mortality was significantly lower (10%) compared to the control group (31.2%) (p<0.001). Similarly, 90-day mortality was significantly lower (25%) compared to the control group (43.75%) (p<0.001). Conclusion Vaccination against COVID-19 independently reduced mortality and morbidity among patients with hip fractures when compared to those who are not vaccinated. Furthermore, it decreased the risk of acquiring COVID-19, and subsequent postoperative complications. Among those who are infected with COVID-19 despite vaccination, the mortality was significantly lesser.
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BACKGROUND: Manual handling forms an important part of a health care worker's daily routine. Faulty techniques may result in musculoskeletal injuries in health workers and further injury to patients. OBJECTIVES: In our study, we assessed the techniques of patient moving and handling by health care workers in our hospital. Our aim was to educate them on standard moving and handling techniques and assess the impact of the same. METHODS: We carried out a time-bound prospective clinical audit wherein we observed workers in the emergency department for a period of 2 weeks to evaluate their moving and handling techniques. This was followed by a training session where the workers were trained in "best-practices," and a 2-week period of reevaluation to assess compliance with standard practices. RESULTS: During bed-to-bed transfers, we found improvements in the following seven parameters after the training session: (a) the use of good posture, (b) the use of wheel stoppers, (c) adjustment of bed height, (d) positioning the receiving bed parallel to patient's bed, (e) general risk assessment before transferring a patient, (f) involvement of at least three carers, and (g) the use of a standard command like "GO" before the transfer. CONCLUSION: Apart from serving the purpose of an audit, our study has revealed that the training of health care providers in safe moving and handling of patients is a neglected subject in India.
