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Proximal femoral fractures in patients with COVID-19

Pneumonia and admission from a nursing home are the strongest predictors of mortality

Proximale Femurfrakturen bei Patienten mit COVID-19

Lungenentzündung und Aufnahme aus einem Pflegeheim sind die stärksten Prädiktoren für die Mortalität

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Abstract

Background

Proximal femoral fractures are severe injuries in geriatric patients. Additionally, geriatric patients are at a high risk of death due to coronavirus disease 2019 (COVID-19).

Objective

To identify predictors of mortality in geriatric patients with COVID-19 and concurrent proximal femoral fractures.

Material and methods

Patients who underwent surgical treatment for proximal femoral fractures and also tested positive for COVID-19 were included. The age, gender, the American Society of Anesthesiology (ASA) score and the admission from a nursing home were considered as variables. The rate of reoperations, the mortality at 3 months and discharge home were evaluated as outcomes.

Results

In this study 46 patients with COVID-19 (female/male 31/15, median age 87.0 years with an interquartile range [IQR] of 9.8 years) met the inclusion criteria. Of these, 32 patients (69.6%) had to be cared for in the intensive care unit and 26 patients (56.5%) had a severe course of COVID-19 with pneumonia. The median length of hospital stay for survivors was 19 (IQR 17.5) days and 4 of the patients (8.7%) required surgical revision. The in-hospital and 3‑month mortality were 40.0% (n = 17) and 43.5% (n = 20), respectively. The factors which influenced the in-hospital and 3‑month mortality rates were admission from a nursing home, the presence of pneumonia (increased the risk of death) and female gender (protective).

Conclusion

The occurrence of COVID-19 in patients with proximal femoral fractures has a high mortality. Admission from a nursing home and the presence of pneumonia increased the risk of death, whereas women were at lower risk.

Zusammenfassung

Hintergrund

Proximale Femurfrakturen (PFF) sind schwere Verletzungen bei geriatrischen Patienten. Darüber hinaus besteht für geriatrische Patienten ein hohes Risiko, an COVID-19 zu sterben.

Ziel der Arbeit

Ermittlung von Prädiktoren für die Mortalität bei geriatrischen Patienten mit COVID-19 und gleichzeitiger proximaler Femurfraktur.

Material und Methoden

Patienten wurden eingeschlossen, die sich einer chirurgischen Behandlung wegen PFF unterzogen und auch positiv auf COVID-19 getestet wurden. Als Variablen wurden Alter, Geschlecht, der ASA-Score, die Aufnahme aus einem Pflegeheim berücksichtigt. Als Ergebnisse wurden die Rate der Reoperationen, die Mortalität im Krankenhaus nach 3 Monaten und die Entlassungen nach Hause ausgewertet.

Ergebnisse

In dieser Studie erfüllten 46 Patienten mit COVID-19 (weiblich/männlich 31/15, mittleres Alter 87,0 Jahre mit einem Interquartilsbereich [IQR] von 9,8 Jahren) die Einschlusskriterien. Davon mussten 32 Patienten (69,6 %) auf der Intensivstation betreut werden. 26 Patienten (56,5 %) hatten einen schweren Verlauf von COVID-19 mit Lungenentzündung. Bei den Überlebenden betrug die mittlere Krankenhausaufenthaltsdauer 19 (IQR 17,5) Tage. Vier der Patienten (8,7 %) benötigten eine chirurgische Revision. Die 3‑Monats-Mortalität im Krankenhaus betrug 40,0 % (n = 17) bzw. 43,5 % (n = 20). Die Faktoren, die die 3‑Monats-Sterblichkeitsraten im Krankenhaus beeinflussten, waren die Aufnahme aus einem Pflegeheim, das Vorliegen einer Lungenentzündung (erhöhtes Sterberisiko) und das weibliche Geschlecht (schützend).

Diskussion

COVID-19, das bei Patienten mit PFF auftritt, weist eine hohe Mortalität auf. Die Aufnahme aus einem Pflegeheim und das Vorliegen einer Lungenentzündung erhöhten das Sterberisiko, wohingegen das weibliche Geschlecht schützend wirkte.

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Acknowledgements

We would like to thank Cyrus Rasti, MD, for the language proofreading of the manuscript.

Funding

This work was supported by the Cooperatio Program, Charles University, Faculty of Medicine in Hradec Králové, research area Metabolic Diseases.

Author information

Authors and Affiliations

  1. Clinic of Orthopedics, Traumatology and Hand Surgery, Klinikum Chemnitz, Chemnitz, Germany

    Petr Kohut, Ronny Langenhan, Niklas Reimers & Anica Kilper

  2. Clinic of Orthopedics and Traumatology, DIAKOMED Diakoniekrankenhaus, Hartmannsdorf, Germany

    Petr Kohut

  3. 3rd Department of Internal Medicine—Metabolism and Gerontology, University Hospital Hradec Králové, Hradec Králové, Czech Republic

    Vojtech Mezera

  4. Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic

    Vojtech Mezera

  5. Clinic of Orthopedics, Traumatology and Hand Surgery, Hegau-Bodensee-Klinikum Singen, Singen, Germany

    Ronny Langenhan

  6. Geriatric Center, Pardubice Hospital, Pardubice, Czech Republic

    Vojtech Mezera

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  1. Petr Kohut
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Contributions

All authors contributed to the study conception and/or design. A. Kilper designed the study and provided an overall guidance. P. Kohut, R. Langenhan and N. Reimers extracted the data from the patients’ medical records. V. Mezera performed the statistical analyses. P. Kohut and V. Mezera wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vojtech Mezera.

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Conflict of interest

P. Kohut, V. Mezera, R. Langenhan, N. Reimers and A. Kilper declare that they have no competing interests.

Ethical standards.

Informed consent was obtained from all participants included in the study. All studies mentioned were in accordance with the ethical standards indicated in each case. Data were processed under the German national terms and regulations including General Data Protection Regulation (GDPR).

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The authors Petr Kohut and Vojtech Mezera contributed equally to the manuscript.

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Kohut, P., Mezera, V., Langenhan, R. et al. Proximal femoral fractures in patients with COVID-19. Z Gerontol Geriat (2024). https://doi.org/10.1007/s00391-024-02317-0

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