A year of COVID-19: effects of a global pandemic on a hip fracture bundled care protocol.
10.4103/singaporemedj.SMJ-2021-351
- Author:
Khai Cheong WONG
1
;
Kenny Xian Khing TAY
;
Suang Bee KOH
;
Tet Sen HOWE
Author Information
1. Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
- Publication Type:Journal Article
- MeSH:
Humans;
COVID-19/epidemiology*;
Male;
Female;
Hip Fractures/epidemiology*;
Aged;
Retrospective Studies;
Aged, 80 and over;
Length of Stay;
Patient Readmission/statistics & numerical data*;
Pandemics;
SARS-CoV-2;
Patient Care Bundles;
Hospital Mortality;
Clinical Protocols;
Time-to-Treatment;
Reoperation
- From:Singapore medical journal
2024;65(12):669-673
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Our aim was to analyse how the coronavirus disease 2019 (COVID-19) pandemic affects a hip fracture bundled care protocol. We hypothesised that key performance indicators, but not short-term outcomes, may be adversely affected.
METHODS:Patients admitted under a hip fracture bundled care protocol were divided into two arms: 'COVID' group included patients admitted in 2020 during the COVID-19 pandemic and 'PRE-COVID' group included patients admitted in 2019. We retrospectively analysed time to admission, time to surgery, length of stay, discharge disposition, as well as rates of 30-day revision surgery, 30-day readmission and inpatient mortality.
RESULTS:There were 307 patients in the PRE-COVID group and 350 patients in the COVID group. There was no significant difference in terms of gender, age and type of hip fracture. The COVID group had a higher proportion of American Society of Anesthesiologists classification III and IV patients (61.4% vs. 50.2% in the PRE-COVID group; P = 0.004). In the COVID group, similar proportion of patients were admitted to the ward within 4 h, but the mean time to surgery was longer (71.8 ± 73.0 h vs. 60.4 ± 72.8 h in the PRE-COVID group; P = 0.046) and few patients underwent operations within 48 h (41.7% vs. 60.3% in the PRE-COVID group; P < 0.001). Mean postoperative length of stay, discharge disposition, as well as rates of inpatient mortality, 30-day revision surgery and 30-day readmission were similar.
CONCLUSION:The volume of hip fractures during the COVID-19 pandemic remained unchanged, although patients admitted during the COVID-19 pandemic appeared to be more deconditioned. Nevertheless, having robust protocols and staff familiar with hip fracture treatment can preserve short-term outcomes for this group of patients, even with strict isolation measures in place during a pandemic.
