Mortality risk of surgically managing orthopaedic trauma during the COVID-19 pandemic

• Main Authors: Balasubramanian Balakumar, Rajpal S. Nandra, Hugo Woffenden, Benjamin Atkin, Ansar Mahmood, George Cooper, Julian Cooper, Paul Hindle
• Format: Article
• Language: English
• Published: The British Editorial Society of Bone & Joint Surgery 2021-05-01
• Series: Bone & Joint Open
• Subjects: morbidity; mortality; covid-19; trauma; surgery; orthopaedics
• Online Access: https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.25.BJO-2020-0189.R1

Aims: It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site. Methods: The primary outcome measure was 30-day mortality. Secondary measures included complications of surgery, COVID-19 infection, and length of stay. Multiple variables were assessed for their contribution to the 30-day mortality. In total, 433 patients were included with a mean age of 65 years; 45% were male, and 90% were Caucasian. Results: Overall mortality was 7.6% for all patients and 15.9% for femoral neck fractures. The mortality rate increased from 7.5% to 44.2% in patients with fracture neck of femur and a COVID-19 infection. The COVID-19 rate in the 30-day postoperative period was 11%. COVID-19 infection, age, and Charlson Comorbidity Index were independent risk factor for mortality. Conclusion: There was a significant risk of contracting COVID-19 due to being admitted to hospital. Using a site which was not treating COVID-19 respiratory patients for surgery did not identify a difference with respect to mortality, nosocomial COVID-19 infection, or length of stay. The COVID-19 pandemic significantly increases perioperative mortality risk in patients with fractured neck of femora but patients with other injuries were not at increased risk.