Fragility hip fractures in the COVID-19 pandemic: A local experience in the United Kingdom

BACKGROUND: Fragility hip fractures are a major cause of morbidity and mortality in the UK. The 2019 novel coronavirus disease (COVID-19) pandemic led to restrictions on trauma services in several hospitals with potential operating delays and unintended negative outcomes. This local study describes the impact of operative pathway changes on clinical outcomes of patients undergoing fragility hip fracture surgery during the COVID-19 pandemic. METHODS: A single centre, retrospective analysis was performed for all patients who presented with fragility hip fractures for operative management between the 23rd March and 29(th) April 2020. RESULTS: Thirty four patients met the inclusion criteria for analysis. The median patient age was 88 years old, with a median inpatient stay of 8 days. Three patients died prior to being operated on. Forty eight percent of patients were operated on within the national 36 hour target. The 30 day all-cause mortality from the date of presentation of injury was 20%. DISCUSSION: Our study demonstrates that the pandemic and changes to operating pathways has had a sizeable impact on the hip fracture service with delays in surgery and an increase in the 30 day mortality. These disruptions to surgical operating systems are likely to continue, with potential ongoing unintended negative consequences as demonstrated in this study. We believe that a focus on solving logistical issues including availability of sufficient operating theatre capacity, redeployment of staff, early multidisciplinary input and counselling patients on the increased outcome risks will help to mitigate risks posed to this vulnerable patient population during these periods.