Hip Fracture Characteristics and Outcomes During COVID-19: A Large Retrospective National Database Review

ABSTRACT Introduction The COVID-19 pandemic has impacted healthcare in various vulnerable patient subpopulations. However, data are lacking on COVID-19’s impact on hip fractures, seen mainly in elderly patients. Using national claims data, we aimed to describe the epidemiology during the first US COVID-19 wave in the United States. Methods We compared patients admitted for hip fractures during March and April of 2020 with those admitted in 2019 in terms of patient and healthcare characteristics, COVID-19 diagnosis, and outcomes. An additional comparison was made between COVID-19 positive and negative patients. Outcomes included length of hospital stay (LOS), admission to an intensive care unit (ICU), ICU LOS, use of mechanical ventilation, 30-day readmission, discharge disposition and a composite variable of post-operative complications. Results Overall, 16,068 hip fractures were observed in 2019 compared to 7,498 in 2020. Hip fracture patients in 2020 (compared to 2019), experienced earlier hospital discharge, were less likely to be admitted to ICU but more likely to be admitted to home. Among 83 hip fracture patients with concomitant COVID-19 diagnosis, we specifically observed more non-surgical treatments, almost doubled LOS, a more than 10-fold increased mortality rate, and higher complication rates, compared with COVID-19 negative patients. Conclusion The COVID-19 pandemic significantly impacted not only volume of hip fractures but also patterns in care and outcomes. These results may inform policymakers in future outbreaks and how this may affect vulnerable patient populations such as those experiencing a hip fracture.