Are Hospitals Safe? A Prospective Study on SARS-CoV-2 Prevalence and Outcome on Surgical Fracture Patients. A Closer Look at Hip Fracture Patients.

OBJECTIVES: To describe clinical characteristics of fracture patients, including a closer look to hip fracture patients, and determine how epidemiological variables may have influenced on a higher vulnerability to SARS-CoV-2 infection, as the basis for the considerations needed to reintroduce elective surgery during the pandemic. DESIGN: Longitudinal prospective cohort study. SETTING: Level I Trauma Center in the East of Spain. PATIENTS/PARTICIPANTS: 144 consecutive fracture patients 18 years or older admitted for surgery. INTERVENTION: Patients were tested for SARS-CoV-2 with either molecular and/or serological techniques and screened for presentation of COVID-19. MAIN OUTCOME MEASUREMENTS: Patients were interviewed and charts reviewed for demographic, epidemiological, clinical and surgical characteristics. RESULTS: We interviewed all patients and tested 137 (95.7%) of them. Three positive patients for SARS-CoV-2 were identified (2.1%). One was asymptomatic and the other two required admission due to COVID-19 related symptoms. Mortality for the whole cohort was 13 patients (9%). Significant association was found between infection by SARS-CoV-2 and epidemiological variables including: intimate exposure to respiratory symptomatic patients (p=0.025) and intimate exposure to SARS-CoV-2 positive patients (p=0.013). No association was found when crowding above 50 people was tested individually (p=0.187). When comparing the 2020 and 2019 hip fracture cohorts we found them to be similar, including 30-day mortality. A significant increase in surgical delay from 1.5 to 1.8 days was observed on the 2020 patients (p=0.034). CONCLUSIONS: Patients may be treated safely at hospitals if strict recommendations are followed. Both cohorts of hip fracture patients had similar 30-day mortality. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.