Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

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Khatri, C, Ward, AE, Nepogodiev, D, Ahmed, I, Chaudhry, D, Dhaif, F, Bankhad-Kendall, B, Kaafarani, H, Bretherton, C, Mahmood, A et al (show 1625 more authors) , Marais, L, Parsons, N, Bhangu, A, Metcalfe, A, Parsons, N, Khatri, C, Siaw-Acheampong, K, Chaudhry, D, Dawson, BE, Evans, JP, Glasbey, JC, Gujjuri, RR, Heritage, E, Jones, CS, Kamarajah, SK, Khatri, C, Keatley, JM, Lawday, S, Li, E, Mckay, SC, Nepogodiev, D, Pellino, G, Tiwari, A, Simoes, JFF, Trout, IM, Venn, ML, Wilkin, RJW, Bhangu, A, Ademuyiwa, AO, Agarwal, A, Al Ameer, E, Alderson, D, Alser, O, Arnaud, AP, Augestad, KM, Bankhead-Kendall, B, Benson, RA, Chakrabortee, S, Blanco-Colino, R, Brar, A, Bravo, A Minaya, Breen, KA, Buarque, I Lima, Caruana, E, Cunha, MF, Davidson, GH, Desai, A, Di Saverio, S, Edwards, J, Elhadi, M, Farik, S, Fiore, M, Fitzgerald, JE, Ford, S, Gallo, G, Ghosh, D, Gomes, GMA, Griffiths, E, Halkias, C, Harrison, EM, Hutchinson, P, Isik, A, Kaafarani, H, Kolias, A, Lawani, I, Lederhuber, H, Leventoglu, S, Loffler, MW, Martin, J, Mashbari, H, Mazingi, D, Mohan, H, Moore, R, Moszkowicz, D, Ng-Kamstra, JS, Metallidis, S, Moug, S, Niquen, M, Ntirenganya, F, Outani, O, Pata, F, Pinkney, TD, Pockney, P, Radenkovic, D, Ramos-De la Medina, A, Roberts, K, Santos, I, Schache, A ORCID: 0000-0001-9466-6038, Schnitzbauer, A, Stewart, GD, Shaw, R ORCID: 0000-0002-5157-4042, Shu, S, Soreide, K, Spinelli, A, Sundar, S, Tabiri, S, Townend, P, Tsoulfas, G, van Ramshorst, G, Vidya, R, Vimalachandran, D, Wright, N, Simoes, JFF, Mak, JKC, Kulkarni, R, Sharma, N, Nankivell, P, Tirotta, F, Parente, A, Breik, O, Kisiel, A, Cato, LD, Saeed, S, Bhangu, A, Griffiths, E, Pathanki, AM, Ford, S, Desai, A, Almond, M, Kamal, M, Chebaro, A, Lecolle, K, Truant, S, El Amrani, M, Zerbib, P, Pruvot, FR, Mathieu, D, Surmei, E, Mattei, L, Marin, H, Dudek, J, Singhal, T, El-Hasani, S, Nehra, D, Walters, A, Cuschieri, J, Davidson, GH, Ho, M, Wade, RG, Johnstone, J, Bourke, G, Brunelli, A, Elkadi, H, Otify, M ORCID: 0000-0002-7884-8680, Pompili, C, Burke, JR, Bagouri, E, Chowdhury, M, Abual-Rub, Z, Kaufmann, A, Munot, S, Lo, T, Young, A, Kowal, M, Wall, J, Peckham-Cooper, A, Winter, SC, Belcher, E, Stavroulias, D, Di Chiara, F, Wallwork, K, Qureishi, A, Lami, M, Sravanam, S, Mastoridis, S, Shah, K, Chidambaram, S, Smillie, R, Shaw, AV, Bandyopadhyay, S, Cernei, C, Bretherton, C, Jeyaretna, D, Ganau, M, Piper, RJ, Duck, E, Brown, S, Jelley, C, Tucker, SC, Bond-Smith, G, Griffin, XL, Tebala, GD, Neal, N, Vatish, M, Noton, TM, Ghattaura, H, Maher, M, Fu, H, Risk, OBF, Majd, Soleymani H, Sinha, S, Shankar, S, Aggarwal, A, Kharkar, H, Lakhoo, K, Verberne, C, Mastoridis, S, Senent-Boza, A, Sanchez-Arteaga, A, Benitez-Linero, I, Manresa-Manresa, F, Tallon-Aguilar, L, Melero-Cortes, L, Fernandez-Marin, MR, Duran-Munoz-Cruzado, VM, Ramallo-Solis, I, Beltran-Miranda, P, Pareja-Ciuro, F, Anton-Eguia, BT, Dawson, AC, Drane, A, Oliva Mompean, F, Gomez-Rosado, J, Reguera-Rosal, J, Valdes-Hernandez, J, 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Anania, G, Urbani, A, Radica, Koleva M, Carcoforo, P, Portinari, M, Sibilla, M, Archer, JE, Odeh, A, Siddaiah, N, Baumber, R, Parry, J, Carmichael, H, Velopulos, CG, Wright, FL, Urban, S, McIntyre, Jr RC, Schroeppel, TJ, Hennessy, EA, Dunn, J, Zier, L, Parmar, C, Mccluney, S, Shah, S, Munoz Vives, JM, Osorio, A, Gomez Diaz, CJ, Guariglia, CA, Soto Montesinos, C, Sanchon, L, Xicola Martinez, M, Guardia, N, Collera, P, Diaz Del Gobbo, R, Sanchez Jimenez, R, Farre Font, R, Flores Clotet, R, Brathwaite, CEM, Liu, H, Petrone, P, Hakmi, H, Sohail, AH, Baltazar, G, Heckburn, R, Aujayeb, A, Townshend, D, McLarty, N, Shenfine, A, Jackson, K, Johnson, C, Madhvani, K, Hampton, M, Hormis, AP, Young, R, Miu, V, Sheridan, K, MacDonald, L, Green, S, Onos, L, Dean, B, Luney, C, Myatt, R, Williams, MA, McVeigh, J, Alqallaf, A, Ben-Sassi, A, Mohamed, I, Mellor, K, Joshi, P, Joshi, Y, Crichton, R, Sonksen, J, Aldridge, K, Layton, GR, Karki, B, Jeong, H, Pankhania, S, Asher, S, Folorunso, A, Mistry, S, 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S, Kaushal, M, Kler, A, Reghuram, V, Tezas, S, Oktseloglou, V, Mosley, F, Monroy, De La Cruz MFI, Bobak, P, Omar, I, Ahad, S, Langlands, F, Brown, V, Hashem, M, Williams, A, Ridgway, A, Pournaras, D, Britton, E, Lostis, E, Ambler, GK, Chu, H, Hopkins, J, Manara, J, Chan, M, Doe, M, Moon, RDC, Lawday, S, Jichi, T, Singleton, W, Mannion, R, Stewart, GD, Ramzi, J, Mohan, M, Singh, AA, Ashcroft, J, Baker, OJ, Coughlin, P, Davies, RJ, Durst, AZED, Abood, A, Habeeb, A, Hudson, VE, Kolias, A, Lamb, B, Luke, L, Mitrasinovic, S, Murphy, S, Ngu, AWT, O'Neill, JR, Waseem, S, Wong, K, Georgiades, F, Hutchinson, PJ, Tan, XS, Pushpa-rajah, J, Colquhoun, A, Masterson, L, Abu-Nayla, I, Walker, C, Balakrishnan, A, Rooney, S, Irune, E, Byrne, MHV, Durrani, A, Richards, T, Venkatesan, Sethuraman A, Combellack, T, Williams, J, Tahhan, G, Mohammed, M, Kornaszewska, M, Valtzoglou, V, Deglurkar, I, Rahman, M, Von Oppell, U, Mehta, D, Koutentakis, M, Chek, Syed Nong SAH, Hill, G, Morris, C, Shinkwin, M, Torkington, J, Cornish, J, Houston, R, Mannan, S, Ayeni, F, Tustin, H, Bordenave, M, Robson, A, Vimalachandran, D ORCID: 0000-0001-5817-8969, Manu, N, Eardley, N, Krishnan, E, Serevina, OL, Martin, E, Smith, C, Jones, A, Mahapatra, Roy S, Clifford, R, Matthews, W, Mohankumar, K, Khawaja, I, Palepa, A, Doulias, T, Premakumar, Y, Jauhari, Y, Koshnow, Z, Bowen, D, Uberai, A, Hirri, F, Stubbs, BM, McDonald, C, Manickavasagam, J, Ragupathy, K, Davison, S, Dalgleish, S, McGrath, N, Kanitkar, R, Payne, CJ, Ramsay, L, Ng, CE, Collier, T, Khan, K, Evans, R, Brennan, C, Henshall, DE, Drake, T, Harrison, EM, Zamvar, V, Tambyraja, A, Skipworth, RJE, Linder, G, McGregor, R, Brennan, P, Mayes, J, Ross, L, Smith, S, White, T, Jamjoom, AAB, Pasricha, R, Holme, T, Abbott, S, Razik, A, Thrumurthy, S, Steinke, J, Baker, M, Howden, D, Baxter, Z, Osagie, L, Bence, M, Fowler, GE, Massey, L, Rajaretnam, N, Evans, J, John, J, Goubran, A, Campain, N, McDermott, FD, McGrath, JS, Ng, M, Pascoe, J, Phillips, JRA, 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Lourenco, S, Balau, P, Godinho, M, Pereira, A, Keller, Deborah S and Smart, Neil J (2021) Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study. BMJ OPEN, 11 (11). e050830-.

Text Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures an international cohort study.pdf - Published version Download (528kB) | Preview

Abstract

<h4>Objectives</h4>Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.<h4>Setting</h4>Prospective, international, multicentre, observational cohort study.<h4>Participants</h4>Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).<h4>Primary outcome</h4>30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.<h4>Results</h4>This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).<h4>Conclusions</h4>Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.<h4>Trial registration number</h4>NCT04323644.

Item Type:	Article
Uncontrolled Keywords:	COVID-19, hip, trauma management
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Clinical Directorate Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User:	Symplectic Admin
Date Deposited:	10 Jan 2022 15:39
Last Modified:	18 Jan 2023 21:18
DOI:	10.1136/bmjopen-2021-050830
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3146135