Lai YH*, Fang S, Amor D, Rosenblatt MA, Okorozo A, Parekh RM
Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai West and Morningside Hospitals,
Study Objective: To assess the impact of the initial COVID-19 surge on preoperative optimization, anesthetic and surgical selection, and perioperative outcomes in patients undergoing urgent repair of hip fractures. Design: Retrospective cohort study. Setting: Two academic hospitals in New York City. Patients: Fifty-five current (2020) and 51 historical control (2019) hip fracture patients. Interventions: Patients diagnosed with hip fracture presenting from March 16th, 2020 to June 7th, 2020 and from the exact time period in 2019 were reviewed. The 2020 cohort were further stratified into COVID-positive and COVID-negative groups. Measurements: Demographic variables, preoperative optimization time (from fracture diagnosis to operating room arrival), number and type of perioperative consult services obtained, intraoperative surgery and anesthesia variables, hospital quality measures, and 30-day mortality. Main Results: Optimization time was shorter for the 2020 cohort compared to 2019 cohort (31.03 [22.48 to 44.18] h vs. 50.87 [28.92 to 66.47] h). More patients in 2020 cohort received subspecialty consults, including cardiology (29.09% vs. 9.80%), pulmonary/critical care (14.55% vs. 0%), infectious disease (14.55% vs. 0%) and palliative care (25.45% vs. 3.92%). The 2020 COVID positive cohort had an increased inpatient (25% vs. 0%) and 30-day (25% vs. 2.33%) mortality. Conclusion: Hip fracture patients with COVID-19 infections were associated with a higher risk for mortality and complications. Despite limitations in resources and a greater disease burden in 2020, timely optimization and access to surgery with a multi-disciplinary team was exemplified. Perioperative outcomes and hospital quality measures were comparable between the 2019 and 2020 surgical cohorts.
COVID-19 Pandemic; Hip fracture; Trauma anesthesia; Preoperative optimization; Perioperative outcomes
Lai YH, Fang S, Amor D, Rosenblatt MA, Okorozo A, Parekh RM. Impact of COVID-19 Pandemic on Preoperative Optimization, Surgical Selection, and Complications in Patients with Hip Fracture. Ann Clin Anesth Res. 2023; 7(1): 1047..