Podium (General) 14

Fragility Hip Fracture Management during the COVID-19 Pandemic: A Multi-Center Experience from a Country with an Emerging Economy

Tabu IA1, Alpuerto BB1, Araneta KS1, Delgado GD1

Introduction: Acute multidisciplinary management of elderly fragility hip fractures significantly decreases morbidity and mortality rates. However, there is little data from a developing country perspective where underlying healthcare delays and inequitable access are exacerbated by the COVID-19 pandemic. This is the first study to report on the characteristics, management, and early outcomes of fragility hip fracture patients admitted during the COVID-19 lockdown in the Philippines.

Methods: A multicenter prospective cohort study was conducted involving 12 hospitals from June 16, 2020 to April 30, 2021. Patient clinical characteristics, laboratory results, treatments, and 30-day outcomes were collected. Factors associated with early mortality were analyzed.

Results: A total of 158 elderly patients with fragility hip fractures were included. Median age was 77 years old. The median time of injury-to-admission was at least 3 (IQR: 1.0 – 13.7) days with delays mainly due to fear of COVID-19 exposure. Eighty percent (80%) of patients underwent surgery with a delayed median time from admission-to-surgery of at least 5 (IQR: 2.5 – 13.6) days mostly due to protracted cardio-pulmonary clearance. The 30-day mortality and morbidity rate was 3.7%. All 5 patients who expired were female, had at least an ASA grade of III, had elevated neutrophils and died within 5 days of admission to the hospital without surgery. Four out of 5 of them were COVID-19 confirmed cases or suspects. Factors significantly associated with early mortality were poor pre-fracture mobility, COVID-19 infection, an abnormal chest radiograph, and conservative treatment.

Conclusion: Despite treatment delays being common, short-term outcomes remain favorable for non-COVID patients with acute fragility fractures treated with surgery compared to those managed conservatively. Given the positive correlation between conservative treatment and mortality, the benefit of surgery still outweighs the risks in physiologically stable COVID-19 positive patients.

Keywords: Hip fractures, Elderly fractures, Orthogeriatrics, Multidisciplinary fracture team, COVID-19 pandemic, Emerging country