IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit

• Published in: The surgeon (Edinburgh) Vol. 20; no. 6; pp. e429 - e446
• Main Authors: Hall, Andrew J., Adam, Karen, Aguado Hernández, Héctor J., Améstica Lazcano, Gedeón, Aragón Achig, Esteban Javier, Ashford–Wilson, Sarah, Baird, Stuart, Bajada, Stefan, Ballantyne, James A., Barkham, Benjamin, Baskaran, Dinnish, Bell, Jean, Benchimol, Javier Alberto, Brooke, Ben, Burns, Shirley, Caruana, Ethan, Cassinello Ogea, M.a Concepción, Castillon, Pablo, Chakrabarti, Anil, Clarke, Jon V., Corsi, Maurizio, Cuarental-García, Javier, Cuthbert, Rory, Daskalakis, Ioannis, Donoso Coppa, Juan Pablo, Duffy, Andrew, Escobar Sánchez, Daniel, Faimali, Martina, Fenner, Christopher, Finlayson, Louise, Freeman, Nicholas, Gagliardo, Nicola, García Cruz, Guillermo, García de Cortázar Antolín, Unai, García Virto, Virginia, Gealy, Sophie, Gil Caballero, Sandra Marcela, Gopireddy, Rajesh, Gurung, Binay, Guzmán Rosales, Guadalupe, Haddad, Nedaa, Hafeez, Mahum, Halligan, Emer, Herreros Ruiz-Valdepeñas, Ruben, Howieson, Alan, Hurtado Ortega, Ana, Hamid, Hytham K.S., Jenkins, Paul J., Johnston, Andrew, Joseph, Sarah, Karanam, Krishna Saga, Konarski, Alastair, Labrador Hernández, Gregorio, Landi, Giovanni, Liew, Ignatius, Logishetty, Kartik, Lopez, Judit, Madan, Suvira, Malik-Tabassum, Khalid, Mallina, Ravi, Martin Legorburo, M. José, Martínez Jiménez, Tania, Martinez Martin, Javier, Mayne, Alistair, McAlinden, Gavan, McDonald, Lorna, McIntyre, Joshua, Medici, Antonio, Mendez, Mijail, Merino Perez, Josu, Nair, Radhika, Nunag, Perrico, Ortés Gómez, Raquel, Page, Siobhan, Panagiotopoulos, Andreas, Papadopoulos, Antonios, Spyridon, Papagiannis, Park, Chang, Pellegrino, Achille, Phadnis, Ashish, Prieto Martín, Rocío, Probert, Annabel, Renton, Duncan, Rickman, Stephen, Robertson, Alastair, Sarraf, Khaled M., Scott, Chloe E.H., Sharaf, Sharief, Shirley, Denise, Sugand, Kapil, Symes, Michael, Tancredi, Francesco, Thomas, Philip, Tosounidis, Theodoros, Tucker, Damien, Vemulapalli, Krishna, Wickramanayake, Udara, Zatti, Giovanni, Zeiton, Moez, White, Tim O.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.12.2022
• Subjects: Audit; Communicable disease; COVID-19; Frailty; Geriatric; Hip fracture; Infection; Meta-audit; Nosocomial; Orthopaedic; Outcomes; Prognosis; Reporting standards; Risk; Trauma; Meta-audit; Prognosis; Risk; Communicable disease; Trauma; Outcomes; COVID-19; Infection; Audit; Hip fracture; Geriatric; Reporting standards; Nosocomial; Frailty; Orthopaedic
• ISSN: 1479-666X; 2405-5840
• DOI: 10.1016/j.surge.2022.02.009

This international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients. A multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1st March-31st May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded. A total of 7090 patients were included, with a mean age of 82.2 (range 50–104) years and 4959 (69.9%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) were positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p = 0.001), residential care (OR 2.15, p < 0.001), inpatient fall (OR 2.23, p = 0.003), cancer (OR 0.63, p = 0.009), ASA grades 4 (OR 1.59, p = 0.008) or 5 (OR 8.28, p < 0.001), and longer admission (OR 1.06 for each increasing day, p < 0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p < 0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p < 0.001). Increasing age (HR 1.03, p = 0.028), male sex (HR 2.35, p < 0.001), renal disease (HR 1.53, p = 0.017), and pulmonary disease (HR 1.45, p = 0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders. The prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality risk. Among COVID-19-positive patients, those who were older, male, with renal or pulmonary disease had a significantly higher 30-day mortality risk. •IMPACT-Global is the largest multicentre observational study undertaken solely in T&O•Prevalence of COVID-19 in hip fracture patients was ten times higher than background•COVID-19 was independently associated with a 3x increased 30-day mortality risk•Nosocomial transmission likely had significant role in COVID-19 prevalence & mortality•Lessons applicable to audit and practice in future communicable disease outbreaks