@article{1fda3c49497f49219145436a1c9a6e72,
title = "Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study",
abstract = "ObjectivesStudies 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.Setting Prospective, international, multicentre, observational cohort study.Participants 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).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results 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).Conclusions 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.",
keywords = "COVID-19, hip, trauma management",
author = "{COVIDSurg Collaborative} and A. Ward and I. Ahmed and A. Mahmood and N. Parsons and Dawson, {B. E.} and Evans, {J. P.} and Jones, {C. S.} and S. Lawday and E. Li and McKay, {S. C.} and A. Tiwari and D. Alderson and J. Edwards and S. Ford and G. Gallo and D. Ghosh and E. Griffiths and Harrison, {E. M.} and P. Hutchinson and J. Martin and R. Moore and K. Roberts and Stewart, {G. D.} and R. Shaw and S. Sundar and N. Wright and N. Sharma and P. Nankivell and E. Griffiths and S. Ford and M. Ho and Wade, {R. G.} and J. Johnstone and Burke, {J. R.} and M. Chowdhury and A. Young and Winter, {S. C.} and Shaw, {A. V.} and S. Brown and Tucker, {S. C.} and H. Fu and S. Sinha and Dawson, {A. C.} and A. Tang and C. Price and G. Williams and L. Smith and L. Elliott and G. McCabe and Z. Li and K. Parkins and Egan, {R. J.} and A. Henry and C. Gill and S. Robertson and C. Sweeney and K. Dickson and Jones, {R. P.} and K. Shahzad and Hughes, {J. L.} and S. Shah and Coleman, {N. L.} and A. Phillips and Ng, {J. C.K.} and M. Hassan and S. Williams and A. Bateman and K. Patel and S. Shaw and J. Sagar and Chan, {C. H.} and A. Mokhtari and B. Main and C. Newton and Blencowe, {N. S.} and Fudulu, {D. P.} and M. Baquedano and M. Caputo and F. Rapetto and A. Hassan and J. Edwards and A. Ward and C. Blundell and S. Brown and T. Newman and M. Lee and Balasubramanian, {S. P.} and D. Simpson and {Rodriguez Fernandez}, {M. I.} and S. Shaikh and Rashid, {M. M.} and K. Milne and A. Turnbull and A. Brunt and Stewart, {K. E.} and Wilson, {M. S.J.} and Brown, {B. C.} and A. Khan and P. Asaad and M. Thomas and K. George and A. Radhakrishnan and Hasan, {M. T.} and J. Shah and K. Bevan and Ong, {C. S.} and S. Bhasin and Archer, {J. E.} and J. Parry and H. Carmichael and Wright, {F. L.} and J. Dunn and S. Shah and H. Liu and K. Jackson and C. Johnson and R. Young and S. Green and B. Dean and Williams, {M. A.} and I. Mohamed and R. Crichton and S. Mistry and B. Singh and Babu, {B. H.B.} and S. Newman and C. Anderson and L. Foster and A. James and G. Salerno and S. Page and King, {S. D.} and J. Luck and M. Patel and {De Vries}, {J. P.P.M.} and J. Gonzalez and A. Singh and P. Gallagher and Lewis, {S. E.} and R. Exley and U. Khan and O. Brown and S. Higgs and R. Preece and G. Dovell and Shah, {H. B.} and A. Taylor and E. Davies and S. Rogers and I. Sharma and J. Dunning and J. Dixon and Hadfield, {J. N.} and B. Smith and J. Reid and D. Watts and Gill, {D. F.} and M. Alotaibi and G. Ruiz and M. Allen and J. Martin and D. Cheng and H. Yang and Wood, {M. L.} and H. Smith and Lacy, {A. M.} and {Mart{\'i}nez P{\'e}rez}, C. and Baldwin, {A. J.} and R. West and A. Catton and J. Singh and P. Patel and M. Kaushal and A. Williams and A. Ridgway and E. Britton and Ambler, {G. K.} and H. Chu and J. Hopkins and M. Chan and M. Doe and S. Lawday and W. Singleton and Stewart, {G. D.} and A. Singh and Baker, {O. J.} and Davies, {R. J.} and S. Murphy and O'Neill, {J. R.} and K. Wong and P. Hutchinson and C. Walker and S. Rooney and Byrne, {M. H.V.} and T. Richards and J. Williams and M. Mohammed and M. Rahman and D. Mehta and G. Hill and C. Morris and J. Cornish and A. Robson and E. Martin and C. Smith and A. Jones and R. Clifford and W. Matthews and D. Bowen and C. McDonald and S. Davison and N. McGrath and Payne, {C. J.} and Ng, {C. E.} and K. Khan and R. Evans and C. Brennan and Harrison, {E. M.} and P. Brennan and S. Smith and T. White and S. Abbott and Fowler, {G. E.} and N. Rajaretnam and J. Evans and McGrath, {J. S.} and M. Ng and Phillips, {J. R.A.} and B. Davidson and C. Hart and J. Knowles and E. Ross and A. Wilkins and H. Cao and T. Chase and K. Williams and O. Brown and C. Tan and X. Luo and C. Park and M. Ibrahim and G. Martin and A. Sahni and Taylor, {F. G.} and J. Reynolds and Alexander, {M. E.} and Smart, {C. J.} and D. Jones and A. Fell and A. Smith and J. Evans and M. Rogers and I. Mohamed and R. Woods and H. Zahid and K. Jackson and C. Johnson and D. Ford and J. Khan and Y. Ahmad and C. Bellis and M. Ismail and A. Witek and S. Singh and S. Mukherjee and D. Ferguson and C. Smith and R. Singh and J. Lane and S. Williams and J. Byrne and A. Khan and D. Johnson and I. Hughes and J. Hall and J. Rooney and Y. Zhang and R. Owen and J. Hunt and M. Thomas and M. Ali and M. Kitchen and M. Jarvis and S. Ali and M. Kitchen and C. Kang and Watson, {L. J.} and G. Harris and G. James and J. Carter and S. Reid and A. Denning and R. Das and S. Powell and I. Flindall and A. Hanson and A. Hill and T. Farrell and Davis, {N. F.} and M. Costa and A. Oliveira and Manso, {M. I.} and P. Miranda and J. Clark and A. Brown and C. Chung and S. Ross and K. Thompson and D. Manning and R. Perkins and Oh, {J. S.} and S. Horvath and Martin, {R. C.G.} and B. Kim and C. Jones and H. Jackson and J. Lambert and Jones, {G. P.} and A. Gardner and Tripathi, {S. S.} and Greenhalgh, {M. S.} and H. Emerson and A. Fisher and C. Barry and Jones, {G. P.} and F. Chen and J. Cheung and Chan, {C. D.} and K. Booth and T. Grainger and A. Rogers and T. Williams and S. Bhattacharya and C. Mellor and J. Hammond and A. Phillips and Rogers, {L. J.} and D. Miller and B. Ho and C. Perkins and R. Campbell and Webb, {J. I.} and J. Noel and A. Pereira and Smart, {Neil J.}",
note = "Publisher Copyright: {\textcopyright} 2021 Author(s). Published by BMJ.",
year = "2021",
month = nov,
day = "30",
doi = "10.1136/bmjopen-2021-050830",
language = "English",
volume = "11",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "11",
}