A comparative study of mortality rate in operated elderly patients of fracture neck of femur, within 90 days of surgery before and during COVID-19 pandemic in the Indian population

Abstract

Fracture neck of the femur is a significant cause of morbidity and mortality in the elderly and surgical interventions are the preferred treatment. The COVID-19 pandemic caused a reduction in operative cases and emphasized non-operative management. We studied the impact of the COVID-19 pandemic on post-operative 90 days mortality of hip fracture in the elderly Indian population. We, retro-prospectively compared data from our hospital over a two-year time frame on a large group. The first confirmed case in Maharashtra was reported on 9th March 2020 in Pune. The cases reported until one year from this date were termed ‘Covid period’ and cases one year before this date were termed ‘Pre-covid period’. After applying exclusion criteria to 638 patients from 2 years of data, 379 patients(208 in Pre-covid and 171 in Covid period) were included and analyzed for mortality rate and secondary outcomes.The pandemic caused a statistically significant increase in postoperative 90 days mortality in the elderly by 75.7% compared to pre-covid mortality. The decrease in incidence of operated fracture neck femur was non-significant during Covid compared to incidence in pre-covid. Pneumonia caused six times more mortality during Covid period.The COVID-19 pandemic caused a statistically significant increase in postoperative mortality. Pneumonia was the significant cause of death in Covid period and should be diagnosed and treated early. A specific subset of the consent process is a must in elderly neck femur fracture undergoing surgery and shared guidelines of this study will help in the decision-making process of future covid pandemic situations.