COVID‐19 is associated with increased care needs and a decreased likelihood of returning home following a hip fracture: The IMPACT frailty study

Abstract

AbstractPurposeThe primary aim was to evaluate the impact of COVID‐19 on frailty in patients surviving a hip fracture. Secondary aims were to assess impact of COVID‐19 on (i) length of stay (LoS) and post‐discharge care needs, (ii) readmissions, and (iii) likelihood of returning to own home.MethodsThis propensity score‐matched case‐control study was conducted in a single centre between 01/03/20–30/11/21. A ‘COVID‐positive’ group of 68 patients was matched to 141 ‘COVID‐negative’ patients. ‘Index’ and ‘current’ Clinical Frailty Scale (CFS) scores were assigned for frailty at admission and at follow‐up. Data were extracted from validated records and included: demographics, injury factors, COVID‐19 status, delirium status, discharge destination, and readmissions. For subgroup analysis controlling for vaccination availability, the periods 1 March 2020–30 November 2020 and 1 February 2021–30 November 2021 were considered pre‐/post‐vaccine periods.ResultsMedian age was 83.0 years, 155/209 (74.2%) were female and median follow‐up was 479 days (interquartile range [IQR] 311). There was an equivalent median increase in CFS in both groups (+1.00 [IQR 1.00–2.00, p = 0.472]). However, adjusted analysis demonstrated COVID‐19 was independently associated with a greater magnitude change (Beta coefficient [β] 0.27, 95% confidence interval [95% CI] 0.00–0.54, p = 0.05). COVID‐19 in the post‐vaccine availability period was associated with a smaller increase versus pre‐vaccine (β −0.64, 95% CI −1.20 to −0.09, p = 0.023). COVID‐19 was independently associated with increased acute LoS (β 4.40, 95% CI 0.22–8.58, p = 0.039), total LoS (β 32.87, 95% CI 21.42–44.33, p < 0.001), readmissions (β 0.71, 95% CI 0.04–1.38, p = 0.039), and a four‐fold increased likelihood of pre‐fracture home‐dwelling patients failing to return home (odds ratio 4.52, 95% CI 2.08–10.34, p < 0.001).ConclusionsHip fracture patients that survived a COVID‐19 infection had increased frailty, longer LoS, more readmissions, and higher care needs. The health and social care burden is likely to be higher than prior to the COVID‐19 pandemic. These findings should inform prognostication, discharge‐planning, and service design to meet the needs of these patients.