Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2021; 12(10): 751-759
Published online Oct 18, 2021. doi: 10.5312/wjo.v12.i10.751
SARS-CoV-2 outbreak impact on a trauma unit
Sarah Mills, Aitor Ibarzábal-Gil, José M Martínez-Diez, Javier Pallarés-Sanmartín, Carlos Kalbakdij-Sánchez, Juan C Rubio-Suárez, Itsaso Losantos-García, E Carlos Rodríguez-Merchán
Sarah Mills, Aitor Ibarzábal-Gil, José M Martínez-Diez, Javier Pallarés-Sanmartín, Carlos Kalbakdij-Sánchez, Juan C Rubio-Suárez, E Carlos Rodríguez-Merchán, Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
Itsaso Losantos-García, Department of Biostatistics, La Paz University Hospital, Madrid 28046, Spain
E Carlos Rodríguez-Merchán, Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
Author contributions: Mills S was the author primarily responsible for the writing of the text; Rubio-Suárez JC and Rodríguez-Merchán EC assisted in the writing and editing of the text; the other authors provided critical expertise and input into the subject matter of the text.
Institutional review board statement: The study was approved by our Hospital’s Ethics Committee (La Paz University Hospital, Madrid, Spain).
Informed consent statement: All patients of this study signed an “informed consent” before surgery.
Conflict-of-interest statement: The authors have nothing to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: E Carlos Rodríguez-Merchán, MD, PhD, Doctor, Department of Orthopedic Surgery, La Paz University Hospital, Paseo de la Castellana, 261, Spain. ecrmerchan@hotmail.com
Received: March 24, 2021
Peer-review started: March 24, 2021
First decision: June 16, 2021
Revised: June 17, 2021
Accepted: August 18, 2021
Article in press: August 18, 2021
Published online: October 18, 2021
Processing time: 203 Days and 16.6 Hours
Abstract
BACKGROUND

From February 2020 onwards, our country has been hit by the coronavirus severe acute respiratory syndrome-2 (SARS-CoV-2) infection. At a glance, hospitals became overrun and had to reformulate all the assistance guidelines, focusing on the coronavirus disease 2019. One year after the start of the pandemic, we present the results of a morbimortality study.

AIM

To analyze how our department was affected by the outbreak in terms of morbimortality, and to analyze demographic data, admission to hospital-related data, and subgroups analyses for patients with hip fractures and polytrauma.

METHODS

We designed a study comparing data from patients who were admitted to our unit due to a lower limb fracture or a high energy trauma during the pandemic (from March to April 2020) to those admitted during the same period in 2019 before the pandemic. during the pandemic situation. Both cohorts completed a minimum of 6 mo of follow-up.

RESULTS

The number of patients admitted to hospital in 2020 was nearly half of those in 2019. Hip fractures in the elderly represented 52 out of 73 of the admitted patients. Twenty patients had a positive test result for SARS-CoV-2 infection. Patients with SARS-CoV-2 infection were admitted to the hospital for a longer time than the non-infected (P < 0.001), and had a higher mortality rate during hospitalization and follow-up (P = 0.02). Patients with a hip fracture associated with a severe respiratory syndrome were mostly selected for conservative treatment (P = 0.03).

CONCLUSION

Mortality and readmission rates were higher in the 2020 cohort and during follow-up, in comparison with the cohort in 2019.

Keywords: Trauma department; COVID-19 pandemic; SARS-CoV-2 outbreak; Hip fractures; Morbimortality; Polytraumatic patients

Core Tip: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection was not a criterion for choosing conservative treatment, unless those patients infected with the virus had a poor general condition that made surgery unadvisable. We did not find a relationship between the employment of anticoagulant therapy and the severity of coronavirus disease 2019 (COVID-19) infection or a different mortality rate. Patients who died during hospitalization due to COVID-19 had higher C-reactive protein levels (P < 0.001) and higher urea levels (P = 0.006). The mortality rate in 2020 was 13.7% during hospitalization; 19% during the first month after discharge, and 24.6% in the 3 mo after discharge. The mortality rate in the COVID-19 positive patient subgroup was 38.9% after 6 mo of follow-up. Non-operative treatment in hip fractures was related to SARS-CoV-2 infection (P = 0.03) and with AO 31.B fractures. Polytrauma patients and high energy fractures were more common in 2019 (24%) than in 2020 (11.5%). The main difference between both periods was the injury mechanism.