The aim was to determine the influence of COVID-19 on 30-day mortality in hip fracture. Secondary aims were to examine: (1) predictors of COVID-19 on presentation and later in the admission; (2) rate of hospital-acquired COVID-19; (3) predictive value of negative swabs on admission. A nationwide multicentre retrospective cohort study of all patients with hip fracture in all 17 Scottish hospitals in March-April. Demographics, blood results, COVID-19 status, Nottingham Hip Fracture Score (NHFS), management, length of stay (LOS), and 30-day mortality were recorded. 78/833 (9.4%) patients had COVID-19 (65 swab-proven). 30-day survival with COVID-19 was lower than without (65.4% vs 91%; p<0.001). COVID-19 within 7 days of admission (likely community-acquired) was independently associated with male sex (OR 2.34, p=0.040, CI 1.04–5.25) and COVID-19 symptoms (OR 15.56, CI 6.61–36.60, p<0.001). COVID-19 within 7–30 days (probable hospital-acquired) was independently associated with male sex (OR 1.73, CI 1.05–2.87, p=0.032), NHFS □7 (OR 1.91, CI 1.09–3.34, p=0.024), pulmonary disease (OR 1.68, CI 1.00–2.81, p=0.049), ASA □3 (OR 2.37, CI 1.13–4.97, p=0.022) and LOS □9 days (OR 1.98, CI 1.18–3.31, p=0.009). 38/65 (58.5%) of COVID-19 cases were probably hospital-acquired. The false negative rate of swabs on admission was 0% in asymptomatic and 2.9% in symptomatic patients. COVID-19 was associated with a threefold-increased 30-day mortality. Nosocomial transmission may have accounted for half of all cases. Identification of risk factors for having COVID-19 on admission, or acquiring COVID-19 later, may guide patient pathways. LOS was the only modifiable risk factor, emphasising the importance of high-quality, timely care.
The primary aim was to assess patient-reported outcomes following a humeral diaphyseal fracture. The secondary aim was to compare the outcomes of patients who achieved union after initial management (operative or non-operative) with those that achieved union after nonunion surgery. From 2008–2017, 291 patients (mean age 55yrs [17–86], 58% [n=168/291] female) were retrospectively identified and available to complete a survey. Sixty-four (22%) were managed with primary surgery and 227 (78%) non-operatively. Outcomes (QuickDASH, EQ-5D, EQ-VAS, SF-12) were obtained at a mean of 5.5yrs (1.2–11.0). After initial management, 229 patients (79%) united (n=62 operative, n=167 non-operative) and 62 (21%) developed a nonunion (n=2 operative, n=60 non-operative; p<0.001). Fifty-two of 56 patients (93%) achieved union after nonunion surgery. The overall mean QuickDASH was 20.8, EQ-5D 0.730, EQ-VAS 74, SF-12 PCS 44.8 and MCS 50.2. Patients who united after nonunion surgery reported a worse functional outcome (mean QuickDASH 27.9 vs. 17.6, p=0.003) and health-related quality of life (HRQoL; mean EQ-5D 0.639 vs. 0.766, p=0.008; EQ-VAS 66 vs. 76, p=0.036; SF-12 PCS 41.8 vs. 46.1, p=0.036) than those who united primarily. When adjusting for confounders, union after nonunion surgery was independently associated with poorer function (difference in QuickDASH 8.1, p=0.019) and HRQoL (difference in EQ-5D -0.102, p=0.028). Humeral diaphyseal union after nonunion surgery was associated with poorer function and HRQoL compared to patients who united primarily. Targeting early operative intervention to patients at risk of nonunion may have an important role, given the potential impact of nonunion on longer-term outcome.
There is conflicting evidence about the functional
outcome and rate of satisfaction of super-elderly patients (≥ 80 years
of age) after carpal tunnel decompression. We compiled outcome data for 756 patients who underwent a carpal
tunnel decompression over an eight-year study period, 97 of whom
were super-elderly, and 659 patients who formed a younger control
group (<
80 years old). There was no significant difference between
the super-elderly patients and the younger control group in terms
of functional outcome according to the mean (0 to 100) QuickDASH
score (adjusted mean difference at one year 1.8; 95% confidence
interval (CI) -3.4 to 7.0) and satisfaction rate (odds ratio (OR)
0.78; 95% CI 0.34 to 1.58). Super-elderly patients were, however,
more likely to have thenar muscle atrophy at presentation (OR 9.2,
95% CI 5.8 to 14.6). When nerve conduction studies were obtained,
super-elderly patients were more likely to have a severe conduction deficit
(OR 12.4, 95% CI 3.0 to 51.3). Super-elderly patients report functional outcome and satisfaction
rates equal to those of their younger counterparts. They are more
likely to have thenar muscle atrophy and a severe nerve conduction
deficit at presentation, and may therefore warrant earlier decompression. Cite this article:
