COVID-19 is associated with increased care needs and a decreased likelihood of returning home following a hip fracture: the IMPACT Frailty Study

A. J. Hall, Nick D Clement, RS Kay, Rose Penfold, Alasdair M J MacLullich, T.O. White, Andrew Duckworth

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Abstract / Description of output

ABSTRACT
Purpose
The 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.

Methods
This 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 were 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 01/03/20-30/11/20 and 01/02/21-30/11/21 were considered pre-/post-vaccine periods.

Results
Median age was 83.0 years, 155/209 (74.2%) were female and median follow-up was 479 days (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 to 44.33, p
Conclusions
Hip 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.
Original languageEnglish
JournalMusculoskeletal Care
DOIs
Publication statusPublished - 11 Mar 2023

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