Is it really advantageous to operate proximal femoral fractures within 48 h from diagnosis? – A multicentric retrospective study exploiting COVID pandemic-related delays in time to surgery
Authors: Giacomo Placella , Bettinelli Giulia , Alberto Iacomella , Damiano Salvato , Alberto Belluati , Georgoulis Jim , Zafeiris Ioannis , Roustemis Anastasios , Trikoupis Ioannis , Kontogeorgakos Vasileios , Antonio Bove , Orabona Nicola , Raffaele Pepe , Adolfo Cuomo , Roberto Maddalena , Vincenzo Caiaffa , Francesco Ippolito , Giovanni Palmisciano , Salvatore Morello , Florio Enrico Francesco , Giovanni Colleluori , Stefano Landi , Daniele Stomeo , Rodrigues-Pinto Ricardo , Amorim-Barbosa Tiago , Diniz Sara E. , Neves Nuno , Silva Miguel Relvas , Lopes Jorge , Milan Krticka , Ira Daniel , Martin Petráš , Ryba Luděk , Vyskočil Robert , Pařízek Dominik , Roselli Mauro , Montanari Giuseppina , Giuseppe Malerba , Mattia Basilico , Nadia Bonfiglio , Giulio Maccauro , Luengo Gonzalo , Gabardo Santiago , Crespo Calvo Emilio , Garcia-Coiradas J. , Baño-Barragan L. , Sanchez-Saz J. , Valle-Cruz J. , Omiste Irene , Anglès Francesc , Castillón Pablo , Uriarte Iker , Jimenez Iñigo , Urra Ioar , Nuñez Jorge H. , Lakhani Kushal , Minguell-Monyart Joan , Jordi Teixidor-Serra , Yaiza Garcia-Sanchez , Rafael Oleo-Taltavull , Kanakaris Nikolaos , Ikechukwu Ejiofor , Parkes Jasmine , Villani Ciro , Mario Cecchini Enrico , Giuseppe Rinonapoli , Carmelinda Ruggiero , Lorenzo Monacchini , Pietro Gregori , Simone Cerbasi , Carola Donato , Raffaele Pascarella , Vincenzo Salini 
Published: May 2022

Objectives:
Hip fractures in the elderly are common injuries that need timely surgical management. Since the beginning of the pandemic, patients with a proximal femoral fracture (PFF) experienced a delay in time to surgery. The primary aim of this study was to evaluate a possible variation in mortality in patients with PFF when comparing COVID-19 negative versus positive.

Methods:
This is a multicentric and retrospective study including 3232 patients with PFF who underwent surgical management. The variables taken into account were age, gender, the time elapsed between arrival at the emergency room and intervention, pre-operative American Society of Anesthesiology score, pre-operative cardiovascular and respiratory disease, and 10-day/1-month/6-month mortality. For 2020, we had an additional column, “COVID-19 swab positivity.”

Results:
COVID-19 infection represents an independent mortality risk factor in patients with PFFs. Despite the delay in time-to-surgery occurring in 2020, no statistically significant variation in terms of mortality was detected. Within our sample, a statistically significant difference was not detected in terms of mortality at 6 months, in patients operated within and beyond 48 h, as well as no difference between those operated within or after 12/24/72 h. The mortality rate among subjects with PFF who tested positive for COVID-19 was statistically significantly higher than in patients with PFF who tested. COVID-19 positivity resulted in an independent factor for mortality after PFF.

Conclusion:
Despite the most recent literature recommending operating PFF patients as soon as possible, no significant difference in mortality was found among patients operated before or after 48 h from diagnosis.