Table 1.
Clinical characteristics and outcomes in 10 patients with COVID-19 who underwent hip fracture surgery.
| Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | Case 6 | Case 7 | Case 8 | Case 9 | Case 10 | |
|---|---|---|---|---|---|---|---|---|---|---|
| Clinical characteristics | ||||||||||
| Age (years), sex | 83 F | 82 F | 90 F | 88 F | 73 M | 81 F | 80 F | 78 F | 75 F | 67 M |
| Comorbidities | Asthma, COPD, OSA, HTN, HLD, breast cancer, CVA, hypothyroidism, Sjogren's disease | HTN, HLD, IBS | HTN, CHF, DM | HTN, DM, pancreatic cancer, renal cancer, dementia | HLD, BPH, OCD | HTN, atrial fibrillation, hypothyroidism, hepatitis C, dementia | Cognitive disorder | HTN, TIA, hypothyroidism | HTN, CAD, DM | Asthma, kidney stones, BPH |
| Time to surgery (days) | 1 | 1 | 1 | 1 | 1 | 2 | 2 | 1 | 1 | 1 |
| Fracture type | 31A2.2 | 31B1.3 | 31A1.2 | 31A1.3 | 31A2.1 | 31A2.3 | 31A2.1 | 31B1.3 | 31A1.3 | 31B1.2 |
| Surgery performed | CMN | Hemi | CMN | CMN | CMN | CMN | CMN | THA | CMN | FNS |
| Type of anesthesia | General | Neuraxial | Neuraxial | General | Neuraxial | Neuraxial | General | Neuraxial | Neuraxial | General |
| Respiratory symptoms on admission | ||||||||||
| Fever | No | No | No | No | No | No | No | No | No | No |
| Chills | No | No | No | No | No | No | No | No | No | No |
| Cough | No | No | No | No | No | No | No | No | No | No |
| Sore throat | No | No | No | No | No | No | No | No | No | No |
| Dyspnea | No | No | No | No | No | No | No | No | No | No |
| Chest pain | No | No | No | No | No | No | No | No | No | No |
| Fatigue | No | No | No | No | No | No | No | No | No | No |
| SpO2 | 100% on RA | 94% on RA | 97% on RA | 89% on RA | 95% on RA | 97% on RA | 95% on RA | 98% on RA | 98% on RA | 98% on RA |
| Laboratory test values on admission | ||||||||||
| WBC (4.5–11.0 K/μL) | 7.7 | 9.5 | 8.7 | 12.0 | 8.4 | 8.5 | 19.5 | 17.7 | 17.0 | 13.1 |
| Hgb/Hct (13.9–16.3 g/dL)/(42–52%) | 11.5/35 | 14.4/43 | 13.0/39 | 10.5/30 | 7.7/23 | 15.3/46 | 12.3/35 | 12.7/39 | 10.5/32 | 12.9/38.5 |
| Platelets (150–450 K/μL) | 170 | 302 | 201 | 204 | 236 | 225 | 223 | 230 | 624 | 164 |
| Creatinine (0.7–1.3 mg/dL) | 0.50 | 0.87 | 0.98 | 0.64 | 1.51 | 0.58 | 0.70 | 0.56 | 1.54 | 1.03 |
| Sodium (135–145 mmol/L) | 138 | 139 | 129 | 136 | 135 | 136 | 136 | 130 | 128 | 139 |
| Potassium (3.5–5.2 mmol/L) | 3.3 | 5.7 | 4.7 | 3.6 | 4.8 | 4.4 | 4.0 | 4.1 | 4.5 | 3.9 |
| PT/INR (12.0–14.2 s)/(0.9–1.1) | 13.6/1.1 | 12.7/1.0 | 13.7/1.1 | 15.0/1.2 | 14.1/1.1 | 15.4/1.3 | 13.8/1.1 | 13.9/1.1 | 14.2/1.1 | 13.8/1.1 |
| PTT (24.6–34.7 s) | 23.2 | 24.5 | 27.3 | 29.8 | 29.2 | 25.6 | 30.0 | 32.4 | 26.5 | 28.8 |
| Inflammatory markers | ||||||||||
| Procalcitonin (<0.15 ng/mL) | 0.09 | 0.09 | – | 0.04 | 0.14 | 0.07 | 0.09 | – | 0.48 | – |
| C reactive protein (<5.1 mg/L) | 194.1 | 32.1 | – | 30.7 | 144.8 | 16.2 | 111.3 | – | – | – |
| D-dimer (<0.5 μg/mL) | 5.85 | 2.88 | – | 8.99 | 6.08 | 4.91 | 8.64 | – | – | – |
| Ferritin (15–150 ng/mL) | 223 | 1220 | – | 13 | 801 | 1893 | 350 | – | – | – |
| LDH (100–220 U/L) | 284 | 228 | – | 357 | 357 | 311 | 453 | – | – | – |
| Chest radiograph on admission | Unremarkable | Unremarkable | Unremarkable | Unremarkable | Multifocal/atypical pneumonia | Unremarkable | Unremarkable | Unremarkable | Unremarkable | Unremarkable |
| COVID-19 medical treatment | Yes (AZM, HCQ) | No | No | Yes (HCQ) | Yes (AZM, HCQ) | No | Yes (AZM, HCQ) | No | No | No |
| Postoperative outcomes | ||||||||||
| SpO2 on POD1 | 99% on RA | 98% on 2L NC | 99% on RA | 96% on 4L NC | 96% on 8L Venturi mask | 97% on RA | 98% on 4L NC | 98% on 2L NC | 95% on RA | 97% on RA |
| SpO2 on POD2 | 98% on RA | 95% on RA | 97% on RA | 94% on 2L NC | 97% on 4L NC | 94% on RA | 94% on 2L NC | 95% on RA | 98% on RA | 98% on RA |
| SpO2 on POD3 | 93% on RA | 99% on RA | 96% on RA | 98% on RA | 96% on 6L NC | ---(discharged on POD2) | 90% on 2L NC | 96% on RA | 96% on RA | 97% on RA |
| Blood transfusion | Yes | No | No | Yes | Yes | No | No | Yes | No | No |
| VTE | Yes | No | No | No | No | No | No | No | No | No |
| Cardiac complication | No | No | No | No | No | No | No | No | No | No |
| Respiratory complication | Yes (respiratory failure) | No | No | No | Yes (prolonged hypoxia requiring supplemental O2) | No | Yes (prolonged hypoxia requiring supplemental O2) | No | No | No |
| AKI | No | No | Yes | No | No | No | No | No | No | No |
| Surgical site complication | No | No | No | No | No | No | No | No | No | No |
| Mortality | Yes (POD 19) | No | No | No | No | No | No | No | No | No |
| LOS (days) | – | 4 | 7 | 20 | 7 | 4 | 9 | 6 | 5 | a |
| Disposition | – | Acute rehab | SAR | SAR | SAR | SAR | SAR | Home | SAR | a |
| Readmission | – | Yes | Yes | No | No | No | No | No | No | – |
| Reason for readmission | – | Symptomatic COVID-19 | Unknown (OSH records unavailable) | – | – | – | – | – | – | – |
| Time of readmission | – | POD 9 | POD 8 | – | – | – | – | – | – | – |
COPD: chronic obstructive pulmonary disease; OSA: obstructive sleep apnea; HTN: hypertension; HLD: hyperlipidemia; CVA: cerebrovascular accident; IBS: irritable bowel syndrome; CHF: congestive heart failure; DM: diabetes mellitus; BPH: benign prostatic hyperplasia; OCD: obsessive compulsive disorder; TIA: transient ischemic attack; CAD: coronary artery disease; CMN: cephalomedullary nail; Hemi: hip hemiarthroplasty; THA: total hip arthroplasty; FNS: Femoral Neck System; RA: room air; AZM: azithromycin; HCQ: hydroxychloroquine; NC: nasal cannula; POD: postoperative day; SAR: subacute rehab; OSH: outside hospital.
a
Remains hospitalized – medically cleared for discharge but awaiting insurance authorization for admission to a rehabilitation facility.