Not only this, but elderly patients with hip fractures often are resident within or are discharged to nursing residential care units, which were particularly hard hit by Covid-19 in Ireland. The typical hip fracture patient, typically elderly, often with significant comorbidities, is among the sector of society at greatest risk to Covid-19. Ĭovid-19 has presented significant challenges to hip fracture management and achieving the blue book standards. Since the introduction of the blue book standards in 2007, the 30-day mortality in hip fracture patients has reduced from 11.9 in 2003 to 7.8% in 2011. These KPIs comprise six targets for hip fracture care, summarised in Table 1. Achieving these KPIs in hip fracture care minimises perioperative risk for these high-risk patients. These have been adopted as the standards of care for hip fracture management within NHS and have also been adopted into KPIs for the Irish Hip Fracture Database. This determined several key performance indicators (KPIs) for hip fracture care. The British Orthopaedic Association and British Geriatric Society published their “Blue Book”, a care pathway for patients with fragility fractures in 2007. The fragility fracture of the proximal femur, otherwise called a “hip fracture”, is of particular importance in the management of trauma in the elderly patient. The median age of the trauma patient has significantly changed, with elderly trauma being a particular challenge. Trauma management and survivability has a significant cause of morbidity, particularly in a population of advancing age. Trauma and orthopaedic surgery services are no different and have been significantly impacted in terms of these services’ response to the pandemic. First identified in Wuhan province in China in December 2019, a novel coronavirus disease, named Covid-19 by the World Health Organisation, has wrought havoc on healthcare systems and impeded the delivery of trauma and orthopaedic care worldwide. The year 2020 has been a year of unprecedented social, economic and healthcare upheaval. These observations are of paramount importance to ensure adequate service planning and provision in the face of a potential “second wave” of Covid-19 infections leading into the winter months of 2020. A positive Covid-19 swab was associated with higher mortality. Conclusionsĭespite improvements in hip fracture care KPIs, the Covid-19 crisis was associated with increased 30-day mortality in hip fracture patients. Statistically significant improvements in time-dependent KPIs (time to ward and time to surgery) were noted in the 2020 cohort. Covid-19 infection was statistically associated with 30-day mortality in the 2020 cohort. Thirty-day mortality in hip fractures during the Covid-19 crisis was 8.3% compared with 2.2% in 2020. ResultsĪ total of 36 hip fractures were recorded in 2020, compared with 45 in 2019, resulting in a 20% reduction in presentations. Covid-19 rates in 2020 were also recorded. We retrospectively reviewed IHFD data to collection demographic data, IHFD standards of care, 30-day mortality rates and complications between 23rd March and 20th May 20. We aim to review Blue Book compliance during the Covid-19 crisis and review outcomes of hip fractures, including Covid-19 infection rates. The hip fracture “Blue book Standards”, the key performance indicators (KPIs) associated with appropriate hip fracture care are challenging during non-crisis times. A fundamentally important and significant portion of trauma services is the treatment of fragility fractures of the proximal femur, otherwise known as hip fractures. Trauma and orthopaedic services are no different. The Covid-19 pandemic has caused worldwide upheaval from early 2020.
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