Mortality risk of surgically managing orthopaedic trauma during the COVID-19 pandemic.

Balakumar, Balasubramanian, Nandra, Rajpal S, Woffenden, Hugo, Atkin, Benjamin, Mahmood, Ansar, Cooper, George, Cooper, Julian and Hindle, Paul (2021) Mortality risk of surgically managing orthopaedic trauma during the COVID-19 pandemic. Bone & joint open, 2 (5). pp. 330-336. ISSN 2633-1462.

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It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site.


The primary outcome measure was 30-day mortality. Secondary measures included complications of surgery, COVID-19 infection, and length of stay. Multiple variables were assessed for their contribution to the 30-day mortality. In total, 433 patients were included with a mean age of 65 years; 45% were male, and 90% were Caucasian.


Overall mortality was 7.6% for all patients and 15.9% for femoral neck fractures. The mortality rate increased from 7.5% to 44.2% in patients with fracture neck of femur and a COVID-19 infection. The COVID-19 rate in the 30-day postoperative period was 11%. COVID-19 infection, age, and Charlson Comorbidity Index were independent risk factor for mortality.


There was a significant risk of contracting COVID-19 due to being admitted to hospital. Using a site which was not treating COVID-19 respiratory patients for surgery did not identify a difference with respect to mortality, nosocomial COVID-19 infection, or length of stay. The COVID-19 pandemic significantly increases perioperative mortality risk in patients with fractured neck of femora but patients with other injuries were not at increased risk. Cite this article:  2021;2(5):330-336.

Item Type: Article
Subjects: WE Musculoskeletal. Orthopaedics
WO Surgery
Divisions: Planned IP Care > Trauma and Orthopaedics
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 03 Jun 2021 10:34
Last Modified: 03 Jun 2021 10:34

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