The effect of the COVID-19 pandemic on hip fracture care: our experience at the University Hospitals of Leicester (UHL)

Abstract

The United Kingdom (UK) Covid-19 pandemic has led to unique changes in the operation of the National Health Service (NHS) including within trauma and orthopaedics. This has led to a significant impact on the NHS ability to provide hip fracture care and sustain emergency surgery. This has led to local hip fracture services changing operations to provide more sustainable care and significant impacts on best practice tariffs. Data was collected using the National Hip Fracture Database data submitted by UHL and split into two cohorts – Pre Covid-19 and Post Covid-19. Data has been collected for 67 consecutive patients in April 2019 (Pre Covid-19) and 87 consecutive patients in April 2020 (Post Covid-19) as of 4th May after the introduction of the Covid-19 measures locally. Data has been collected on demographics- age and sex, ASA, admission time, time of operation, 30 day mortality and length of stay. The average time to theatre in the pre Covid-19 cohort was 27.3 hours and in the post Covid-19 cohort was 45.1 hours. This is an increase of 65.2%. All patients in the pre Covid-19 cohort were operated on and 4 in the post Covid-19 were conservatively managed. However, there were no significant effects on 30 day mortality or length of stay. In conclusion, the measures taken due to the Covid-19 pandemic had a profound impact on the care of hip fracture patients with significant delays in time to theatre. As a result, it is clear that the measures influenced practice at UHL and the best practice tariffs were not met.