COVID-19 vaccination improved outcomes in the treatment of geriatric hip fractures between December 2020 and January 2022

Abstract

Introduction:

Geriatric hip fracture patients are at high risk for perioperative morbidity and mortality from COVID-19. This study analyses the impact of COVID-19 vaccination on geriatric hip fracture outcomes. We hypothesise that having the COVID-19 vaccine improves outcomes for geriatric patients treated for hip fracture.

Methods:

Between December 2020 and January 2022, 506 patients treated for hip fracture were analysed for demographics, hospital quality measures, and outcomes. Patients were grouped according to vaccine series administration status. During the study period, there were 329 (65%) unvaccinated patients (NV), 14 (3%) partially vaccinated (PV) patients, 138 (27%) fully vaccinated (FV) patients, and 25 (5%) patients received a booster shot (BV). Variables were compared using chi square, independent sample t-tests or ANOVA as appropriate. Multivariable logistic regression was used to independently assess the impact of vaccination.

Results:

The rate of minor complications decreased if any vaccination status was achieved (NV: 37.99%, PV: 21.34%, FV: 28.26%, BV: 20.00%; p = 0.054). Vaccinated patients had a decreased need for Intensive Care Unit (ICU) level care (NV: 14.89%, PV: 7.14%, FV: 5.80%, BV: 8.00%; p = 0.038). There were no differences in inpatient or 30-day mortality, major complications, length of stay, home discharge, or readmission within 30 or 90 days. Vaccination against COVID-19 was independently protective against the need for ICU level care. Additionally, female gender and vaccination against COVID-19 decreased the rate of minor complications. Older age and higher comorbidity burden increased the rate of minor complications.

Discussion:

In the hip fracture population, vaccination against COVID-19 was protective against the need for ICU level care and decreased overall minor complications. Larger studies are needed to determine if vaccination decreases mortality in this population. These findings have resource allocation implications including ICU bed availability during pandemics and patient outreach to improve vaccination status.

Keywords

COVID-19 vaccination geriatric hip fracture ICU outcomes

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References

World Health Organization. WHO coronavirus (COVID-19) dashboard, https://covid19.who.int (2021, accessed 16 December 2021).

Centers for Disease Control and Prevention. COVID data tracker, https://covid.cdc.gov/covid-data-tracker/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fcases-in-us.html#demographicsovertime (2021, accessed 21 December 2021).

Centers for Disease Control and Prevention. COVID-19: people with certain medical conditions, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html#:~:text=Older%20adults%20are%20more%20likely,aged%2018%2D29 (2022, accessed 16 February 2022).

Haskel

Lin

Kaplan

, et al. Hip fracture volume does not change at a New York City level 1 trauma center during a period of social distancing. Geriatr Orthop Surg Rehabil 2020; 11: 2151459320972674.

Sterling

. Gender and race/ethnicity differences in hip fracture incidence, morbidity, mortality, and function. Clin Orthop Relat Res 2011; 469: 1913–1918.

Braithwaite

Col

Wong

. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 2003; 51: 364–370.

Holt

Smith

Duncan

, et al. Outcome after surgery for the treatment of hip fracture in the extremely elderly. J Bone Joint Surg Am 2008; 90:1899–1905.

LeBrun

Konnaris

Ghahramani

, et al. Hip fracture outcomes during the COVID-19 pandemic: early results from New York. J Orthop Trauma 2020; 34: 403–410.

Egol

Konda

Bird

, et al. Increased mortality and major complications in hip fracture care during the COVID-19 pandemic: a New York City perspective. J Orthop Trauma 2020; 34: 395–402.

10.

Katella

. Comparing the COVID-19 vaccines: how are they different? https://www.yalemedicine.org/news/covid-19-vaccine-comparison (2021, accessed 18 February 2022).

11.

Pilishvili

Gierke

Fleming-Dutra

, et al. Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel. N Engl J Med 2021; 385: e90.

12.

Haas

Angulo

McLaughlin

, et al. Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data. Lancet 2021; 397: 1819–1829.

13.

U.S. Food & Drug Administration. FDA authorizes booster dose of Pfizer-BioNTech COVID-19 vaccine for certain populations, https://www.fda.gov/news-events/press-announcements/fda-authorizes-booster-dose-pfizer-biontech-covid-19-vaccine-certain-populations (2021, accessed 18 February 2022).

14.

Dolgin

. COVID vaccine immunity is waning - how much does that matter? Nature 2021; 597: 606–607.

15.

Khoury

Cromer

Reynaldi

, et al. Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection. Nat Med 2021; 27: 1205–1211.

16.

Patalon

Gazit

Pitzer

, et al. Odds of testing positive for SARS-CoV-2 following receipt of 3 vs 2 doses of the BNT162b2 mRNA vaccine. JAMA Intern Med 2022; 182: 179–184.

17.

Barda

Dagan

Cohen

, et al. Effectiveness of a third dose of the BNT162b2 mRNA COVID-19 vaccine for preventing severe outcomes in Israel: an observational study. Lancet 2021; 398: 2093–2100.

18.

Voysey

Clemens

Madhi

, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet 2021; 397: 99–111.

19.

Fabiani

Puopolo

Morciano

, et al. Effectiveness of mRNA vaccines and waning of protection against SARS-CoV-2 infection and severe covid-19 during predominant circulation of the delta variant in Italy: retrospective cohort study. BMJ 2022; 376: e069052.

20.

Tracking COVID-19 in California. Unvaccinated and vaccinated data, https://covid19.ca.gov/state-dashboard/#postvax-status (2021, accessed 16 December 2021).

21.

Centers for Disease Control & Prevention. Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines: Pfizer-BioNTech, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Pfizer-BioNTech.html (2022, accessed 18 February 2022).

22.

Centers for Disease Control & Prevention. Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines: Moderna, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html (2022, accessed 18 February 2022).

23.

Centers for Disease Control & Prevention. J&J/Janssen, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/janssen.html (2022, accessed 18 February 2022).

24.

Immovilli

Morelli

Antonucci

, et al. COVID-19 mortality and ICU admission: the Italian experience. Crit Care 2020; 24: 228.

25.

Zang

Chen

Wang

, et al. The effect of early mobilization in critically ill patients: a meta-analysis. Nurs Crit Care 2020; 25: 360–367.

26.

Kumar

Yassin

Bhowmick

, et al. Recommendations from the 2016 guidelines for the management of adults with hospital-acquired or ventilator-associated pneumonia. P T 2017; 42: 767–772.

27.

Kalil

Metersky

Klompas

, et al. Executive summary: management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63: 575–582.

28.

InformedHealth.org. What happens if you get pneumonia in the hospital? https://www.ncbi.nlm.nih.gov/books/NBK525788/ (2018, accessed 16 December 2021).