Increased complications of proximal femur fractures during the COVID-19 pandemic: a nationwide medical claims database study in Japan.

Introduction: Coronavirus disease 2019 (COVID-19) is a worldwide pandemic, and mortality increases in elderly patients with comorbidities. This study aims to examine the in-hospital complications and mortality for elderly patients with proximal femur fractures during the COVID-19 pandemic or countermeasure periods.

Materials and methods: The proximal femur fractures undergoing surgery during the COVID-19 pandemic or countermeasure period were compared with the pre-pandemic in a Japanese national inpatient data. The assessed outcomes were the development of pneumonia, deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality during hospitalization in two periods, and those for COVID-19-positive patients.

Results: A total of 284,922 proximal femur fractures aged over 65 years were included. In the COVID-19 pandemic period compared to the pre-pandemic, the odds of pneumonia, DVT, PE, and mortality decreased to 0.942 (95% confidence interval [CI]: 0.901 - 0.986, P = 0.0102) and 0.839 (95% CI: 0.745 - 0.946, P = 0.004), increased to 1.153 (95% CI: 1.112 - 1.195, P < 0.001), and 1.048 (95% CI: 0.982 - 1.118, P = 0.1554), respectively. For COVID-19 positivity at admission, the odds of PE increased significantly to 12.95 (95% CI: 8.795 - 19.06, P < 0.001). For COVID-19 positivity during hospitalization, the odds of pneumonia and mortality were increased to 2.896 (95% CI: 1.820 - 4.608, P < 0.001) and 6.303 (95% CI: 3.440 - 11.55, P < 0.001), respectively.

Conclusion: These findings alert healthcare professionals and patients to the elevated complications, especially PE rate for proximal femoral fracture with COVID-19 positive.