Elderly Patients With Proximal Femoral Fractures and SARS-CoV-2 Infection: An Observational Study on 30-Day Postoperative Mortality

PURPOSE: Hip fractures in older adults require multidisciplinary care and are associated with high morbidity and mortality. The COVID-19 pandemic has particularly impacted this vulnerable population. This study evaluated the 30-day outcomes of elderly patients with hip fractures and SARS-CoV-2 infection treated in a single center. METHODS: We conducted a retrospective cohort study including patients admitted between July 2020 and December 2022 with proximal femoral fractures. Demographic data, comorbidities, COVID-19 status, and postoperative outcomes were collected from electronic records. Patients were categorized into four groups according to COVID-19 status and surgical timing (≤48 h vs. >48 h). Mortality, complications, and hospital stay were analyzed. RESULTS: A total of 185 patients (mean age 80 years) were included; 56 (30.3%) tested positive for COVID-19. COVID-19-positive patients had significantly higher comorbidity scores and required postoperative oxygen therapy more frequently. Thirty-day mortality was markedly higher among infected patients (OR 7.01; 95% CI 4.94-8.77; p<0.00001). They also showed increased in-hospital mortality, complications, and prolonged hospitalization. CONCLUSION: SARS-CoV-2 infection significantly worsened short-term outcomes in elderly patients with hip fractures. A coordinated multidisciplinary approach remains crucial to reduce mortality and improve survival in this fragile population.