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Background <p>Hip fractures (HF) are among the most prevalent diagnoses in geriatric traumatology, with persistently high incidence even during the COVID-19 pandemic. Concomitant SARS-CoV-2 infection adds clinical complexity and has been associated with increased mortality and prolonged hospitalisation. This study aimed to assess the impact of SARS-CoV-2 subvariants B.1.1.7 (Alpha), B.1.617.2 (Delta), and B.1.1.529 (Omicron) on postoperative outcomes in patients undergoing surgical treatment for HF.</p> Methods <p>A retrospective multicentre study was conducted using data from the German Registry for Geriatric Trauma (ATR-DGU<sup>®</sup>) between March 2021 and April 2022 across 119 hospitals. 12,707 patients undergoing HF surgery were included and stratified by predominant subvariant periods: Alpha (<i>n</i> = 3714), Delta (<i>n</i> = 5434), and Omicron (<i>n</i> = 3559). Each cohort was further stratified by SARS-CoV-2 status at admission.</p> Results <p>During the Alpha period, in-hospital mortality and length of stay were similar between COVID-19-comorbid (8.3%, 13 days) and SARS-CoV-2-negative patients (5.4%, 15 days). In the Delta and Omicron periods, mortality was significantly higher among COVID-19-comorbid patients (14.3% and 13.9%) compared to SARS-CoV-2-negative patients (5.8%, <i>p</i> = 0.017; 5.7%, <i>p</i> &lt; 0.001), with longer hospitalisations (17 vs. 15 days, <i>p</i> &lt; 0.05). COVID-19-comorbid patients were more frequently institutionalised and exhibited lower levels of pre-fracture mobility compared to SARS-CoV-2-negative patients.</p> Conclusion <p>COVID-19-positive patients showed lower mortality during the Alpha period and higher mortality during the Delta and Omicron periods. Overall, COVID-19 comorbidity was associated with increased in-hospital mortality and longer hospitalisation. These observations may be influenced by unmeasured confounding.</p> Trial registration <p>Not applicable. This retrospective study used anonymized data from the German Registry for Geriatric Trauma (ATR-DGU<sup>®</sup>) and was approved by the ethics committee of the University of Muenster (reference number: 2022-268-f-S). This study was conducted in accordance with the Declaration of Helsinki.</p>

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Impact of SARS-CoV-2 subvariants on postoperative outcomes in geriatric hip fracture patients – a multinational multicentre study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月20日

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  • Gregor Toporowski,
  • Christian M. Mueller-Mai,
  • Katherine Rascher,
  • Jonas Wiedemann

摘要

Background

Hip fractures (HF) are among the most prevalent diagnoses in geriatric traumatology, with persistently high incidence even during the COVID-19 pandemic. Concomitant SARS-CoV-2 infection adds clinical complexity and has been associated with increased mortality and prolonged hospitalisation. This study aimed to assess the impact of SARS-CoV-2 subvariants B.1.1.7 (Alpha), B.1.617.2 (Delta), and B.1.1.529 (Omicron) on postoperative outcomes in patients undergoing surgical treatment for HF.

Methods

A retrospective multicentre study was conducted using data from the German Registry for Geriatric Trauma (ATR-DGU®) between March 2021 and April 2022 across 119 hospitals. 12,707 patients undergoing HF surgery were included and stratified by predominant subvariant periods: Alpha (n = 3714), Delta (n = 5434), and Omicron (n = 3559). Each cohort was further stratified by SARS-CoV-2 status at admission.

Results

During the Alpha period, in-hospital mortality and length of stay were similar between COVID-19-comorbid (8.3%, 13 days) and SARS-CoV-2-negative patients (5.4%, 15 days). In the Delta and Omicron periods, mortality was significantly higher among COVID-19-comorbid patients (14.3% and 13.9%) compared to SARS-CoV-2-negative patients (5.8%, p = 0.017; 5.7%, p < 0.001), with longer hospitalisations (17 vs. 15 days, p < 0.05). COVID-19-comorbid patients were more frequently institutionalised and exhibited lower levels of pre-fracture mobility compared to SARS-CoV-2-negative patients.

Conclusion

COVID-19-positive patients showed lower mortality during the Alpha period and higher mortality during the Delta and Omicron periods. Overall, COVID-19 comorbidity was associated with increased in-hospital mortality and longer hospitalisation. These observations may be influenced by unmeasured confounding.

Trial registration

Not applicable. This retrospective study used anonymized data from the German Registry for Geriatric Trauma (ATR-DGU®) and was approved by the ethics committee of the University of Muenster (reference number: 2022-268-f-S). This study was conducted in accordance with the Declaration of Helsinki.