ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
The enhancement of medical treatment of proximal femur fracture despite COVID-19 pandemic - a retrospective analysis of a level 1 trauma center.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe COVID-19 pandemic challenged the world´s healtcare systems. Patients with a proximal femur fracture possibly suffered from a deteriorated medical treatment. Therefore, we conducted a comparison of three years 2018, 2020 and 2022. The potential consequences of pandemic´s restrictions as delays in surgical intervention, extended hospital stays, and increased morbidity and mortality rates were analysed.
methodsWe conducted a retrospective single-center study in a Level I trauma center. The study includes patient data from the years 2018, 2020, and 2022. Data were sourced from inpatient records, operating theatre reports, and external clinical documentation. Only patients who received operative care were included in the analysis. Basic demographic and epidemiological characteristics were recorded. The association between time to surgery and intraoperative as well as postoperative outcomes was compared among these three time periods. Statistical analyses were performed.
resultsA total of 431 patients were included across the years 2018 (pre-pandemic), 2020 (during the pandemic), and 2022 (post-acute phase). The mean patient age was 78.2 years, with 278 female and 153 male patients. There was a statistically significant decreasing delay in time from admission to surgical intervention in 2018 compared to 2020 (p < 0.05). In 2022, surgical timing (38.9 h) showed further decrease compared to 2018 (p < 0.05). The average length of hospital stay was highest in 2018 (16.2 ± 18.8 days), compared to 2020 (13.2 ± 8.8 days) and 2022 (12.7 ± 10.4 days), with a statistically significant difference between 2018 and 2022 (p = 0.015). In-hospital morbidity, including complications such as embolism and cardiopulmonary resuscitation, was highest in the 2022 cohort. Mortality within 30 days post-surgery also peaked in 2022 at 7.6%, compared to 4.9% in 2018 and 0.7% in 2020.
conclusionForemost, the measures of the pandemic did not correlate whether with a delayed surgical treatment nor an aggravated outcome. A significant decrease in time to surgery was observed over the years. Perioperative complications-most notably pneumonia and delirium-remained closely associated with surgical delay. Furthermore, extended time to surgery was linked to decreased mobility and increased mortality, even independently from pandemic restrictions.
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