Impact of COVID-19 on Timing of Hip-Fracture Surgeries: An Interrupted Time-Series Analysis of the Pre/Post-Quarantine Period in Northern Italy

Document Type : Original Article

Authors

1 Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – Università di Bologna, Bologna, Italy

2 Department of Public Health Sciences and Paediatrics, Università di Torino, Torino, Italy

Abstract

Background 
To assess whether the imposition of the coronavirus disease 2019 (COVID-19) national quarantine (March 10, 2020) resulted in a shift in the proportion of patients operated for hip fracture on the day of admission, the following day and two days after admission in the region of Piedmont, northern Italy.
 

Methods 
Interrupted time-series analysis (ITSA) comparing hospitalization rate and timing of hip-fracture surgeries between pre- and post-quarantine period. The same data observed in Piedmont the year before were included as a control time series with no “intervention” (quarantine) in the middle of the observation period.
 

Results 
We found that 70.3% and 69.4% of hip-fracture patients received surgery within 2 days of hospital admission in the 16 weeks before and after the national quarantine, respectively. One-day surgery went from 46.0% to 46.5%, and same- day surgery from 13.3% to 12.4%. Unchanged trends were confirmed by ITSA after controlling for the 32-week time- series observed the year before. In the second week of March 2020, there was a borderline significant decrease in weekly hospital admissions for hip fractures as compared with that of the same week of March 2019 (–1.95 per 100 000, 95% CI = –4.10 to 0.21, P value = .075), followed by a weekly significant increase in the hospitalization rate (+0.14 per 100 000, 95% CI = 0.01 to 0.27, P value = .039), although the difference-in-differences of slopes failed to achieve statistical significance (0.19 per 100 000, 95% CI = –0.03 to 0.41, P value = .090).
 

Conclusion 
Our study shows that the timing of hip-fracture surgery was unchanged during the lockdown period. This suggests that  the healthcare systems can be resilient and able to guarantee a high-quality and safe healthcare to hipfracture patients, even in the most challenging working conditions.

Keywords

Main Subjects


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Articles in Press, Corrected Proof
Available Online from 01 September 2021
  • Receive Date: 02 February 2021
  • Revise Date: 05 July 2021
  • Accept Date: 10 August 2021