Effect of Covid-19 on best practice care of hip fracture patients: An analysis from the National Hip Fracture Database (NHFD).

Background: Best practice tariff (BPT) has brought significant improvements in hip fracture care; the 2019 report showing a 30-day mortality of 6.1%. Data relating to more than 65,000 patients who sustain a fractured neck of femur (FNOF) are recorded each year in the National Hip Fracture Database (NHFD). The aim of our study was to review the impact of COVID-19 on BPT.

Methods: Data was extracted from the NHFD for England, Wales and Northern Ireland. The months of March to June 2020 (lockdown period related to COVID-19) were compared to the same period in 2019. Data used in this study was collated and analysed between 14th and 17th October 2020.

Results: Data for more than 40,000 patients was reviewed. BPT dropped -4.3% in March, -12.6% in April, -12.9% in May 2020, and -7.2% in June. Prompt surgery remained stable (four-month average + 0.1%). The most significant changes were noted for timely orthogeriatric review (-7.6%, p < 0.001), bone health assessment (-7.3%, p < 0.001) and post-operative delirium assessment (-6.6%, p < 0.001). 30-day mortality increased to 13.7% in March 2020 and remained high in April 2020 (11.3%) and May (7.3%). Acute hospital length of stay was lowest in May 2020 (11.7 days).

Conclusion: Patients sustaining FNOF in March 2020 had an associated 30-day mortality of 13.7%. During the COVID-19 pandemic, there was a significant reduction in BPT. The most significant changes were observed in timely orthogeriatric review. Maintaining a high standard of multidisciplinary care for this vulnerable group of patients is crucial during future spikes of COVID-19.