key: cord-0854062-ijad75fp
authors: Muse, Iyabo O.; Montilla, Elilary; Gruson, Konrad I.; Berger, Jay
title: Perioperative management of patients with hip fractures and COVID-19: A single institution's early experiences
date: 2020-07-27
journal: J Clin Anesth
DOI: 10.1016/j.jclinane.2020.110017
sha: c8457f8df98bd51099802c808a98b6b8c42750a0
doc_id: 854062
cord_uid: ijad75fp

• Good perioperative outcomes seen in patients with COVID-19 that underwent hip fracture repair after 48 hours of admission; • Short cephalomedullary nailing should be strongly considered over long nail for symptomatic COVID-19 patients with intertrochanteric hip fracture. • Regional anesthesia is preferred over general anesthesia in COVID-19 patients with hip fracture. • COVID-19 affects the immune system by releasing inflammatory proteins that can cause multiorgan failure. • Surgical repair should be reserved for patients with either mild or moderate COVID-19 infection.

The COVID-19 pandemic caused the cancellation of all elective surgeries in New York State; nevertheless, non-elective surgeries still needed to be performed. The mortality and morbidity associated with a hip fracture is reduced if repair occurs within 48 hours of admission [1] .

Two international case series demonstrated elevated risk for perioperative morbidity and mortality following hip fracture repair in coronavirus patients [2, 3] . On the contrary, we describe the successful management of five COVID-19 patients who underwent surgery.

After institutional review board (#2020-11706) approval at Montefiore Medical Center, a retrospective case series of patients undergoing surgical repair of a hip fracture between March 19, 2020 and April 30, 2020 was performed. Written consent to publish the case was obtained from patients. [4] . Patients should be placed on chemoprophylaxis if not contraindicated preoperatively and resumed on postoperatively. Low molecular weight heparin is preferred. In situations where heparin is contraindicated, non-heparin anticoagulation agents should be used.

Regional anesthesia has been shown to be safe in COVID-19 patients [5] . Spinal anesthesia was utilized in order to decrease the risk of viral aerosolization. Short cephalomedullary nail was used in three of the four patients with IT fracture to decrease surgery time and blood loss;  Short cephalomedullary nailing should be strongly considered over long nail for symptomatic COVID-19 patients with intertrochanteric hip fracture.

 Regional anesthesia is preferred over general anesthesia in COVID-19 patients with hip fracture.

 COVID-19 affects the immune system by releasing inflammatory proteins that can cause multiorgan failure.

 Surgical repair should be reserved for patients with either mild or moderate COVID-19 infection.

AAOS Clinical Practice Guideline: Management of hip fractures in the elderly

Treatment of proximal femoral fragility fractures in patients with COVID-19 during the SARS-CoV-2 outbreak in northern Italy

Characteristics and early prognosis of COVID-19 infection in fracture patients

Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

Spinal anaesthesia for patients with

Yes