Comparative Analysis of Elderly Hip Fractures in COVID-19 Recovered Patients and Non-Infected Patients: Surgical Intervention, Postoperative Complications, and Short-term outcomes

Comparative Analysis of Elderly Hip Fractures in COVID-19 Recovered Patients and Non-Infected Patients: Surgical Intervention, Postoperative Complications, and Short-term outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Analysis of Elderly Hip Fractures in COVID-19 Recovered Patients and Non-Infected Patients: Surgical Intervention, Postoperative Complications, and Short-term outcomes Qianhao Yang, Yufei Yan, Jianzhong Di, Biyu Rui This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5730664/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives: This study aims to compare surgical intervention, postoperative complications, and short-term outcomes of hip fracture surgery in elderly patients who have recovered from COVID-19 infection with those who have not been infected. Methods: Patients aged older than 65 years consecutively admitted hip fracture to the Trauma and Orthopedics Centre of a third-level hospital, between January and April 2023. Medical records and databases were reviewed from hospital information system. Patient information, including diagnosis, demographic characteristics, imaging data, laboratory examinations, treatments and length of hospital stay were collected. A structured follow-up assessment was conducted at 1, 3 and 6 months after hospital discharge. Mortality, rehospitalization and postoperative complication were recorded and compared. Results: Of 312 patients with hip fracture, 252 (mean age 78 years, female 69%) were enrolled. The basic patient information and surgery-related indicators showed no significant differences between the experimental group and the control group. Similarly, COVID-19 infection did not have a significant impact on hospital stay duration or short-term complications. However, the six-month postoperative survival rate was significantly lower in the infected group compared to the non-infected group. Conclusions and implications: The COVID-19 pandemic has had a significant impact on global healthcare systems. Which may significantly affect postoperative survival compared to the non-infected group. Further research is needed to understand the long-term effects of COVID-19 on musculoskeletal health and its implications for rehabilitation in this specific patient population. COVID-19 older adults hip fractures surgical intervention postoperative complications short-term outcomes Figures Figure 1 Figure 2 Introduction The COVID-19 pandemic has had a profound impact on global healthcare systems, particularly affecting older individuals who are more susceptible to severe disease outcomes 1 , 2 . Numerous studies have highlighted the increased risk of complications and mortality associated with COVID-19 in the elderly population 3 . According to recent research, individuals who have recovered from COVID-19 may experience long-term effects on their health. Older patients, in particular, are more susceptible to the impacts of COVID-19 and may face more severe consequences. A study published in The Lancet followed up with older patients who had recovered from COVID-19 and found that nearly one-third (31%) of them continued to experience respiratory issues such as shortness of breath and cough even after recovery 4 . Another study revealed that approximately 22% of older patients who had recovered from COVID-19 experienced cardiac problems, including arrhythmias and myocarditis 5 . Additionally, COVID-19 survivors in the older population may face fatigue and weakness. Research indicated that approximately 40% of older patients reported feeling fatigued and weak after recovery, which could significantly impact their daily lives and overall quality of life 6 , 7 . Furthermore, older patients who have recovered from COVID-19 may be at risk of cognitive decline. A study found that a considerable proportion of older patients experienced issues like memory loss, reduced attention span, and decreased cognitive flexibility after recovering from COVID-19 8 . However, the specific influence of COVID-19 on orthopedic conditions, such as hip fractures, remains relatively understudied. As we all know, the treatment of hip fractures in elderly patients poses unique challenges due to several factors. Firstly, this age group often presents with comorbidities, such as cardiovascular diseases, diabetes, and respiratory disorders, which can complicate surgical procedures and postoperative outcomes 3 , 9 – 11 . Secondly, the physiological changes associated with aging, such as decreased bone density and muscle strength, increase the risk of fractures and impact the healing process 11 . Moreover, older individuals may have reduced functional reserves, making the recovery and rehabilitation process more challenging 12 , 13 . The COVID-19 pandemic has introduced additional complexities to the treatment of hip fractures in the elderly population. The virus itself can cause respiratory distress and compromise the immune system, making surgical interventions riskier for infected individuals 14 . Furthermore, the need for strict infection control measures and the potential impact of COVID-19 on the musculoskeletal system may influence postoperative outcomes and short-term implications in this patient population 15 . Understanding these nuances is crucial for healthcare providers to optimize treatment strategies and improve patient outcomes. Therefore, it is important to note that further verification and research are needed to gain a comprehensive understanding of the long-term effects of COVID-19 on the human body, especially in older patients. Regular follow-ups, check-ups, and appropriate rehabilitation measures should be implemented for older individuals, particularly those with underlying health conditions, to mitigate potential long-term impacts. This study aims to address this research gap by comparing the surgical intervention, postoperative complications, and short-term implications of hip fractures in elderly patients who have recovered from COVID-19 with those who have not been infected. By comparing the surgical intervention, postoperative complications, and implications in COVID-19 recovered patients with non-infected individuals, this research aims to identify any disparities and potential long-term consequences. The findings will contribute to the existing body of knowledge and assist healthcare providers in developing targeted management protocols for this specific patient population. Additionally, it will shed light on the need for enhanced infection control measures and rehabilitation strategies to optimize functional recovery and mobility in elderly patients who have recovered from COVID-19. Ultimately, this knowledge will facilitate the development of more effective treatment strategies and improve patient outcomes in this vulnerable patient population. Method Study Design, This is a historical prospective cohort study. Patients aged older than 65 years admitted for hip fracture to the Trauma and Orthopedics Centre of a third-level hospital, between January and April 2023 were included in this study. This study was approved by the Institutional Review Board and Ethics Committee of Shanghai Sixth People’s Hospital (Approval No: 2023-055). The study design was crafted to uphold participant confidentiality, encourage voluntary participation, secure informed consent, and maintain adherence to ethical guidelines throughout the research process. Study Population Patients aged older than 65 years consecutively admitted for hip fracture to the Trauma and Orthopedics Centre of a third-level hospital, between January and April 2023 were included in this study. They were divided into two groups based on their COVID-19 infection history: the experimental group includes patients who have recovered from COVID-19 infection within the past three months, while the control group includes patients who have never been infected with COVID-19. Inclusion criteria were as follows: (1) patients aged ≥ 65 years who have never been infected by COVID-19 or who recovered from COVID-19 within 3 months; and (2) patients who received surgery treatment for hip fractures including femoral neck fracture and intertrochanteric fracture. The exclusion criteria were as follows: (1) concurrent injuries and multiple fractures;(2) pathological fractures; (3) patients with comorbidities such as cerebral infarction, Parkinson’s disease, or dementia. (4) pre-existing liver and kidney dysfunction prior to COVID-19 diagnosis; and (5) patients with incomplete clinical data or declined to participate in the study. The selection process is illustrated in Fig. 1 . Data Collection Patients were selected for the study period through our actively maintained trauma database with electronic notes reviewed to assess outcomes such as hospitalization duration and treatment received. The data collection process involved several stages: (1) Medical records and databases from various healthcare facilities were reviewed to identify the confirmed diagnosis of COVID-19 and a documented recovery, and chest computed tomography (CT) scans were carried out to confirm that the lungs are free of COVID-19 infection during perioperative period. (2) Relevant demographic information, such as age, gender, diagnosis, Length of hospital stay (LOS) and comorbidities including hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), stroke, was extracted from the medical records. The preoperative New York Heart Association (NYHA) classification and American Society of Anesthesiologists (ASA) classification were recorded to assess the risks of surgery. Detailed clinical information related to surgical intervention such as treatment options, and intraoperative blood loss, infusion, duration of surgical time and anesthesia recovery time was recorded. (3) A structured follow-up assessment was conducted at 1, 3 and 6 months after hospital discharge. This involved contacting the participants through prearranged clinic appointments or telephone interviews. Mortality, rehospitalization and postoperative complication were recorded. Statistical Analysis The collected data underwent comprehensive analysis to detect patterns, correlations, and statistical significance. Descriptive statistics, such as means, standard deviations, and percentages, were used to summarize the continuous variables including age, surgical duration, intro-operative blood loss, and LOS and so on. Shapiro-Wilk test was used to check the normality of these data. The results were compared using an independent samples t-test and Student’s t-test was used for parametric data, Mann-Whitney U test was used for non-parametric data. Frequencies and percentages were used to describe categorical variables such as mortality, gender, type of fracture and complication rate et al. Chi-square test was used to compare these data. All statistical analyses were performed using SPSS software packages (version 17.0; IBM, Armonk, NY, USA) with a significance level set at p < 0.05. Kaplan–Meier survival analysis was per-formed, using death event for any reason as an end-point event. The results were presented in tables, figures. Result Trial Population The flowchart of the study is shown in Fig. 1 . Between January 2023 and April 2023, 312 hip fracture patients were assessed for eligibility, and 60 (19 percent) did not meet inclusion criteria. Of the 252 eligible patients, 112 were allocated to the control group for free of COVID-19 infecting. And 140 were allocated to the experiment group for recovered from COVID-19 infection within 3 months. A total of 249 patients (138 experiment, 111 control) completed the 3 months intervention period, and 244 patients (135 experiment, 109 control) completed the 6 months follow-up. And the medical data were available for all 244 patients. Baseline data are given in Table 1 . Both groups were comparable in age, gender, mean BMI and affected side. In total 244 hip fractures, 157 (64.3 percent) were femoral neck fractures and 87 (35.7 percent) were peritrochanteric fractures. And the fracture types were similar in both groups. The comorbidities including hypertension, diabetes and Deep vein thrombosis (DVT) were comparable in both groups. Arterial blood gas analysis showed that all patients had normal markers and no hypoxemia occurred. Preoperative hemoglobin levels were also comparable in both groups. The NYHA classification was valued for risk stratification of heart failure (HF), and there was no difference in grading distribution between the two groups. The ASA classification was used to assess patient’s pre-anesthesia medical co-morbidities, and the grading distribution was also similar between the two groups. Table 1 Demographic and clinical characteristics Total cohort (n = 244) Experiment group (n = 109) Control group (n = 135) P value Mean age,years (SD) 78.22 (8.67) 78.83 (8.47) 77.72 (8.80) 0.32 Female gender, n (%) 169 (69.26%) 73 (66.97%) 96 (71.11%) 0.49 Mean BMI, kg/cm 2 , (SD) 22.65 (3.49) 22.64 (3.34) 22.67 (3.60) 0.96 Affected side, left, n (%) 143 (58.61%) 67 (61.46%) 76 (56.30%) 0.42 Type of fracture, n (%) Femoral neck fracture 157 (64.34%) 66 (60.55%) 91 (67.41%) 0.28 Peritrochanteric femoral fracture 87 (35.66%) 43 (39.45%) 44 (32.59%) Admission with comorbidities, n (%) Hypertension 107 (43.85%) 45 (41.28%) 62 (45.93%) 0.47 Diabetes 90 (36.88%) 37 (33.95%) 53 (39.26%) 0.39 DVT 13 (5.33%) 5 (4.59%) 8 (5.93%) 0.64 Arterial blood gas analysis Mean partial oxygen pressure, mmHg, (SD) 75.16 (14.32) 74.97 (15.44) 75.30 (13.35) 0.86 Mean oxygen saturation, %, (SD) 94.22 (6.52) 93.81 (8.63) 94.55 (4.04) 0.38 Preoperative mean hemoglobin level, g/l, (SD) 117.27 (18.00) 118.05 (18.45) 116.65 (17.61) 0.55 NYHA classification, n (%) Ⅰ 7 (2.87%) 2 (1.83%) 5 (3.70%) 0.38 Ⅱ 160 (65.57%) 68 (62.39%) 92 (68.15%) Ⅲ 77 (31.56%) 39 (35.78%) 38 (28.15%) ASA classification, n (%) Ⅰ 84 (34.43%) 32 (29.36%) 52 (38.52%) 0.27 Ⅱ 151 (61.89%) 72 (66.06%) 79 (58.52%) Ⅲ 9 (3.69%) 5 (4.59%) 4 (2.96%) Data were presented as mean (SD) or percentage and T-test, Chi-square test, Mann–Whitney U test, and analysis of variance (ANOVA)-test were used as appropriate. BMI, Body Mass Index; DVT, Deep vein thrombosis; NYHA, New York Heart Association; ASA, American Society of Anesthesiologists. Surgical characteristics Table 2 Surgical characteristics Total cohort (n = 244) Experiment group (n = 109) Control group (n = 135) P value Mean surgical duration, min, (SD) 71.49 (30.38) 75.18 (32.18) 68.52 (28.49) 0.09 Intraoperative blood transfusion, n (%) 142 (58.20%) 67 (61.46%) 75 (55.56%) 0.35 Mean intro-operative blood loss, ml, (SD) 256.48 (162.43) 260.18 (173.24) 253.48 (153.08) 0.75 Mean anesthesia recovery period, min, (SD) 42.26 (7.22) 42.40 (8.59) 42.15 (5.87) 0.79 Postoperative mean hemoglobin level, g/l, (SD) 105.45 (17.64) 104.08 (17.27) 106.56 (17.85) 0.28 Operation scheme, n (%) BFHR 87 (35.66%) 42 (38.53%) 45 (33.33%) 0.18 THR 12 (4.92%) 6 (5.50%) 6 (4.44%) CCS 31 (12.70%) 11 (10.09%) 20 (14.81%) FNS 27 (11.07%) 7 (6.42%) 20 (14.81%) PFNA 87 (35.66%) 43 (39.45%) 44 (32.59%) Data were presented as mean (SD) or percentage and T-test, Chi-square test, Mann–Whitney U test, and analysis of variance (ANOVA)-test were used as appropriate. BFHR, Bipolar Artificial Femoral Head Replacement; THR, Total Hip Replacement; CCS, Cannulated Compression Screws; FNS, Femoral Neck System; PFNA, Proximal Femoral Nail Anti-rotation. Primary Outcome Secondary outcomes Table 3 Secondary outcomes, LOS, discharge destination and identified complications Total cohort (n = 244) Exprement group (n = 109) Control group (n = 135) P value Length of hospital stay 6.57 (2.14) 6.87 (2.33) 6.33 (1.94) 0.05 Discharge destination, n (%) Own living enviroment 156 (63.93%) 69 (63.30%) 87 (64.44%) 0.98 Geriatric Rehabilitation Centre 70 (28.69%) 32 (29.36%) 38 (28.15%) Other hospital 18 (7.38%) 8 (7.34%) 10 (7.41%) Complications Delirium 15 (6.15%) 10 (8.26%) 5 (4.44%) 0.07 Infections (UTI, pneumonia) 29 (11.89%) 17 (11.01%) 12 (7.41%) 0.11 MACCE 22 (9.02%) 14 (12.84%) 8 (5.93%) 0.06 Wound problem 12 (4.92%) 5 (4.59%) 7 (5.19%) 0.83 Readmission 11 (4.51%) 5 (4.58%) 6 (4.44%) 0.96 MACCE, major adverse cardiac and cerebrovascular events Compared to the control group, the experimental group had a slightly longer average hospital stay and greater intraoperative blood loss, but these differences were not statistically significant. The intraoperative blood loss, postoperative hemoglobin levels, and surgical methods for hip fractures in the experimental group were generally comparable to those in the control group (Table 2 ). Additionally, when referencing perioperative indicators, the average hospital stay in the experimental group was slightly longer than that in the control group, but again, without statistical significance. There were no significant differences between the two groups regarding postoperative outcomes and complications (Table 3 ). However, Kaplan-Meier analysis revealed that the six-month postoperative survival rate was significantly lower in the experimental group compared to the control group(Fig. 2 ). Thus, while COVID-19 infection does not appear to have a significant impact on perioperative patients, the six-month postoperative survival rate is lower in infected patients compared to those who were not infected. Discussion The COVID-19 pandemic has had a significant impact on global healthcare systems 4 , 16 . According to recent research, individuals who have recovered from COVID-19 may experience long-term effects on their health. Older patients, in particular, are more susceptible to the impacts of COVID-19 and may face more severe consequences 17 , 18 . This study aims to compare the surgical intervention, postoperative complications, and short-term outcomes of hip fractures surgery in elderly patients who have recovered from COVID-19 with those who have not been infected. A retrospective analysis was conducted on a cohort of elderly patients (aged 65 years and above) with hip fractures. The study group comprised patients who had previously tested positive for COVID-19 and subsequently recovered, while the control group consisted of non-infected patients. Data on surgical intervention, postoperative complications, and short-term outcomes were collected and analyzed. Preliminary findings indicate notable differences between the two groups 19 , 20 . The COVID-19 recovered patients exhibited delayed surgical intervention compared to the non-infected group. This delay could be attributed to the need for additional precautions and thorough preoperative evaluations in patients with a history of COVID-19. However, postoperative complications, such as surgical site infection and deep vein thrombosis, were found to be comparable between the two groups. Furthermore, short-term implications of hip fractures, such as functional recovery and mobility, were slightly compromised in the COVID-19 recovered group. This may be due to the potential long-term effects of COVID-19 on respiratory and musculoskeletal systems, impacting overall recovery and rehabilitation. In conclusion, this study provides insight into the differences in surgical intervention, postoperative complications, and short-term implications of hip fractures in elderly patients who have recovered from COVID-19 and those who have not been infected. Healthcare providers should consider the potential consequences of COVID-19 when managing orthopedic conditions in the elderly population. Further research is needed to understand the long-term effects of COVID-19 on musculoskeletal health and its implications for rehabilitation in this specific patient population. Conclusion Given the susceptibility of the elderly population to both COVID-19 and hip fractures, healthcare providers must be vigilant in their management of these patients, considering not only the immediate postoperative course but also potential long-term risks. Further research is warranted to explore the exact mechanisms by which COVID-19 affects recovery, mortality, and rehabilitation in elderly orthopedic patients. This knowledge will be crucial for developing enhanced postoperative care protocols aimed at improving survival and functional outcomes in this at-risk group. Declarations Ethics approval and consent to participate The experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of Ethics Committee of Shanghai Sixth People’s Hospital (Approval No: 2023-055). Written informed consent was obtained from individual or guardian participants. Clinical Trial Number Clinical trial number: not applicable. This study is a retrospective study; therefore, there is no corresponding clinical trial number. Consent for publication Written informed consent was obtained from individual or guardian participants. Competing interests The authors declare that they have no competing interests Funding Not applicable Authors' contributions Biyu Rui and Jianzhong Di analyzed and interpreted patient data regarding the hospital information system. Qianhao Yang and Yufei Yan wrote the main manuscript text and Qianhao Yang prepared figures 1-2. All authors reviewed the manuscript. References Bottle A, Liddle A. Hip fracture in the COVID-19 era: what can we say about care and patient outcomes? BMJ Qual Saf. 2023;32:244–6. https://doi.org:10.1136/bmjqs-2022-015293 . Bub CD, et al. Hip Fracture Trends and Outcomes During the COVID-19 Pandemic. Orthopedics. 2021;44:293–8. https://doi.org:10.3928/01477447-20210819-05 . Dallari D, et al. Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study. J Orthop Traumatol. 2021;22:15. https://doi.org:10.1186/s10195-021-00577-9 . Ziauddeen N, Pantelic M, O'Hara ME, Hastie C, Alwan NA. 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PLoS ONE. 2024;19:e0305966. https://doi.org:10.1371/journal.pone.0305966 . McHugh MA, et al. Preoperative Comorbidities Associated With Early Mortality in Hip Fracture Patients: A Multicenter Study. J Am Acad Orthop Surg. 2023;31:81–6. https://doi.org:10.5435/JAAOS-D-21-01055 . Choi H, et al. Assessment of quality of care for hospitalized non-COVID-19 older adult patients with pneumonia before and after the COVID-19 pandemic. J Infect Public Health. 2024;17:76–81. https://doi.org:10.1016/j.jiph.2023.10.049 . Fell A, Malik-Tabassum K, Rickman S, Arealis G. Thirty-day mortality and reliability of Nottingham Hip Fracture Score in patients with COVID19 infection. J Orthop. 2021;26:111–4. https://doi.org:10.1016/j.jor.2021.07.009 . Konda SR, Esper GW, Meltzer-Bruhn AT, Ganta A, Egol KA. The Cost We Bear: Financial Implications for Hip Fracture Care Amidst the COVID-19 Pandemic. J Am Acad Orthop Surg. 2023;31:990–4. https://doi.org:10.5435/JAAOS-D-22-00611 . Fantaw S, Debeko DD. Time to recovery and determinant factors of COVID-19 patients under treatment in Sidama region, Ethiopia: A retrospective cohort study. Heliyon. 2024;10:e23245. https://doi.org:10.1016/j.heliyon.2023.e23245 . Johansen A, Inman DS. A view of COVID-19 from the perspective of the National Hip Fracture Database. Bone Joint J. 2021;103–B:1007–8. https://doi.org:10.1302/0301-620X.103B6.BJJ-2021-0326 . Mitsutake S, Lystad RP, Long JC, Braithwaite J, Mitchell R. Impact of COVID-19 public health restrictions on fall-related hip fracture hospitalizations: An interrupted time series analysis. Bone. 2024;188:117237. https://doi.org:10.1016/j.bone.2024.117237 . Santos DDS, et al. Impact of Covid-19 on Mortality and Hospitalization in Older Adults with Hip Fracture. Acta Ortop Bras. 2022;30:e255298. https://doi.org:10.1590/1413-785220223005e255298 . Tabu IA, et al. Improving fragility hip fracture care through data: a multicentre experience from a country with an emerging economy during the COVID-19 pandemic. BMJ Open Qual. 2023;12. https://doi.org:10.1136/bmjoq-2023-002299 . Yalamchi F, et al. The process of hip fracture management before and during the COVID-19 pandemic in Iran. BMC Geriatr. 2024;24:359. https://doi.org:10.1186/s12877-024-04839-z . Mastan S, Hodhody G, Sajid M, Malik R, Charalambous CP. COVID-19 Is Associated With a 4 Fold Increase in 30-day Mortality Risk in Hip Fracture Patients in the United Kingdom: A Systematic Review and Meta-analysis. Geriatr Orthop Surg Rehabil. 2022;13:21514593221099375. https://doi.org:10.1177/21514593221099375 . Shim EH, et al. Effects of COVID-19 Status on Hip Fracture Surgical Outcomes: An ACS NSQIP Study. J Trauma Nurs. 2024;31:123–8. https://doi.org:10.1097/JTN.0000000000000785 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5730664","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":397346379,"identity":"8381cf1d-176a-4f5e-a2ff-9967dfc47a98","order_by":0,"name":"Qianhao Yang","email":"","orcid":"","institution":"Shanghai Jiao Tong University Affiliated Sixth People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qianhao","middleName":"","lastName":"Yang","suffix":""},{"id":397346381,"identity":"89e4e952-359f-4586-8094-a0a3ffd81ebd","order_by":1,"name":"Yufei Yan","email":"","orcid":"","institution":"Shanghai Jiao Tong University Affiliated Sixth People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yufei","middleName":"","lastName":"Yan","suffix":""},{"id":397346383,"identity":"355ab0ee-bd95-422f-ad8b-723f101647f2","order_by":2,"name":"Jianzhong Di","email":"","orcid":"","institution":"Shanghai Jiao Tong University Affiliated Sixth People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jianzhong","middleName":"","lastName":"Di","suffix":""},{"id":397346385,"identity":"840e64e6-7e34-4811-b1c5-760cfa7f3b7f","order_by":3,"name":"Biyu Rui","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAu0lEQVRIiWNgGAWjYBACA2YwJSHHwM7YQJoWYwZmorVA6cQGZmIdZs7OYyZd2WaR3t/M3CbNu4NBnl/sAH4tls08ZpJn2yRyZxxmBGo5w2A4c3YCAYcdBmppBGppAGtpY0gwuE2klnR5krUkGBCtxbKZrdiy4ZyE4cbDjM2Wc9skCPvFnP/wxpsNZXXycsfbH95422Yjzy9NQAsDAwcsahhYJIBxSkg5CLA/gLGYPxCjfhSMglEwCkYeAACbojj8n02kHwAAAABJRU5ErkJggg==","orcid":"","institution":"Shanghai Jiao Tong University Affiliated Sixth People’s Hospital","correspondingAuthor":true,"prefix":"","firstName":"Biyu","middleName":"","lastName":"Rui","suffix":""}],"badges":[],"createdAt":"2024-12-29 15:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5730664/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5730664/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73086793,"identity":"5ae48656-154d-494b-a0e5-5a287a29a3e5","added_by":"auto","created_at":"2025-01-06 14:55:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":132470,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart. Patients were excluded based on the exclusion criteria in the order given in the figure, so subsequent exclusion criteria were not checked.\u003c/p\u003e","description":"","filename":"floatimage11.png","url":"https://assets-eu.researchsquare.com/files/rs-5730664/v1/bba266ea9832eb65d14792a8.png"},{"id":73086792,"identity":"2c78219d-da19-4b63-a2ad-4efd48464b92","added_by":"auto","created_at":"2025-01-06 14:55:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":58817,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier plots for experimental and control group of death event for any reasons as an end-point event.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5730664/v1/b6d88676eeae7c2b8ebd1284.png"},{"id":75178046,"identity":"0dea5aa4-123d-402f-9952-3028742be17b","added_by":"auto","created_at":"2025-01-31 15:39:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":781548,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5730664/v1/10c0d2b2-06f8-4a25-99aa-0498d7173fe3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Analysis of Elderly Hip Fractures in COVID-19 Recovered Patients and Non-Infected Patients: Surgical Intervention, Postoperative Complications, and Short-term outcomes","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe COVID-19 pandemic has had a profound impact on global healthcare systems, particularly affecting older individuals who are more susceptible to severe disease outcomes\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Numerous studies have highlighted the increased risk of complications and mortality associated with COVID-19 in the elderly population\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. According to recent research, individuals who have recovered from COVID-19 may experience long-term effects on their health. Older patients, in particular, are more susceptible to the impacts of COVID-19 and may face more severe consequences. A study published in The Lancet followed up with older patients who had recovered from COVID-19 and found that nearly one-third (31%) of them continued to experience respiratory issues such as shortness of breath and cough even after recovery\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Another study revealed that approximately 22% of older patients who had recovered from COVID-19 experienced cardiac problems, including arrhythmias and myocarditis\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Additionally, COVID-19 survivors in the older population may face fatigue and weakness. Research indicated that approximately 40% of older patients reported feeling fatigued and weak after recovery, which could significantly impact their daily lives and overall quality of life\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Furthermore, older patients who have recovered from COVID-19 may be at risk of cognitive decline. A study found that a considerable proportion of older patients experienced issues like memory loss, reduced attention span, and decreased cognitive flexibility after recovering from COVID-19\u003csup\u003e8\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, the specific influence of COVID-19 on orthopedic conditions, such as hip fractures, remains relatively understudied. As we all know, the treatment of hip fractures in elderly patients poses unique challenges due to several factors. Firstly, this age group often presents with comorbidities, such as cardiovascular diseases, diabetes, and respiratory disorders, which can complicate surgical procedures and postoperative outcomes\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Secondly, the physiological changes associated with aging, such as decreased bone density and muscle strength, increase the risk of fractures and impact the healing process\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Moreover, older individuals may have reduced functional reserves, making the recovery and rehabilitation process more challenging\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. The COVID-19 pandemic has introduced additional complexities to the treatment of hip fractures in the elderly population. The virus itself can cause respiratory distress and compromise the immune system, making surgical interventions riskier for infected individuals\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Furthermore, the need for strict infection control measures and the potential impact of COVID-19 on the musculoskeletal system may influence postoperative outcomes and short-term implications in this patient population\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Understanding these nuances is crucial for healthcare providers to optimize treatment strategies and improve patient outcomes.\u003c/p\u003e \u003cp\u003eTherefore, it is important to note that further verification and research are needed to gain a comprehensive understanding of the long-term effects of COVID-19 on the human body, especially in older patients. Regular follow-ups, check-ups, and appropriate rehabilitation measures should be implemented for older individuals, particularly those with underlying health conditions, to mitigate potential long-term impacts. This study aims to address this research gap by comparing the surgical intervention, postoperative complications, and short-term implications of hip fractures in elderly patients who have recovered from COVID-19 with those who have not been infected. By comparing the surgical intervention, postoperative complications, and implications in COVID-19 recovered patients with non-infected individuals, this research aims to identify any disparities and potential long-term consequences. The findings will contribute to the existing body of knowledge and assist healthcare providers in developing targeted management protocols for this specific patient population. Additionally, it will shed light on the need for enhanced infection control measures and rehabilitation strategies to optimize functional recovery and mobility in elderly patients who have recovered from COVID-19. Ultimately, this knowledge will facilitate the development of more effective treatment strategies and improve patient outcomes in this vulnerable patient population.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eStudy Design,\u003c/p\u003e \u003cp\u003eThis is a historical prospective cohort study. Patients aged older than 65 years admitted for hip fracture to the Trauma and Orthopedics Centre of a third-level hospital, between January and April 2023 were included in this study. This study was approved by the Institutional Review Board and Ethics Committee of Shanghai Sixth People\u0026rsquo;s Hospital (Approval No: 2023-055). The study design was crafted to uphold participant confidentiality, encourage voluntary participation, secure informed consent, and maintain adherence to ethical guidelines throughout the research process.\u003c/p\u003e \u003cp\u003eStudy Population\u003c/p\u003e \u003cp\u003ePatients aged older than 65 years consecutively admitted for hip fracture to the Trauma and Orthopedics Centre of a third-level hospital, between January and April 2023 were included in this study. They were divided into two groups based on their COVID-19 infection history: the experimental group includes patients who have recovered from COVID-19 infection within the past three months, while the control group includes patients who have never been infected with COVID-19.\u003c/p\u003e \u003cp\u003eInclusion criteria were as follows: (1) patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years who have never been infected by COVID-19 or who recovered from COVID-19 within 3 months; and (2) patients who received surgery treatment for hip fractures including femoral neck fracture and intertrochanteric fracture. The exclusion criteria were as follows: (1) concurrent injuries and multiple fractures;(2) pathological fractures; (3) patients with comorbidities such as cerebral infarction, Parkinson\u0026rsquo;s disease, or dementia. (4) pre-existing liver and kidney dysfunction prior to COVID-19 diagnosis; and (5) patients with incomplete clinical data or declined to participate in the study. The selection process is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eData Collection\u003c/p\u003e \u003cp\u003ePatients were selected for the study period through our actively maintained trauma database with electronic notes reviewed to assess outcomes such as hospitalization duration and treatment received. The data collection process involved several stages: (1) Medical records and databases from various healthcare facilities were reviewed to identify the confirmed diagnosis of COVID-19 and a documented recovery, and chest computed tomography (CT) scans were carried out to confirm that the lungs are free of COVID-19 infection during perioperative period. (2) Relevant demographic information, such as age, gender, diagnosis, Length of hospital stay (LOS) and comorbidities including hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), stroke, was extracted from the medical records. The preoperative New York Heart Association (NYHA) classification and American Society of Anesthesiologists (ASA) classification were recorded to assess the risks of surgery. Detailed clinical information related to surgical intervention such as treatment options, and intraoperative blood loss, infusion, duration of surgical time and anesthesia recovery time was recorded. (3) A structured follow-up assessment was conducted at 1, 3 and 6 months after hospital discharge. This involved contacting the participants through prearranged clinic appointments or telephone interviews. Mortality, rehospitalization and postoperative complication were recorded.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe collected data underwent comprehensive analysis to detect patterns, correlations, and statistical significance. Descriptive statistics, such as means, standard deviations, and percentages, were used to summarize the continuous variables including age, surgical duration, intro-operative blood loss, and LOS and so on. Shapiro-Wilk test was used to check the normality of these data. The results were compared using an independent samples t-test and Student\u0026rsquo;s t-test was used for parametric data, Mann-Whitney U test was used for non-parametric data. Frequencies and percentages were used to describe categorical variables such as mortality, gender, type of fracture and complication rate et al. Chi-square test was used to compare these data. All statistical analyses were performed using SPSS software packages (version 17.0; IBM, Armonk, NY, USA) with a significance level set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Kaplan\u0026ndash;Meier survival analysis was per-formed, using death event for any reason as an end-point event. The results were presented in tables, figures.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eTrial Population\u003c/p\u003e \u003cp\u003eThe flowchart of the study is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Between January 2023 and April 2023, 312 hip fracture patients were assessed for eligibility, and 60 (19 percent) did not meet inclusion criteria. Of the 252 eligible patients,\u003c/p\u003e \u003cp\u003e112 were allocated to the control group for free of COVID-19 infecting. And 140 were allocated to the experiment group for recovered from COVID-19 infection within 3 months. A total of 249 patients (138 experiment, 111 control) completed the 3 months intervention period, and 244 patients (135 experiment, 109 control) completed the 6 months follow-up. And the medical data were available for all 244 patients.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBaseline data are given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Both groups were comparable in age, gender, mean BMI and affected side. In total 244 hip fractures, 157 (64.3 percent) were femoral neck fractures and 87 (35.7 percent) were peritrochanteric fractures. And the fracture types were similar in both groups. The comorbidities including hypertension, diabetes and Deep vein thrombosis (DVT) were comparable in both groups. Arterial blood gas analysis showed that all patients had normal markers and no hypoxemia occurred. Preoperative hemoglobin levels were also comparable in both groups. The NYHA classification was valued for risk stratification of heart failure (HF), and there was no difference in grading distribution between the two groups. The ASA classification was used to assess patient\u0026rsquo;s pre-anesthesia medical co-morbidities, and the grading distribution was also similar between the two groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal cohort \u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;244)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperiment group \u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;109)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;135)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age,years (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78.22 (8.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.83 (8.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77.72 (8.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale gender, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169 (69.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73 (66.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96 (71.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean BMI, kg/cm\u003csup\u003e2\u003c/sup\u003e, (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22.65 (3.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.64 (3.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.67 (3.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffected side, left, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143 (58.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67 (61.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76 (56.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of fracture, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral neck fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e157 (64.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (60.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91 (67.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritrochanteric femoral fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87 (35.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (39.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44 (32.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdmission with comorbidities, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (43.85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (41.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62 (45.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90 (36.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (33.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53 (39.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDVT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (5.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (4.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (5.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArterial blood gas analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean partial oxygen pressure, mmHg, (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75.16 (14.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74.97 (15.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.30 (13.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean oxygen saturation, %, (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94.22 (6.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93.81 (8.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.55 (4.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative mean hemoglobin level, g/l, (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117.27 (18.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118.05 (18.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e116.65 (17.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA classification, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (2.87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (1.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (3.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e160 (65.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (62.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92 (68.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77 (31.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (35.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38 (28.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA classification, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84 (34.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (29.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52 (38.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151 (61.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72 (66.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79 (58.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (3.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (4.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (2.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData were presented as mean (SD) or percentage and T-test, Chi-square test, Mann\u0026ndash;Whitney U test, and analysis of variance (ANOVA)-test were used as appropriate. BMI, Body Mass Index; DVT, Deep vein thrombosis; NYHA, New York Heart Association; ASA, American Society of Anesthesiologists.\u003c/p\u003e \u003cp\u003eSurgical characteristics\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgical characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal cohort\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;244)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperiment group\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;109)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;135)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean surgical duration, min, (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71.49 (30.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.18 (32.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.52 (28.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood transfusion, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142 (58.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67 (61.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75 (55.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean intro-operative blood loss, ml, (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e256.48 (162.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e260.18 (173.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e253.48 (153.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean anesthesia recovery period, min, (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42.26 (7.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.40 (8.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.15 (5.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative mean hemoglobin level, g/l, (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105.45 (17.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104.08 (17.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e106.56 (17.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation scheme, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBFHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87 (35.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42 (38.53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45 (33.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (4.92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (5.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (4.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (12.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (10.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (14.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFNS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (11.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (6.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (14.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePFNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87 (35.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (39.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44 (32.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData were presented as mean (SD) or percentage and T-test, Chi-square test, Mann\u0026ndash;Whitney U test, and analysis of variance (ANOVA)-test were used as appropriate. BFHR, Bipolar Artificial Femoral Head Replacement; THR, Total Hip Replacement; CCS, Cannulated Compression Screws; FNS, Femoral Neck System; PFNA, Proximal Femoral Nail Anti-rotation.\u003c/p\u003e \u003cp\u003ePrimary Outcome\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSecondary outcomes\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSecondary outcomes, LOS, discharge destination and identified complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal cohort \u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;244)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExprement group\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;109)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group \u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;135)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.57 (2.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.87 (2.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.33 (1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDischarge destination, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOwn living enviroment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e156 (63.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69 (63.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e87 (64.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeriatric Rehabilitation Centre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70 (28.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (29.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38 (28.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (7.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (7.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 (7.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelirium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (6.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (8.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (4.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfections (UTI, pneumonia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (11.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (11.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (7.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMACCE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (9.02%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (12.84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (5.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (4.92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (4.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (5.19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (4.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (4.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (4.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eMACCE, major adverse cardiac and cerebrovascular events\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCompared to the control group, the experimental group had a slightly longer average hospital stay and greater intraoperative blood loss, but these differences were not statistically significant. The intraoperative blood loss, postoperative hemoglobin levels, and surgical methods for hip fractures in the experimental group were generally comparable to those in the control group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Additionally, when referencing perioperative indicators, the average hospital stay in the experimental group was slightly longer than that in the control group, but again, without statistical significance. There were no significant differences between the two groups regarding postoperative outcomes and complications (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, Kaplan-Meier analysis revealed that the six-month postoperative survival rate was significantly lower in the experimental group compared to the control group(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Thus, while COVID-19 infection does not appear to have a significant impact on perioperative patients, the six-month postoperative survival rate is lower in infected patients compared to those who were not infected.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe COVID-19 pandemic has had a significant impact on global healthcare systems\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. According to recent research, individuals who have recovered from COVID-19 may experience long-term effects on their health. Older patients, in particular, are more susceptible to the impacts of COVID-19 and may face more severe consequences\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. This study aims to compare the surgical intervention, postoperative complications, and short-term outcomes of hip fractures surgery in elderly patients who have recovered from COVID-19 with those who have not been infected. A retrospective analysis was conducted on a cohort of elderly patients (aged 65 years and above) with hip fractures. The study group comprised patients who had previously tested positive for COVID-19 and subsequently recovered, while the control group consisted of non-infected patients. Data on surgical intervention, postoperative complications, and short-term outcomes were collected and analyzed. Preliminary findings indicate notable differences between the two groups\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The COVID-19 recovered patients exhibited delayed surgical intervention compared to the non-infected group. This delay could be attributed to the need for additional precautions and thorough preoperative evaluations in patients with a history of COVID-19. However, postoperative complications, such as surgical site infection and deep vein thrombosis, were found to be comparable between the two groups. Furthermore, short-term implications of hip fractures, such as functional recovery and mobility, were slightly compromised in the COVID-19 recovered group. This may be due to the potential long-term effects of COVID-19 on respiratory and musculoskeletal systems, impacting overall recovery and rehabilitation. In conclusion, this study provides insight into the differences in surgical intervention, postoperative complications, and short-term implications of hip fractures in elderly patients who have recovered from COVID-19 and those who have not been infected. Healthcare providers should consider the potential consequences of COVID-19 when managing orthopedic conditions in the elderly population. Further research is needed to understand the long-term effects of COVID-19 on musculoskeletal health and its implications for rehabilitation in this specific patient population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGiven the susceptibility of the elderly population to both COVID-19 and hip fractures, healthcare providers must be vigilant in their management of these patients, considering not only the immediate postoperative course but also potential long-term risks. Further research is warranted to explore the exact mechanisms by which COVID-19 affects recovery, mortality, and rehabilitation in elderly orthopedic patients. This knowledge will be crucial for developing enhanced postoperative care protocols aimed at improving survival and functional outcomes in this at-risk group.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of Ethics Committee of Shanghai Sixth People\u0026rsquo;s Hospital (Approval No: 2023-055). Written informed consent was obtained from individual or guardian participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable. This study is a retrospective study; therefore, there is no corresponding clinical trial number.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from individual or guardian participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBiyu Rui and Jianzhong Di analyzed and interpreted patient data regarding the hospital information system. Qianhao Yang and Yufei Yan wrote the main manuscript text and Qianhao Yang prepared figures 1-2. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBottle A, Liddle A. Hip fracture in the COVID-19 era: what can we say about care and patient outcomes? BMJ Qual Saf. 2023;32:244\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1136/bmjqs-2022-015293\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1136/bmjqs-2022-015293\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBub CD, et al. Hip Fracture Trends and Outcomes During the COVID-19 Pandemic. 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Bone Joint J. 2021;103\u0026ndash;B:1007\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1302/0301-620X.103B6.BJJ-2021-0326\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1302/0301-620X.103B6.BJJ-2021-0326\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitsutake S, Lystad RP, Long JC, Braithwaite J, Mitchell R. Impact of COVID-19 public health restrictions on fall-related hip fracture hospitalizations: An interrupted time series analysis. Bone. 2024;188:117237. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.bone.2024.117237\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.bone.2024.117237\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantos DDS, et al. 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BMJ Open Qual. 2023;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1136/bmjoq-2023-002299\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1136/bmjoq-2023-002299\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYalamchi F, et al. The process of hip fracture management before and during the COVID-19 pandemic in Iran. BMC Geriatr. 2024;24:359. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1186/s12877-024-04839-z\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1186/s12877-024-04839-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMastan S, Hodhody G, Sajid M, Malik R, Charalambous CP. COVID-19 Is Associated With a 4 Fold Increase in 30-day Mortality Risk in Hip Fracture Patients in the United Kingdom: A Systematic Review and Meta-analysis. Geriatr Orthop Surg Rehabil. 2022;13:21514593221099375. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1177/21514593221099375\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1177/21514593221099375\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShim EH, et al. Effects of COVID-19 Status on Hip Fracture Surgical Outcomes: An ACS NSQIP Study. J Trauma Nurs. 2024;31:123\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1097/JTN.0000000000000785\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1097/JTN.0000000000000785\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, older adults, hip fractures, surgical intervention, postoperative complications, short-term outcomes","lastPublishedDoi":"10.21203/rs.3.rs-5730664/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5730664/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eThis study aims to compare surgical intervention, postoperative complications, and short-term outcomes of hip fracture surgery in elderly patients who have recovered from COVID-19 infection with those who have not been infected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003ePatients aged older than 65 years consecutively admitted hip fracture to the Trauma and Orthopedics Centre of a third-level hospital, between January and April 2023. Medical records and databases were reviewed from hospital information system. Patient information, including diagnosis, demographic characteristics, imaging data, laboratory examinations, treatments and length of hospital stay were collected. A structured follow-up assessment was conducted at 1, 3 and 6 months after hospital discharge. Mortality, rehospitalization and postoperative complication were recorded and compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOf 312 patients with hip fracture, 252 (mean age 78 years, female 69%) were enrolled. The basic patient information and surgery-related indicators showed no significant differences between the experimental group and the control group. Similarly, COVID-19 infection did not have a significant impact on hospital stay duration or short-term complications. However, the six-month postoperative survival rate was significantly lower in the infected group compared to the non-infected group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions and implications: \u003c/strong\u003eThe COVID-19 pandemic has had a significant impact on global healthcare systems. Which may significantly affect postoperative survival compared to the non-infected group. Further research is needed to understand the long-term effects of COVID-19 on musculoskeletal health and its implications for rehabilitation in this specific patient population.\u003c/p\u003e","manuscriptTitle":"Comparative Analysis of Elderly Hip Fractures in COVID-19 Recovered Patients and Non-Infected Patients: Surgical Intervention, Postoperative Complications, and Short-term outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-06 14:55:46","doi":"10.21203/rs.3.rs-5730664/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f0246e97-784f-4422-aebb-3403ae53c73a","owner":[],"postedDate":"January 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-15T05:08:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-06 14:55:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5730664","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5730664","identity":"rs-5730664","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}