Impact of COVID-۱۹ on Timing of Hip-Fracture Surgeries: An Interrupted Time-Series Analysis of the Pre/Post-Quarantine Period in Northern Italy

Background  To assess whether the imposition of the coronavirus disease ۲۰۱۹ (COVID-۱۹) national quarantine (March ۱۰, ۲۰۲۰) resulted in a shift in the proportion of patients operated for hip fracture on the day of admission, the following day and two days after admission in the region of Piedmont, northern Italy. Methods  Interrupted time-series analysis (ITSA) comparing hospitalization rate and timing of hip-fracture surgeries between pre- and post-quarantine period. The same data observed in Piedmont the year before were included as a control time series with no “intervention” (quarantine) in the middle of the observation period. Results  We found that ۷۰.۳% and ۶۹.۴% of hip-fracture patients received surgery within ۲ days of hospital admission in the ۱۶ weeks before and after the national quarantine, respectively. One-day surgery went from ۴۶.۰% to ۴۶.۵%, and same- day surgery from ۱۳.۳% to ۱۲.۴%. Unchanged trends were confirmed by ITSA after controlling for the ۳۲-week time- series observed the year before. In the second week of March ۲۰۲۰, there was a borderline significant decrease in weekly hospital admissions for hip fractures as compared with that of the same week of March ۲۰۱۹ (–۱.۹۵ per ۱۰۰ ۰۰۰, ۹۵% CI = –۴.۱۰ to ۰.۲۱, P value = .۰۷۵), followed by a weekly significant increase in the hospitalization rate (+۰.۱۴ per ۱۰۰ ۰۰۰, ۹۵% CI = ۰.۰۱ to ۰.۲۷, P value = .۰۳۹), although the difference-in-differences of slopes failed to achieve statistical significance (۰.۱۹ per ۱۰۰ ۰۰۰, ۹۵% CI = –۰.۰۳ to ۰.۴۱, P value = .۰۹۰). Conclusion  Our study shows that the timing of hip-fracture surgery was unchanged during the lockdown period. This suggests that  the healthcare systems can be resilient and able to guarantee a high-quality and safe healthcare to hipfracture patients, even in the most challenging working conditions.

Keywords:

Quality of Care , Hip Fractures , Elderly , COVID-۱۹ Pandemic , Interrupted Time Series , Italy