A STUDY of patients admitted to Scotland's largest hospital with hip fractures over a five-week period at the height of the Covid pandemic found there was no difference in death rates or complications compared to the same period in 2019.

The findings from the Queen Elizabeth University Hospital in Glasgow are understood to have surprised surgeons, who were expecting mortality this group of patients - who tend to be elderly - to be much higher than normal.

Even among patients who tested positive for Covid while in hospital, the mortality rate was 20 per cent - lower than the levels seen in comparable patient groups in countries including Spain and the US.

"We expected it would be way higher," said a source.

"We expected that if you got Covid it would be almost a death sentence, and Covid with a hip fracture would definitely be a death sentence.

"We can always do better - some people have succumbed - but I think the performance has been good."

READ MORE: Surgeon warns fifth of hip fracture patients caught coronavirus in hospital 

The study found that 10 of the 76 hip fracture patients admitted to the hospital between March 20 and April 25 this year tested positive for Covid-19 - one before surgery, and the remaining nine while they were recovering.

However, the researchers note that since 21 of the 76 patients were not screened for the virus, "it is likely that the rate of infection in our patients was higher".

Of these 10 patients two died, with the infection listed a the "primary cause of death" for both.

On average, the virus was detected 25 days after surgery.

The researchers state: "It is likely, therefore, that many of these infections were picked up in hospital. Our unit consists entirely of single rooms and admitted only patients with orthopaedic trauma during the pandemic.

"Hip fracture patients were transferred after an average of nine days to the offsite rehabilitation wards, which consist mainly of multi- occupant accommodation.

"It is possible that some infections were transmitted after transfer to rehabilitation."

Investigations have previously been launched into a string of coronavirus cases among patients who were transferred from single rooms at the QEUH to Gartnavel hospital to recuperate following surgery in order to keep the superhospital as empty as possible in case of an influx of Covid-related admissions.

Whistleblowers claimed in May that the virus had spread through shared wards at Gartnavel "like a cruise ship", claiming 25 patients' lives.

READ MORE: Covid-19 'spread like cruise ship' after patients were transferred to Gartnavel 

A spokeswoman for NHS Greater Glasgow and Clyde said transfer to Gartnavel is "the established pathway for patients requiring hospital care and convalescence following surgery following their acute admission".

She added: "Our priority throughout the pandemic has been to do all we can to provide safe and effective care for patients and maintain the safety of our staff, patients and visitors to our sites.

"We were one of the first NHS boards in Scotland to implement universal PPE for health care workers and we test in line with national guidance."

The study of hip fracture patients at the QEUH is among the first in the world to compare outcomes this year, during the pandemic, against previous years.

Crucially - in spite of the Covid deaths - the researchers found "no difference" in the overall 30-day mortality rate for patients admitted to the QEUH with hip fractures from March 20 in 2020, against those admitted in 2019.

In both years, there were 76 hip fracture admissions over the five week period, and there were no significant difference in their demographic profile - such as age, sex, and deprivation status.

In the 2020 group, 11 died within 30 days of surgery, compared to ten in the 2019 group. The difference was not statistically significant

There was also no significant difference in the rates of post-operative intensive care admissions, blood clots, dislocation, infection or length of hospital stay in 2020 compared to 2019.

Pulmonary complications were seen in greater numbers during the pandemic, with 15 of the 76 patients affected by problems such as post-operative pneumonia, compared to eight in 2019.

However, the authors caution that this was on "only an absolute rise of 10% and the difference was not significant".

Like previous studies in Edinburgh, England and Greece, the Glasgow study noted that while the trauma orthopaedic caseload - such as car crash injuries - declined, there was no change in the number of patients being admitted with hip fractures during the pandemic.

These patients are typically elderly - the median age in the QEUH study was 83 - and are prone to falls.

READ MORE: Orthopaedic surgeon says it will 'be years' before waiting lists recover from Covid delays  

Delay to surgery following a hip fracture is linked to higher mortality, but the suspension of elective work meant the QEUH was able to dedicate five theatres for trauma patients where normally there would only be three.

This also helped to "offset the increased time taken for patient transfers, deep cleaning of theatres, and the use of personal protective equipment [PPE]" as part of Covid infection-control measures.

The study also found that mortality rates among the Covid positive hip fracture patients operated on at the QEUH - at 20% - was lower than that seen in other countries.

Studies from Spain at New York, where hospitals faced huge influxes of coronavirus patients, put the figure at 30% and 56% respectively.

The researchers suggest this might be due longer waits for theatre: 2.4 days in Spain, and 1.5 days in New York, compared to 23 hours in the Glasgow study.

"In large part I think that's because we weren't overwhelmed," said the source.

"We did stop elective so that we could keep up with demand, which never went away.

"Despite lockdown, people are still falling at home. That's where these old people come from - from nursing homes, their own homes - and that never dried up, so it was business as usual for us in a way."