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Background and Aims Patients with hip fractures are one of the vulnerable groups for developing severe COVID-19. This study aims to assess the influence of COVID-19 infection on hip fracture surgery using data from the Korean National Health Insurance System.

Methods This retrospective study utilized data from Korean NHIS. We included patients admitted with operation codes specific to hip fracture between January 1, 2020, and December 31, 2021. We classified patients into a COVID (+) group with a diagnosis code (U071) 30 days around surgery and a COVID (-) group without the code in the same period. The primary outcome was 30-day mortality. Secondary outcomes were pulmonary complications, ICU admission, cardiac arrest, myocardial infarction, other thromboembolic events, surgical site infection, sepsis, acute renal failure, and hepatic failure.

Results Among 92,599 patients, 200 had a COVID-19 diagnosis code, while 86,284 did not. After 1:4 propensity score matching (PSM) by age, sex, Charlson Comorbidity Index, American Society of Anesthesiologists Physical status more than 3, total 995 patients were included in each group. 30-day mortality showed no significant differences between the two groups both before and after PSM. The COVID (+) group demonstrated significantly elevated rates of pneumonia. Hospital length of stay and admission costs were also significantly longer and higher, respectively. Comparing anesthetic method, there was no differences were observed in mortality and postoperative complications based on general and regional anesthesia.

Conclusions COVID-19 infection is associated with increased rates of postoperative pneumonia, longer hospital stays, and increased admission costs, in patients who underwent hip fracture surgery.