{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T17:31:02Z","timestamp":1772213462506,"version":"3.50.1"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T00:00:00Z","timestamp":1644969600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>As COVID-19 roared through the world, governments worldwide enforced containment measures that affected various treatment pathways, including those for hip fractures (HFs). This study aimed to measure process and outcome indicators related to the quality of care provided to non-COVID-19 elderly patients affected by HF in Emilia-Romagna, a region of Italy severely hit by the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We collected the hospital discharge records of all patients admitted to the hospitals of Emilia-Romagna with a diagnosis of HF from January to May in the years 2019 (pre-pandemic period) and 2020 (pandemic period). We analyzed surgery rate, surgery delays, length of hospital stay, timely rehabilitation, and 30-day mortality for each HF patient. We evaluated monthly data (2020 vs. 2019) with the chi-square and t-test, where appropriate. Logistic regression was used to investigate the differences in 30-day mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our study included 5379 patients with HF. In April and May 2020, there was a significant increase in the proportion of HF patients that did not undergo timely surgery. In March 2020, we found a significant increase in mortality (OR = 2.22). Male sex (OR = 1.92), age \u226590 years (OR = 4.33), surgery after 48 hours (OR = 3.08) and not receiving surgery (OR = 6.19) were significantly associated with increased mortality. After adjusting for the aforementioned factors, patients hospitalized in March 2020 still suffered higher mortality (OR = 2.21).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There was a reduction in the overall quality of care provided to non-COVID-19 elderly patients affected by HF, whose mortality increased in March 2020. Patients\u2019 characteristics and variations in processes of care partially explained this increase. Policymakers and professionals involved in the management of COVID-19 patients should be aware of the needs of patients with other health needs, which should be carefully investigated and included in future emergency preparedness and response plans.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0263944","type":"journal-article","created":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T13:37:36Z","timestamp":1645018656000},"page":"e0263944","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":19,"title":["Variations of the quality of care during the COVID-19 pandemic affected the mortality rate of non-COVID-19 patients with hip fracture"],"prefix":"10.1371","volume":"17","author":[{"given":"Davide","family":"Golinelli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8288-0563","authenticated-orcid":true,"given":"Francesco","family":"Sanmarchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7505-0702","authenticated-orcid":true,"given":"Angelo","family":"Capodici","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5034-7446","authenticated-orcid":true,"given":"Giorgia","family":"Gribaudo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia","family":"Altini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Rosa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7775-1695","authenticated-orcid":true,"given":"Francesco","family":"Esposito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Pia","family":"Fantini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2882-4223","authenticated-orcid":true,"given":"Jacopo","family":"Lenzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,2,16]]},"reference":[{"key":"pone.0263944.ref001","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1016\/j.injury.2018.04.015","article-title":"Epidemiology and social costs of hip fracture","volume":"49","author":"Nicola Veronese","year":"2018","journal-title":"Injury"},{"issue":"11","key":"pone.0263944.ref002","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1016\/j.injury.2013.06.018","article-title":"Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures","volume":"44","author":"IS Liem","year":"2013","journal-title":"Injury"},{"issue":"4","key":"pone.0263944.ref003","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.injury.2019.03.031","article-title":"The impact of time to surgery after hip fracture on mortality at 30- and 90-days: Does a single benchmark apply to all?","volume":"50","author":"LA Beaupre","year":"2019","journal-title":"Injury"},{"issue":"2","key":"pone.0263944.ref004","first-page":"138","article-title":"AAOS Clinical Practice Guideline: Management of Hip Fractures in the Elderly [published correction appears in J Am Acad Orthop Surg. 2015 Apr;23(4):266]","volume":"23","author":"KC Roberts","year":"2015","journal-title":"J Am Acad Orthop Surg"},{"issue":"1","key":"pone.0263944.ref005","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1186\/s12913-018-3523-x","article-title":"Impact of rehabilitation on mortality and readmissions after surgery for hip fracture","volume":"18","author":"D Tedesco","year":"2018","journal-title":"BMC Health Serv Res"},{"issue":"11","key":"pone.0263944.ref006","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.1093\/gerona\/glaa199","article-title":"Length of Hospital Stay for Hip Fracture and 30-Day Mortality in People With Alzheimer\u2019s Disease: A Cohort Study in Finland","volume":"75","author":"P Lavikainen","year":"2020","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"6","key":"pone.0263944.ref007","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1007\/s00264-018-3928-5","article-title":"Which is the optimal orthogeriatric care model to prevent mortality of elderly subjects post hip fractures? A systematic review and meta-analysis based on current clinical practice","volume":"43","author":"J Moyet","year":"2019","journal-title":"Int Orthop"},{"issue":"2","key":"pone.0263944.ref008","doi-asserted-by":"crossref","first-page":"e338","DOI":"10.1002\/onco.13578","article-title":"Dramatic Changes in Oncology Care Pathways During the COVID-19 Pandemic: The French ONCOCARE-COV Study","volume":"26","author":"M Brugel","year":"2021","journal-title":"Oncologist"},{"key":"pone.0263944.ref009","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1038\/s43018-020-0074-y","article-title":"The impact of the COVID-19 pandemic on cancer care","volume":"1","author":"M. Richards","year":"2020","journal-title":"Nat Cancer"},{"key":"pone.0263944.ref010","first-page":"2020","article-title":"Management of orthopaedic and traumatology patients during the Coronavirus disease (COVID-19) pandemic in northern Italy","volume":"28","author":"P.S. Randelli","year":"1683","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"7","key":"pone.0263944.ref011","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1016\/j.injury.2020.06.006","article-title":"The Evolving COVID-19 Effect on Hip Fracture Patients","volume":"51","author":"J. N. Hadfield","year":"2020","journal-title":"Injury"},{"issue":"7","key":"pone.0263944.ref012","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.1016\/j.injury.2020.04.033","article-title":"Trauma service reorganization in Bologna (Italy) during COVID-19 pandemic","volume":"51","author":"A. Di Martino","year":"2020","journal-title":"Injury"},{"issue":"6","key":"pone.0263944.ref013","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1007\/s00167-020-06032-2","article-title":"Massive cutback in orthopaedic healthcare services due to the COVID-19 pandemic","volume":"28","author":"Board of the AGA-Society of Arthroscopy and Joint-Surgery","year":"2020","journal-title":"Knee surgerysports traumatology, arthroscopy: official journal of the ESSKA"},{"issue":"10","key":"pone.0263944.ref014","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1007\/s00264-020-04769-6","article-title":"Prolonged social lockdown during COVID-19 pandemic and hip fracture epidemiology","volume":"44","author":"PA Slullitel","year":"2020","journal-title":"Int Orthop"},{"issue":"9","key":"pone.0263944.ref015","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1038\/s41574-020-0379-z","article-title":"Managing fragility fractures during the COVID-19 pandemic","volume":"16","author":"N Napoli","year":"2020","journal-title":"Nat Rev Endocrinol"},{"issue":"5","key":"pone.0263944.ref016","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1007\/s40258-020-00608-2","article-title":"Comment on: \"The Italian NHS: What Lessons to Draw from COVID-19?\"","volume":"18","author":"D Golinelli","year":"2020","journal-title":"Appl Health Econ Health Policy"},{"issue":"4","key":"pone.0263944.ref017","doi-asserted-by":"crossref","first-page":"880","DOI":"10.3390\/jcm10040880","article-title":"Effects of the COVID-19 Epidemic on Hospital Admissions for Non-Communicable Diseases in a Large Italian University-Hospital: A Descriptive Case-Series Study","volume":"10","author":"C Caminiti","year":"2021","journal-title":"Journal of Clinical Medicine"},{"issue":"12","key":"pone.0263944.ref018","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1001\/jama.1988.03410120089033","article-title":"The quality of care. How can it be assessed?","volume":"260","author":"A. Donabedian","year":"1988","journal-title":"JAMA"},{"key":"pone.0263944.ref019","first-page":"1178632921991122","article-title":"Cost Determinants of Continuum-Care Episodes for Hip Fracture","volume":"14","author":"D Golinelli","year":"2021","journal-title":"Health Serv Insights"},{"issue":"10","key":"pone.0263944.ref020","doi-asserted-by":"crossref","first-page":"e0240899","DOI":"10.1371\/journal.pone.0240899","article-title":"Modified-Chronic Disease Score (M-CDS): Predicting the individual risk of death using drug prescriptions","volume":"15","author":"M Iommi","year":"2020","journal-title":"PLoS One"},{"key":"pone.0263944.ref021","doi-asserted-by":"crossref","first-page":"575","DOI":"10.2147\/JPR.S285814","article-title":"The Aftermath of COVID-19 Lockdown on Daily Life Activities in Orthopaedic Patients","volume":"14","author":"P Persiani","year":"2021","journal-title":"J Pain Res"},{"issue":"3","key":"pone.0263944.ref022","doi-asserted-by":"crossref","first-page":"e0248995","DOI":"10.1371\/journal.pone.0248995","article-title":"Non-COVID-19 patients in times of pandemic: Emergency department visits, hospitalizations and cause-specific mortality in Northern Italy","volume":"16","author":"L Santi","year":"2021","journal-title":"PLoS One"},{"key":"pone.0263944.ref023","first-page":"22","article-title":"Patterns of Emergency Department visits for acute and chronic diseases during the two pandemic waves in Italy [published online ahead of print, 2021 Jul 9]","volume":"50","author":"D Golinelli","year":"2021","journal-title":"Am J Emerg Med"},{"key":"pone.0263944.ref024","first-page":"1","article-title":"Fear of Contagion: One of the Most Devious Enemies to Fight During the COVID-19 Pandemic","author":"E Baldi","year":"2020","journal-title":"Disaster Med Public Health Prep"},{"key":"pone.0263944.ref025","doi-asserted-by":"crossref","first-page":"567379","DOI":"10.3389\/fpsyg.2020.567379","article-title":"Is Fear of COVID-19 Contagious? The Effects of Emotion Contagion and Social Media Use on Anxiety in Response to the Coronavirus Pandemic","volume":"11","author":"MG Wheaton","year":"2021","journal-title":"Front Psychol"},{"key":"pone.0263944.ref026","article-title":"SORVEGLIANZA STRUTTURE RESIDENZIALI SOCIO-SANITARIE NELL\u2019EMERGENZA COVID-19: Report Nazionale Andamento temporale dell\u2019epidemia di COVID-19","author":"Istituto Superiore Di Sanit\u00e0: Donfrancesco C","year":"2021","journal-title":"ISS"},{"issue":"5","key":"pone.0263944.ref027","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1111\/jgs.16477","article-title":"American Geriatrics Society Policy Brief: COVID-19 and Nursing Homes","volume":"68","author":"American Geriatrics Society","year":"2020","journal-title":"J Am Geriatr Soc"},{"issue":"11","key":"pone.0263944.ref028","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1302\/2633-1462.111.BJO-2020-0132.R1","article-title":"NOF-COV19 Study Collaborative Group. Impact of COVID-19 on clinical outcomes for patients with fractured hip: a multicentre observational cohort study","volume":"1","author":"D Rasidovic","year":"2020","journal-title":"Bone Jt Open"},{"issue":"1","key":"pone.0263944.ref029","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jcot.2020.11.007","article-title":"Letter to the editor: Coronavirus disease 2019 (COVID-19) markedly increased mortality in patients with hip fracture: A systematic review and meta-analysis","volume":"12","author":"ND Clement","year":"2021","journal-title":"J Clin Orthop Trauma"},{"key":"pone.0263944.ref030","article-title":"In- and out-of-hospital mortality for myocardial infarction during the first wave of the COVID-19 pandemic in Emilia-Romagna, Italy: A population-based observational study","author":"G. Campo","year":"2021","journal-title":"The Lancet Regional Health Europe"},{"key":"pone.0263944.ref031","doi-asserted-by":"crossref","first-page":"e12046","DOI":"10.7717\/peerj.12046","article-title":"COVID-19 and regional differences in the timeliness of hip-fracture surgery: an interrupted time-series analysis","volume":"9","author":"D Golinelli","year":"2021","journal-title":"PeerJ"},{"issue":"7","key":"pone.0263944.ref032","doi-asserted-by":"crossref","first-page":"e2117359","DOI":"10.1001\/jamanetworkopen.2021.17359","article-title":"Exploring the Gap Between Excess Mortality and COVID-19 Deaths in 67 Countries","volume":"4","author":"F Sanmarchi","year":"2021","journal-title":"JAMA Netw Open"},{"key":"pone.0263944.ref033","doi-asserted-by":"crossref","first-page":"101257","DOI":"10.1016\/j.mex.2021.101257","article-title":"Small-scale spatial distribution of COVID-19-related excess mortality","volume":"8","author":"D Gibertoni","year":"2021","journal-title":"MethodsX"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263944","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T13:38:24Z","timestamp":1645018704000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263944"}},"subtitle":[],"editor":[{"given":"Hans-Peter","family":"Simmen","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,2,16]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0263944","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.11.27.21266927","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,16]]}}}