# Hospital-acquired COVID-19 and its effect on length of stay and mortality in orthopedic admissions: A matched cohort study

## TL;DR

Hospital-acquired COVID-19 in orthopedic patients leads to longer hospital stays and earlier death after discharge, despite similar overall mortality rates.

## Contribution

This study identifies the specific impact of hospital-acquired COVID-19 on recovery and mortality in orthopedic patients.

## Key findings

- Hospital-acquired COVID-19 patients had significantly longer hospital stays compared to controls.
- Infected patients had shorter time to death after discharge compared to uninfected patients.
- ICU admissions occurred only in the COVID-19 group despite similar baseline characteristics.

## Abstract

Hospital-acquired COVID-19 poses a significant threat to orthopedic patients, a population already at risk due to immobility, comorbidities, and extended hospital stays. The combined burden of musculoskeletal injury and SARS-CoV-2 infection may prolong recovery, increase complications, and influence survival. This study aimed to evaluate the impact of nosocomial COVID-19 on hospitalization outcomes in orthopedic patients.

A retrospective cohort study was conducted at a tertiary orthopedic center, analyzing patients hospitalized between 2020 and 2022. COVID-19-positive patients (n = 84) who acquired the infection during admission were matched 1:1 with uninfected controls (n = 84) based on age, gender, and BMI. Data were collected on demographics, comorbidities, hospitalization duration, complications, ICU transfers, and mortality outcomes. Statistical analysis included t-tests, Mann-Whitney U tests, and significance set at p < 0.05.

COVID-19-positive patients experienced significantly longer hospital stays (median 13.9 vs. 4.3 days, p < 0.001) and shorter time to death post-discharge (median 135 vs. 540 days, p = 0.027) compared to controls. Mortality rates were similar between groups (23.8 % vs. 22.6 %, p = 0.86), and ICU admissions occurred only in the COVID-19 group (3.3 %). Baseline characteristics and comorbidity profiles were comparable.

Orthopedic patients who contract COVID-19 during hospitalization face a prolonged hospital course and earlier mortality despite similar overall death rates. These findings highlight the importance of infection prevention strategies, including preoperative screening and deferring elective procedures in infected individuals, to mitigate complications associated with immobility, delayed recovery, and systemic decline.