In-hospital mortality among orthopedic trauma patients during and outside the COVID-19 pandemic: a nationwide population-based analysis of 2.67 million hospitalizations in Poland

Orthopedic trauma is a leading contributor to morbidity and mortality worldwide. The COVID-19 pandemic created unprecedented disruptions to hospital services, but its indirect effects on in-hospital mortality among orthopedic patients remain poorly quantified. We conducted a nationwide retrospective analysis of 2 674 263 orthopedic hospitalizations in Poland between 2019 and 2023. Hospital admissions were classified as occurring during COVID-19 (19 months across five national pandemic waves) or non-COVID periods (41 months). We examined overall, age-stratified, and injury site–specific mortality using descriptive statistics, Z-tests for proportions, and effect size estimates including risk difference, relative risk, odds ratios, and number needed to harm. Overall in-hospital mortality was 1.06% (28 441 deaths). Mortality was significantly higher during the COVID-19 period than in non-COVID months (1.35% vs. 1.01%; RR 1.34, 95% CI 1.30–1.38; NNH 290). Age strongly modified outcomes: excess risk was minimal in young adults (18–40 years; NNH ~ 3 700), moderate in middle-aged patients (41–65 years; NNH ~ 621), and greatest among older adults (65 + years; NNH ~ 111). Mortality rose across all injury sites, with the largest absolute excess in head trauma (RD 0.68% points; NNH 148) and the steepest relative increase in chest injuries (RR 1.48, 95% CI 1.27–1.73). The COVID-19 pandemic was associated with a marked rise in in-hospital mortality among orthopedic patients in Poland, disproportionately affecting older adults and those with head or chest injuries. These findings underscore the need for resilient trauma and orthopedic care pathways that maintain operative and critical care capacity during future health system disruptions.