Expedited Hip Fracture Surgery in Patients on Direct Oral Anticoagulants Does Not Increase Perioperative Blood Loss.

IF 1.6 3区医学 Q3 ORTHOPEDICS Journal of Orthopaedic Trauma Pub Date : 2025-03-06 DOI:10.1097/BOT.0000000000002974

Juntian Wang, Peter Aldo Giammanco, Paal Nilssen, Julia Stone, Kathleen Breda, Milton Little, Charles Moon, Peter Yim, Carol Lin

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Abstract

Objectives: To compare blood loss and transfusion rates in geriatric hip fracture patients on direct oral anticoagulants undergoing surgery ≤ 24 hours from admission (Expedited group) versus 24-72 hours from admission (Delayed group).

Methods: Design: Retrospective cohort study.

Setting: Level I Trauma Center.

Patient selection criteria: Patients aged ≥ 65 with a femoral neck, intertrochanteric, or subtrochanteric fracture (AO/OTA 31A, 31B, and 32) on factor Xa inhibitors (apixaban or rivaroxaban) prior to admission from April 2014 to April 2024 were included.Outcome Measures and Comparisons: Primary outcomes were preoperative blood loss (difference between admission hemoglobin (Hgb) and lowest preoperative Hgb), overall blood loss (difference between admission Hgb and lowest postoperative Hgb within four days postop), and transfusion rates. Secondary outcomes were length of stay (LOS) and 90-day complication (cerebrovascular accident, myocardial infarction, deep venous thrombosis, pulmonary embolism, urinary tract infection, gastrointestinal bleed, pneumonia, acute kidney failure, surgical site infection), readmission, reoperation, and mortality rates.

Results: The Expedited group (n=67) and Delayed group (n=183) were similar in age (85.2±6.8 years (67-97) vs. 84.4±7.5 years (65-101), p=0.405) and sex (50.7% vs. 37.2% male, p=0.084). The Delayed group had higher preoperative blood loss (1.2±1.3 g/dL vs. 0.80±1.0 g/dL, p=0.003) with no differences in overall blood loss (2.9±.1.7 g/dL vs. 2.9±1.7 g/dL, p=0.881) and transfusion rates (28.4% vs. 25.4%, p=0.634). The Expedited group had a shorter LOS (6.0±5.6 days vs. 7.1±3.3 days, p<0.001). The Delayed group had a higher 90-day complication rate (41.5% vs. 19.4%, p=0.001). The Expedited group did not have higher rates of 90-day readmission (22.4% vs. 25.7%, p=0.593), reoperation (4.5% vs. 3.8%, p=0.730), or mortality (9.0% vs 6.6%, p=0.581).

Conclusions: For geriatric hip fracture patients on factor Xa inhibitors, surgery ≤ 24 hours from admission reduced preoperative blood loss without increasing risk for overall bleeding, transfusion, or 90-day complication.

Level of evidence: Therapeutic Level III.

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来源期刊

Journal of Orthopaedic Trauma 医学-运动科学

CiteScore

3.90

自引率

8.70%

发文量

396

审稿时长

3-8 weeks

期刊介绍： Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.