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

{"title":"Expedited Hip Fracture Surgery in Patients on Direct Oral Anticoagulants Does Not Increase Perioperative Blood Loss.","authors":"Juntian Wang, Peter Aldo Giammanco, Paal Nilssen, Julia Stone, Kathleen Breda, Milton Little, Charles Moon, Peter Yim, Carol Lin","doi":"10.1097/BOT.0000000000002974","DOIUrl":null,"url":null,"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.","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOT.0000000000002974","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

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.

查看原文本刊更多论文

直接口服抗凝剂的髋部骨折患者加速手术不会增加围手术期出血量。

目的：比较老年髋部骨折患者在入院≤24小时（加速组）和24-72小时（延迟组）手术后直接口服抗凝剂的失血量和输血率。方法：设计：回顾性队列研究。地点：一级创伤中心。患者选择标准：纳入2014年4月至2024年4月入院前服用Xa因子抑制剂（阿哌沙班或利伐沙班）的年龄≥65岁、股骨颈、粗隆间或粗隆下骨折（AO/OTA 31A、31B和32）的患者。结果测量和比较：主要结果为术前失血量（入院血红蛋白（Hgb）与最低术前血红蛋白的差异）、总失血量（入院血红蛋白与术后最低血红蛋白在术后4天内的差异）和输血率。次要结局是住院时间（LOS）和90天并发症（脑血管意外、心肌梗死、深静脉血栓形成、肺栓塞、尿路感染、胃肠道出血、肺炎、急性肾衰竭、手术部位感染）、再入院、再手术和死亡率。结果：加速组（n=67）和延迟组（n=183）在年龄（85.2±6.8岁（67-97）比84.4±7.5岁（65-101），p=0.405）和性别（50.7%比37.2%,p=0.084）上相似。延迟组术前出血量较高（1.2±1.3 g/dL vs. 0.80±1.0 g/dL, p=0.003），但总出血量（2.9±0.1.7 g/dL vs. 2.9±1.7 g/dL, p=0.881）和输血率（28.4% vs. 25.4%, p=0.634）差异无统计学意义。加速组的LOS较短（6.0±5.6天vs. 7.1±3.3天）。结论：对于服用Xa因子抑制剂的老年髋部骨折患者，入院后≤24小时的手术可减少术前失血量，而不会增加总体出血、输血或90天并发症的风险。证据等级：治疗性III级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

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.