Journal of orthopaedic trauma · 2025
Expedited Hip Fracture Surgery in Patients on Direct Oral Anticoagulants Does Not Increase Perioperative Blood Loss.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Wang Juntian, Giammanco Peter Aldo, Nilssen Paal, Stone Julia, Breda Kathleen, Little Milton, Moon Charles, Yim Peter, Lin Carol
Аннотация
OBJECTIVES: To compare blood loss and transfusion rates in geriatric patients with hip fracture on direct oral anticoagulants undergoing surgery ≤24 hours from admission (Expedited group) versus 24-72 hours from admission (Delayed group).
DESIGN: Retrospective cohort study.
SETTING: Level I trauma center.
PATIENT SELECTION CRITERIA: Patients aged ≥65 years with a femoral neck, intertrochanteric, or subtrochanteric fracture (AO/OTA 31A, 31B, and 32) on factor Xa inhibitors (apixaban or rivaroxaban) before 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 4 days postoperation), and transfusion rates. Secondary outcomes were length of stay 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) versus 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 ± 0.1.7 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 length of stay (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 patients with hip fracture 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. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective cohort study.
SETTING: Level I trauma center.
PATIENT SELECTION CRITERIA: Patients aged ≥65 years with a femoral neck, intertrochanteric, or subtrochanteric fracture (AO/OTA 31A, 31B, and 32) on factor Xa inhibitors (apixaban or rivaroxaban) before 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 4 days postoperation), and transfusion rates. Secondary outcomes were length of stay 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) versus 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 ± 0.1.7 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 length of stay (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 patients with hip fracture 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. See Instructions for Authors for a complete description of levels of evidence.