Clinical Outcomes and Surgical Complications Among Patients with Bleeding Disorders After Acute Hip Fracture Surgery.

OBJECTIVE

To compare short-term (≤30 days) outcomes of hip fracture between patients with and without bleeding disorders.

DESIGN

Retrospective database review.

SETTING

The study setting included hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database.

PATIENTS: Patients with acute hip fractures were identified from the National Surgical Quality Improvement Program database between 2016 and 2019.

INTERVENTION: Open reduction internal fixation or hemiarthroplasty.

MAIN OUTCOME MEASUREMENTS: Mortality, readmission, reoperation, length of stay, and complication were main outcome measurements.

RESULTS

There were 63,718 patients undergoing hip surgery, and 16.0% had a bleeding disorder. After adjusting for confounders, multivariable regression models showed that cases with bleeding disorders were associated with higher rates of transfusion [odds ratio (OR) 1.404; confidence interval (CI), 1.335-1.479], myocardial infarction (OR 1.367; CI, 1.190-1.572), pneumonia (OR 1.193; CI, 1.078-1.321), renal failure (OR 1.843; CI, 1.363-2.491), surgical site infections (OR 1.429; CI, 1.185-1.175), sepsis (OR 1.25; CI, 1.034-1.511), and readmission (OR 1.314; CI, 1.224-1.408). However, bleeding disorders were not associated with mortality (OR 0.947; CI, 0.866-1.036) or reoperation (OR 1.061; CI, 0.925-1.220).

CONCLUSIONS

Hip fracture surgery in patients with bleeding disorders is not associated with higher risks of short-term mortality or reoperation. However, special consideration should be taken when calculating preoperative risks of complications among bleeding disorder patients.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.