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Expedited Hip Fracture Surgery in Patients on Direct Oral Anticoagulants Does Not Increase Perioperative Blood Loss
Juntian Wang1, Peter Aldo Giammanco2, Paal Nilssen1
1Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA; and.
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.
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