Chronic anticoagulation therapy associated with increased complications following hemiarthroplasty in hip fracture patients

Femoral neck fractures in older adults are commonly treated with hip hemiarthroplasty (HA). Many older adults who sustain femoral neck fractures are also receiving long-term anticoagulation therapy, which may negatively affect patient outcomes after HA. We sought to investigate whether long-term anticoagulation therapy is associated with increased risks of surgical wound complications among older adults treated with HA for femoral neck fracture.

Patients ≥ 60 years old who underwent HA within two days of admission for femoral neck fracture between October 1, 2015-December 31, 2021 were identified using codes in the Premier Healthcare Database. Long-term anticoagulation therapy was defined as an active prescription of anticoagulant medication at time of admission. A propensity score for the probability of long-term anticoagulant therapy was used to match patients. The adjusted odds of 90-day infectious surgical wound complications (deep and superficial) and non-infectious surgical wound complications (wound dehiscence, seroma, or hematoma) were determined from the matched patients.

7218 patients on long-term anticoagulation therapy were matched to 7218 patients with no history of anticoagulation therapy. Patients with a history of long-term anticoagulation therapy experienced higher unadjusted rates of non-infectious surgical wound complications (2.15% vs. 1.29%, p < 0.001). No difference in the incidence of surgical site infection was observed between groups (1.73% vs. 1.30%, p = 0.111). After propensity score matching, patients on long-term anticoagulation therapy had higher odds of non-infectious (adjusted odds ratio [aOR]: 1.65, 95% confidence interval [CI] 1.27-2.15, p < 0.001) and infectious (aOR: 1.38, CI 1.05-1.81, p = 0.021) surgical wound complications.

Long-term anticoagulation therapy confers an independent risk of wound complications among older adults undergoing HA for femoral neck fracture.