The impact of antithrombotic therapy on surgical delay and 2-year mortality in older patients with hip fracture: a prospective observational study

López, Samuel González; Casa, Carmen da; Pablos‐Hernández, Carmen; Pescador, David; Díaz-Álvarez, Agustín; Asensio, Nuria; Blanco, Juan F.

doi:10.1007/s41999-020-00293-3

Cited by 4 publications

(1 citation statement)

References 40 publications

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“…Third, two papers on the problems of antithrombotics and especially anticoagulants in acute hip fracture care are published [5,6]. They illustrate the problems with drug-related problems in hip fracture care.…”

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confidence: 99%

Orthogeriatrics: much more action is needed

Ranhoff

2020

Eur Geriatr Med

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mentioning

confidence: 99%

Orthogeriatrics: much more action is needed

Ranhoff

2020

Eur Geriatr Med

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30-day mortality after hip fracture surgery: Influence of postoperative factors

et al. 2021

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Purpose The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. The aim of this work is to analyse preoperative and postoperative factors potentially related to early 30-day mortality in patients over 65 undergoing hip fracture surgery. Methods Prospective cohort study including all consecutive primary hip fracture patients over 65 admitted to Trauma and Orthopaedics department from January 1, 2018 to December 31, 2019. Bed-ridden, non- surgically treated patients, and high energy trauma or tumoral aetiology fractures were excluded. A total of 943 patients were eligible (attrition rate: 2.1%). Follow-up included 30-days after discharge. We noted the 30-day mortality after hip fracture surgery, analysing 130 potentially related variables including biodemographic, fracture-related, preoperative, and postoperative clinical factors. Qualitative variables were assessed by χ2, and quantitative variables by non-parametric tests. Odds ratio determined by binary logistic regression. We selected preventable candidate variables for multivariate risk assessment by logistic regression. Results A total of 923 patients were enrolled (mean age 86.22±6.8, 72.9% women). The 30-day mortality rate was 6.0%. We noted significant increased mortality on men (OR = 2.381[1.371–4.136], p = 0.002), ageing patients (ORyear = 1.073[1.025–1.122], p = 0.002), and longer time to surgery (ORday = 1.183[1.039–1146], p<0.001), on other 20 preoperative clinical variables, like lymphopenia (lymphocyte count <103/μl, OR = 1.842[1.063–3.191], p = 0.029), hypoalbuminemia (≤3.5g/dl, OR = 2.474[1.316–4.643], p = 0.005), and oral anticoagulant intake (OR = 2.499[1.415–4.415], p = 0.002), and on 25 postoperative clinical variables, like arrhythmia (OR = 13.937[6.263–31.017], p<0.001), respiratory insufficiency (OR = 7.002[3.947–12.419], p<0.001), hyperkalaemia (OR = 10.378[3.909–27.555], p<0.001), nutritional supply requirement (OR = 3.576[1.894–6.752], p = 0.021), or early arthroplasty dislocation (OR = 6.557[1.206–35.640], p = 0.029). We developed a predictive model for early mortality after hip fracture surgery based on postoperative factors with 96.0% sensitivity and 60.7% specificity (AUC = 0.863). Conclusion We revealed that not only preoperative, but also postoperative factors have a great impact after hip fracture surgery. The influence of post-operative factors on 30-day mortality has a logical basis, albeit so far they have not been identified or quantified before. Our results provide an advantageous picture of the 30-day mortality after hip fracture surgery.

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Relationship between the severity of preoperative anemia and postoperative deep vein thrombosis in patients with bone trauma: a cohort study

Yang

Zhang

et al. 2023

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Objective To analyze the relationship between preoperative anemia and postoperative deep vein thrombosis (DVT) in patients with lower limb bone trauma who have a high rate of preoperative anemia. Method In this retrospective cohort study, 957 patients at our center were included. Patients were categorized based on their last preoperative hematocrit (HCT) results. The univariate analysis included general preoperative conditions, complications, surgical and fracture-related factors, preoperative laboratory indicators, anticoagulation, and anemia in patients with DVT (284 cases) and those without DVT (673 cases) after surgery. Results Among the 284 cases with postoperative thrombosis, 61(21.5%) had no anemia before surgery, while 223(78.5%) had anemia before surgery. Among those with anemia, 65(22.9%) had mild anemia, and 158 had moderate to severe anemia. Age over 65 years old, total length of stay (LOS) exceeding 14 days, preoperative anticoagulation, delay of more than 24 h in starting anticoagulation after surgery, 30%≤HCT < 33% and blood transfusion, and HCT < 27% and blood transfusion were identified as independent risk factors for postoperative DVT formation. The ROC curves showed that a preoperative HCT of 35.15% (AUC = 0.670, sensitivity = 64.6%, specificity = 61.2%) in males and 33.45% (AUC = 0.637, sensitivity = 63.7%, specificity = 60.2%) in females were the cut-off values for predicting postoperative DVT occurrence. Conclusions The risk of postoperative DVT increases with the severity of preoperative anemia in patients with bone trauma, and perioperative blood transfusion further increases the risk of DVT. Trial registration: ChiCTR2100049356.

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The impact of antithrombotic therapy on surgical delay and 2-year mortality in older patients with hip fracture: a prospective observational study

Cited by 4 publications

References 40 publications

Orthogeriatrics: much more action is needed

Orthogeriatrics: much more action is needed

30-day mortality after hip fracture surgery: Influence of postoperative factors

Relationship between the severity of preoperative anemia and postoperative deep vein thrombosis in patients with bone trauma: a cohort study

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