‘Tiers of delay’: Warfarin, hip fractures and target driven care

Eardley, William; Freeman, Hannah; MacLeod, Kirsty; Tate, Anne

doi:10.1016/j.ijsu.2014.08.069

Cited by 15 publications

(28 citation statements)

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“…Age of surviving patients is indeed correlated to the time of operation. Additionally, the intake of anticoagulants is correlated to the timing of operation, as we and several other studies were able to demonstrate. An early operation may reduce mortality, which could not be proven by this study.…”

Section: Discussioncontrasting

confidence: 49%

Hip Fractures: Therapy, Timing, and Complication Spectrum

Saul

Riekenberg

Ammon

et al. 2019

Orthopaedic Surgery

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ObjectiveInvestigation of the treatment of femur fractures and the type of femur fracture‐associated complications regarding timing of surgery and length of hospital stay.MethodsIn this retrospective cohort study, a total of 358 hip fractures were evaluated retrospectively from 1 January 2008 until 31 December 2010 at a level I trauma center in Germany. Inclusion criteria was age >18 years and a proximal femur fracture. Both sexes were evaluated. Mean age was 75.5 years, most patients were female (63.7%). Intervention was the operative treatment of proximal femur fracture. Outcome parameters were time until surgery, complications, reoperations, mortality, and length of hospital stay.ResultsAmong the proximal femur fractures (n = 358), 46.6% were pertrochanteric, 11.2% subtrochanteric, and 42.2% femoral neck fractures. Operation upon hip fractures was managed regularly within 24 hours of injury (73%; mean for femoral neck: 28.3 hrs.; mean for pertrochanteric fractures: 21.4 hrs.; mean for subtrochanteric fractures: 19.5 hrs.). Delayed treatment, as well as implantation of hip total endoprosthesis (TEP), increased the overall length of hospital stay (15.4 vs 17.6 days; 18.1 vs 15.8 days). Accordingly, surgical procedures performed within 24 hours of injury resulted in a shorter hospital residence. Longest delay of operation was measured for hip fractures (28.3 hrs.).In 351 patients, secondary injuries were detected in 94 individuals (26%), with fractures being the most common secondary injury (n = 40). We recorded postoperative complications of nonsurgical and surgical origin, and 33.6% of our patient cohort displayed complications. Complications were distributed among 118 patients. There was no significant difference in complications regarding the time of operation, with most nonsurgical and surgical complications appearing within 24 hours after operation (n = 110 vs n = 31). Nonsurgical complications, such as anemia (n = 49) and electrolyte imbalances (n = 30), were observed more frequently than surgical complications (n = 107 vs n = 34); however, these complications were reduced by delay in surgery (82.0% in 6–24 hrs. vs 74.2% in ≥24 hrs.). Anticoagulant therapy and age did not affect postoperative complications. The hospital mortality of patients was 6.2%. Follow‐up was restrained to ambulatory visits in the clinic.ConclusionsSurgical management of hip fractures performed within 24 hours of injury minimizes hospital stay. We did not detect significant differences in the spectrum or number of complications regarding delay of surgery. Surgical complications mainly occur with rapid primary care, and medical complications can be reduced by more intensive preparation of patient and operation procedures.

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Section: Discussioncontrasting

confidence: 49%

Hip Fractures: Therapy, Timing, and Complication Spectrum

Saul

Riekenberg

Ammon

et al. 2019

Orthopaedic Surgery

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“…Whether DOACs should be temporarily paused to avoid surgical and anaesthesiological complications and, if so, when it should be paused remains to be established. Anticoagulation has in several studies been identified as a risk factor for delayed hip fracture surgery [7][8][9][10]. Most guidelines advocate that hip fracture surgery should be performed within 48 h after admission, preferably within 24 h, to reduce the rate of medical complications and mortality [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Do direct oral anticoagulants (DOACs) cause delayed surgery, longer length of hospital stay, and poorer outcome for hip fracture patients?

et al. 2020

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The aim of this study was to determine whether DOAC-users with a hip fracture have delayed surgery, longer length of hospital stay or altered risk of bleeding complications compared to non-users. Findings DOAC-users with a hip fracture did not have increased surgical delay, length of stay or risk of reported bleeding complications compared to patients without anticoagulation prior to surgery. Message Our study does not support delayed surgery for DOAC-users suffering a hip fracture.

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“…Anticoagulated patients presenting with a hip fracture have been associated with delays in surgical fixation [14][15][16][17][18]. The potential need for reversal and fear of bleeding has been postulated as reasons for this delay.…”

Section: Introductionmentioning

confidence: 99%

Do anticoagulants affect outcomes of hip fracture surgery? A cross-sectional analysis

Hoerlyck

Ong

Gregersen

et al. 2019

Arch Orthop Trauma Surg

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Introduction The management of patients with a hip fracture is affected by the use of oral anticoagulants. A cross-sectional analysis was undertaken to investigate health outcome differences in those anticoagulated compared to those not anticoagulated. Methods Patients aged 50 years and over presenting to a large university hospital with hip fractures were identified from the service registry. Patient characteristics and health outcomes between those not anticoagulated were compared with those anticoagulated (warfarin and direct oral anticoagulants, DOAC). Results 200/2307 (9%) patients were anticoagulated. 84% were on warfarin, and the rest a DOAC. Compared to those anticoagulated, there was a higher prevalence of dementia (25% vs. 18%, p = 0.02) and a lower prevalence of cardiovascular disease (54% vs. 78%, p < 0.01), atrial fibrillation (10% vs. 82%, p < 0.01), and polypharmacy (55% vs. 76%, p < 0.01). Renal function was lower in the anticoagulated group. Time to operation for those not anticoagulated and anticoagulated was a median (IQR) of 25 (15) and 27 (18) hours. There was no difference in blood transfusion and hospital mortality. Postoperative complications were similar except a higher rate of renal failure (14% vs. 19%, p = 0.04) and heart failure (1% vs. 5%, p < 0.01), and a longer length of stay [median (IQR): 14 (10) vs. 16 (12) days] in the anticoagulated group. This was no longer significant after adjustment of confounders. Conclusion There was no statistically significant difference in health outcomes between those anticoagulated and those not after adjusting for patient characteristics. It was feasible to avoid significant delay in hip fracture surgery in those anticoagulated.

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‘Tiers of delay’: Warfarin, hip fractures and target driven care

Cited by 15 publications

References 0 publications

Hip Fractures: Therapy, Timing, and Complication Spectrum

Hip Fractures: Therapy, Timing, and Complication Spectrum

Do direct oral anticoagulants (DOACs) cause delayed surgery, longer length of hospital stay, and poorer outcome for hip fracture patients?

Do anticoagulants affect outcomes of hip fracture surgery? A cross-sectional analysis

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