Seth M Tarrant1,2, Raymond G Kim1, Kassandra L McGregor1, Kerrin Palazzi3, John Attia1,2,3, Zsolt J Balogh1,2. 1. Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia. 2. Discipline of Surgery, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; and. 3. Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
Abstract
OBJECTIVE: To determine how timing of surgery affects transfusion, major complications, and mortality in patients who sustain a geriatric hip fracture while taking dual antiplatelet therapy (DAPT; typically aspirin and clopidogrel). DESIGN: Retrospective cohort study. SETTING: University-affiliated Level 1 Trauma Center. PATIENTS: Patients 65 years of age or older on DAPT with a geriatric hip fracture were investigated at a single institution between 2002 and 2017. Demographic and perioperative data were collected from patient records, institutional databases, and national hip fracture registry. INTERVENTION: Fixation or arthroplasty. MAIN OUTCOME MEASUREMENT: Transfusion, major complications, and 30-day mortality. RESULTS: Of the 6724 patients sustaining a geriatric hip fracture, 122 patients were taking DAPT on admission. Timing of surgery did not influence transfused units (incidence rate ratio 1.00, 95% confidence interval: 0.87-1.15, P = 0.968) but did affect major complications (time modeled as quadratic term; odds ratios ranging from 0.20 to 7.91, ptime = 0.001, ptime*time<0.001) and 30-day mortality (odds ratio 1.32, 95% confidence interval: 1.03-1.68, P = 0.030). CONCLUSION: Surgical delay does not change the need for transfusion of hip fracture patients on DAPT, but it is associated with increased probabilities of major complications and 30-day mortality. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVE: To determine how timing of surgery affects transfusion, major complications, and mortality in patients who sustain a geriatric hip fracture while taking dual antiplatelet therapy (DAPT; typically aspirin and clopidogrel). DESIGN: Retrospective cohort study. SETTING: University-affiliated Level 1 Trauma Center. PATIENTS: Patients 65 years of age or older on DAPT with a geriatric hip fracture were investigated at a single institution between 2002 and 2017. Demographic and perioperative data were collected from patient records, institutional databases, and national hip fracture registry. INTERVENTION: Fixation or arthroplasty. MAIN OUTCOME MEASUREMENT: Transfusion, major complications, and 30-day mortality. RESULTS: Of the 6724 patients sustaining a geriatric hip fracture, 122 patients were taking DAPT on admission. Timing of surgery did not influence transfused units (incidence rate ratio 1.00, 95% confidence interval: 0.87-1.15, P = 0.968) but did affect major complications (time modeled as quadratic term; odds ratios ranging from 0.20 to 7.91, ptime = 0.001, ptime*time<0.001) and 30-day mortality (odds ratio 1.32, 95% confidence interval: 1.03-1.68, P = 0.030). CONCLUSION: Surgical delay does not change the need for transfusion of hip fracturepatients on DAPT, but it is associated with increased probabilities of major complications and 30-day mortality. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Authors: Antonio De Vincentis; Astrid Ursula Behr; Giuseppe Bellelli; Marco Bravi; Anna Castaldo; Lucia Galluzzo; Giovanni Iolascon; Stefania Maggi; Emilio Martini; Alberto Momoli; Graziano Onder; Marco Paoletta; Luca Pietrogrande; Mauro Roselli; Mauro Ruggeri; Carmelinda Ruggiero; Fabio Santacaterina; Luigi Tritapepe; Amedeo Zurlo; Raffaele Antonelli Incalzi Journal: Aging Clin Exp Res Date: 2021-07-21 Impact factor: 3.636