Effect of timing of operation on prognosis of hip fracture in patients who used direct oral anticoagulant before injury
10.3760/cma.j.cn115396-20241102-00334
- VernacularTitle:手术时机选择对伤前使用直接口服抗凝药患者髋部骨折预后的影响
- Author:
Dan JIAN
1
;
Jun WANG
;
Fenlan CHEN
Author Information
1. 南京中医药大学附属南京中医院麻醉科手术室，南京 210001
- Keywords:
Surgical procedures, operative;
Direct oral anticoagulant;
Hip fracture;
Prognosis;
Postoperative complications
- From:
International Journal of Surgery
2025;52(11):747-752
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the influence of operation timing on the prognosis of hip fracture in patients who used direct oral anticoagulant (DOAC) before injury.Methods:A retrospective case-control study was conducted to analyze the clinical data of 90 patients who used DOAC before hip fracture and were admitted to Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine from January 2022 to August 2023. Among them, there were 53 males and 37 females, aged 65 to 89 years with a mean age of (76.24±6.92) years. Patients were divided into the early operation group ( n=45) and the delayed operation group ( n=45) according to the timing of operation. The early operation group underwent hip fracture surgery within 2 days after DOAC withdrawal, while the delayed operation group underwent hip fracture surgery more than 2 days after DOAC withdrawal. The two groups were compared and evaluated in terms of fracture site, surgical method, operation time, length of hospital stay, Harris hip score (HHS), intraoperative blood loss, blood transfusion rate, blood transfusion volume, hemoglobin (Hb) change rate, incidence of postoperative complications, intensive care unit (ICU) admission rate and duration, and mortality rate. The measurement data with normal distribution were expressed as mean ± standard deviation ( ± s), and intergroup comparison was performed using the t-test. The count data were expressed as cases and percentages, and intergroup comparison was conducted using the Chi-test or Fisher exact test probability method. Comparisons among multiple time points were analyzed by repeated measures analysis of variance. Results:There was no statistically significant differences were observed between the two groups in terms of fracture site and surgical method ( P>0.05). The ICU admission rate and length of hospital stay in the early operation group were lower than those in the delayed operation group, with statistically significant differences ( P<0.05). There were no statistically significant differences between the two groups in intraoperative blood loss, operation time, blood transfusion rate, blood transfusion volume, Hb change rate and other indicators ( P>0.05). The total incidence of postoperative complications in the early operation group was lower than that in the delayed operation group [15.6% (7/45) vs 53.3% (24/45)], with statistically significant difference ( P<0.05). The HHS score of the early operation group at 1 month after operation was significantly higher than that of the delayed operation group, with statistically significant difference ( F=7.75, P<0.05). At 1 and 12 months after operation, there were no statistically significant differences in the mortality between the two groups of patients who used DOAC before hip fracture [0 (0/45) vs 2.2% (1/45); 4.4% (2/45) vs 6.7% (3/45); P>0.05]. Conclusion:For patients who used DOAC before injury, hip fracture surgery within 2 days after DOAC was stopped after admission can help to reduce the ICU admission rate, shorten the length of stay, reduce the risk of postoperative complications, and promote the early recovery of hip joint function, without affecting the amount of blood loss, blood transfusion rate and blood transfusion.
