Tarrant Seth M, Kim Raymond G, McGregor Kassandra L, Palazzi Kerrin, Attia John, Balogh Zsolt J
Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia.
Discipline of Surgery, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; and.
J Orthop Trauma. 2020 Oct;34(10):559-565. doi: 10.1097/BOT.0000000000001779.
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).
Retrospective cohort study.
University-affiliated Level 1 Trauma Center.
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.
Fixation or arthroplasty.
Transfusion, major complications, and 30-day mortality.
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).
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.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定手术时机如何影响接受双重抗血小板治疗（DAPT，通常为阿司匹林和氯吡格雷）的老年髋部骨折患者的输血情况、主要并发症及死亡率。
回顾性队列研究。
大学附属一级创伤中心。
2002年至2017年期间在单一机构对65岁及以上接受DAPT且发生老年髋部骨折的患者进行调查。从患者记录、机构数据库和国家髋部骨折登记处收集人口统计学和围手术期数据。
内固定或关节置换术。
输血情况、主要并发症及30天死亡率。
在6724例发生老年髋部骨折的患者中，122例入院时正在接受DAPT治疗。手术时机不影响输血量（发病率比为1.00，95%置信区间：0.87 - 1.15，P = 0.968），但确实会影响主要并发症（时间建模为二次项；优势比范围为0.20至7.91，ptime = 0.001，ptime*time < 0.001）和30天死亡率（优势比为1.32，95%置信区间：1.03 - 1.68，P = 0.030）。
手术延迟不会改变接受DAPT治疗的髋部骨折患者的输血需求，但与主要并发症和30天死亡率增加相关。
治疗性三级。有关证据级别的完整描述，请参阅作者指南。
