Merchán-Galvis Angela, Anaya Rafael, Rodriguez Mireia, Llorca Jordi, Castejón Mercé, Gil José María, Millan Angélica, Estepa Verónica, Cardona Elena, Garcia-Sanchez Yaiza, Ruiz Ana, Martinez-Zapata Maria Jose
Public Health and Clinical Epidemiology Service-Iberoamerican Cochrane Centre, IIB Sant Pau, 08025 Barcelona, Spain.
Department of Social Medicine and Family Health, Universidad del Cauca, Popayan 190003, Colombia.
J Clin Med. 2023 Jan 31;12(3):1130. doi: 10.3390/jcm12031130.
We evaluated a strategy to shorten the time from admission to surgery in patients with proximal femur fractures on chronic antiplatelet therapy. We reported a 12-month follow-up on complications and quality of life (QoL).
Multicentre, open-label, randomized, parallel clinical trial. Patients were randomized to either early platelet function-guided surgery (experimental group) or delayed surgery (control group). Medical and surgical complications and QoL (EQ-5D-5L questionnaire) were assessed during the hospital stay, and after hospital discharge at 30 days, and 6 and 12 months.
From 156 randomized patients, 143 patients underwent surgery. The mean age was 85.5 (7.8) years and 68.0% were female. After hospital discharge, 5.7% of patients had surgical wound complications and 55.9% had medical complications, with 42.7% having serious adverse events. QoL improved significantly after surgery, with the best scores at the six-month follow-up. The overall mortality was 32.2%. There were no differences between early and delayed surgery groups in any assessed outcomes.
It seems safe to reduce the time of surgery under neuraxial anaesthesia in patients with hip fractures on chronic antiplatelet therapy by platelet function testing. QoL in particular improves in the first six months after surgery.
我们评估了一种缩短接受慢性抗血小板治疗的股骨近端骨折患者从入院到手术时间的策略。我们报告了关于并发症和生活质量（QoL）的12个月随访情况。
多中心、开放标签、随机、平行临床试验。患者被随机分为早期血小板功能引导手术组（实验组）或延迟手术组（对照组）。在住院期间、出院后30天、6个月和12个月时评估医疗和手术并发症以及生活质量（EQ-5D-5L问卷）。
156例随机分组的患者中，143例接受了手术。平均年龄为85.5（7.8）岁，68.0%为女性。出院后，5.7%的患者出现手术伤口并发症，55.9%的患者出现医疗并发症，42.7%的患者发生严重不良事件。手术后生活质量显著改善，在六个月随访时得分最高。总死亡率为32.2%。早期和延迟手术组在任何评估结果上均无差异。
通过血小板功能检测，对于接受慢性抗血小板治疗的髋部骨折患者，在神经轴索麻醉下缩短手术时间似乎是安全的。特别是手术后的前六个月生活质量有所改善。
