Department of Anesthesiology and Intensive Care, Hautepierre Hospital, Strasbourg University Hospital, Service d'Anesthésie-Réanimation, 1 avenue Molière, Strasbourg 67200, France.
Department of Anesthesiology and Intensive Care, Hautepierre Hospital, Strasbourg University Hospital, Service d'Anesthésie-Réanimation, 1 avenue Molière, Strasbourg 67200, France.
Injury. 2023 Aug;54(8):110813. doi: 10.1016/j.injury.2023.05.044. Epub 2023 May 19.
Early hip fracture surgery is recommended to decrease mortality, however the impact of a delay in surgery due to previous treatment with direct oral anticoagulants (DOA) is unknown. Our objective was to determine if early surgery, defined as surgery within 48 h of hospital admission is associated with decreased postoperative mortality. We tested the hypothesis that early surgery was beneficial with regard for mortality in patients treated with direct oral anticoagulants.
Retrospective cohort study in a French University Hospital including patient admitted for Hip fracture. The main exposure was wait time for surgery defined as the total time, in hours, between hospital admission and surgery. The main outcome was mortality within 30 days after hip fracture surgery.
In 3429 patients, the overall 30-day mortality was 4.1% (95% CI 3.5%; 4.9%). In DOA + patients, the 30-day mortality rates in the early and delayed surgery groups were 1.2% and 5.9%, respectively, with estimated risk difference of -4.4 (with a 2% probability of this difference is > 0). In the DOA + group, early surgery tended to be associated with a higher percentage receiving red-blood cells (64.6% vs 54.8%, respectively, estimated risk difference of 9.9% with a 93% probability of this difference is > 0) and lower risk of pneumonia (1.2% vs 8.2%, respectively; estimated difference of -6.7% with 0.3% probability of superiority).
Early hip fracture surgery was associated with improved survival in patients previously treated with DOAs.
建议早期进行髋关节骨折手术以降低死亡率，但是由于之前使用直接口服抗凝剂（DOA）而导致手术延迟的影响尚不清楚。我们的目的是确定早期手术（定义为入院后 48 小时内进行的手术）是否与术后死亡率降低相关。我们检验了这样一个假设，即在接受直接口服抗凝剂治疗的患者中，早期手术在死亡率方面是有益的。
这是一项在法国大学医院进行的回顾性队列研究，纳入了因髋关节骨折入院的患者。主要暴露因素是手术等待时间，定义为从入院到手术的总时间（以小时计）。主要结局是髋关节骨折手术后 30 天内的死亡率。
在 3429 名患者中，总体 30 天死亡率为 4.1%（95%CI 3.5%~4.9%）。在 DOA+患者中，早期手术组和延迟手术组的 30 天死亡率分别为 1.2%和 5.9%，估计风险差异为-4.4（这种差异大于 0 的概率为 2%）。在 DOA+组中，早期手术与接受红细胞输注的比例较高相关（分别为 64.6%和 54.8%，估计风险差异为 9.9%，这种差异大于 0 的概率为 93%），且肺炎风险较低（分别为 1.2%和 8.2%，估计差异为-6.7%，这种差异占优的概率为 0.3%）。
对于之前接受 DOA 治疗的患者，早期髋关节骨折手术与生存率的提高相关。
