Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, Republic of Korea.
Department of Orthopedic Surgery, National Police Hospital, Seoul, Republic of Korea.
Eur J Trauma Emerg Surg. 2024 Apr;50(2):347-358. doi: 10.1007/s00068-023-02368-9. Epub 2023 Sep 28.
To compare the various perioperative outcomes in an urgent surgery setting among patients with proximal femur fracture (PFF) who received platelet aggregation inhibitors (PAIs) and those who did not.
We retrospectively reviewed the data of 1,838 patients who underwent surgery for PFF between January 2011 and January 2021. We conducted 1:1 propensity-score matching and compared the perioperative outcomes, including operation time, postoperative complications, hospital stay, mortality, and variables related to bleeding risk (e.g., number of transfusion profiles, hemoglobin levels, and laboratory data, including coagulation battery).
Of the 492 patients who were treated with PAIs, 484 were 1:1 matched to the untreated control group. The PAI group showed shorter operation time than the matched control group (72.3 min for PAI vs. 77.7 min for control; P = 0.041), and the control group showed more pulmonary thromboembolism (0.2% for PAI vs 1.7% for control; P = 0.046) than the PAI group. The other complications and length of hospital stay, mortality rate, transfusion profile, and the laboratory test (except preoperative international normalized ratio, INR) showed no significant difference between the groups. Subgroup analyses of the patients treated with only aspirin (aspirin: 306, matched control: 306), only clopidogrel (clopidogrel: 100, matched control: 100), and others who were treated with dual anticoagulation (dual anticoagulation: 78, matched control: 78) showed no significant differences in perioperative outcomes among the groups.
The patients who were treated with PAI could undergo PFF surgery safely without delay, which led to no significant difference in operation time, postoperative complication risk, perioperative blood transfusion, and variables related to bleeding risk. Therefore, we believe that it is unnecessary to delay surgery for patients with PFF who receive PAI.
比较在接受血小板聚集抑制剂（PAI）和未接受 PAI 的股骨近端骨折（PFF）患者的紧急手术环境中的各种围手术期结果。
我们回顾性分析了 2011 年 1 月至 2021 年 1 月期间接受 PFF 手术的 1838 名患者的数据。我们进行了 1:1 倾向评分匹配，并比较了围手术期结果，包括手术时间、术后并发症、住院时间、死亡率和与出血风险相关的变量（例如，输血情况、血红蛋白水平和实验室数据，包括凝血谱）。
在接受 PAI 治疗的 492 名患者中，有 484 名患者与未接受治疗的对照组进行了 1:1 匹配。PAI 组的手术时间短于匹配对照组（PAI 组为 72.3 分钟，对照组为 77.7 分钟；P=0.041），对照组的肺血栓栓塞症多于 PAI 组（PAI 组为 0.2%，对照组为 1.7%；P=0.046）。两组之间的其他并发症、住院时间、死亡率、输血情况和实验室检查（除术前国际标准化比值 INR 外）均无显著差异。仅接受阿司匹林（阿司匹林：306 例，匹配对照组：306 例）、氯吡格雷（氯吡格雷：100 例，匹配对照组：100 例）和其他接受双联抗凝治疗（双联抗凝：78 例，匹配对照组：78 例）的患者亚组分析显示，各组围手术期结果无显著差异。
接受 PAI 治疗的患者可以安全地进行 PFF 手术，而不会导致手术时间、术后并发症风险、围手术期输血和与出血风险相关的变量出现显著差异。因此，我们认为对于接受 PAI 的 PFF 患者，无需延迟手术。
