Bernate Juan David, López Ana Milena, Rojas Liévano Jorge, Pesantez Rodrigo, Patiño Aldo, Sanint Valentina, Salavarrieta Julián, Morales Diana, Olarte Carlos Mario
Orthopaedics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
Geriatrics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
Eur J Orthop Surg Traumatol. 2025 Apr 26;35(1):170. doi: 10.1007/s00590-025-04286-5.
The management of elderly patients undergoing hip fracture surgery often involves those on anticoagulation therapy, posing challenges in surgical timing and outcomes. This study evaluates the prevalence of anticoagulation therapy, its impact on surgical timing, and postoperative outcomes within an Orthogeriatric Clinical Care Center (OCCC).
A retrospective review of 638 patients aged 65 and above treated for hip fractures from May 2014 to December 2023 at the OCCC was conducted. Data on anticoagulant use, surgical timing, and outcomes were analyzed using multivariate logistic regression to adjust for confounders, such as age, preoperative hemoglobin levels, and comorbidities.
Anticoagulation therapy was present in 14.7% of patients, primarily with direct oral anticoagulants (12.2%). There was no significant delay in surgical timing for anticoagulated patients (mean time to surgery: 31.5 ± 23.3 h) compared to non-anticoagulated patients (28.7 ± 15.7 h, p = 0.272). Additionally, no significant differences were observed in transfusion requirements, ICU admissions, or mortality rates at 30 days and 1 year postoperatively between the two groups.
Timely surgery for hip fractures is achievable in elderly patients on anticoagulation therapy and does not negatively impact critical postoperative outcomes when managed within a structured OCCC protocol. These findings support the use of standardized perioperative anticoagulation management protocols to ensure timely surgery and optimize patient recovery. Further research is recommended to validate these findings in broader clinical settings.
老年髋部骨折手术患者的管理通常涉及接受抗凝治疗的患者，这在手术时机和手术结果方面带来了挑战。本研究评估了抗凝治疗的普遍性、其对手术时机的影响以及在老年骨科临床护理中心（OCCC）内的术后结果。
对2014年5月至2023年12月在OCCC接受治疗的638例65岁及以上髋部骨折患者进行回顾性研究。使用多变量逻辑回归分析抗凝药物使用、手术时机和结果的数据，以调整年龄、术前血红蛋白水平和合并症等混杂因素。
14.7%的患者接受了抗凝治疗，主要使用直接口服抗凝剂（12.2%）。与未接受抗凝治疗的患者相比，接受抗凝治疗的患者手术时机没有显著延迟（平均手术时间：31.5±23.3小时）（28.7±15.7小时，p=0.272）。此外，两组在术后30天和1年的输血需求、入住重症监护病房情况或死亡率方面没有观察到显著差异。
对于接受抗凝治疗的老年患者，及时进行髋部骨折手术是可行的，并且在结构化的OCCC方案管理下，不会对关键的术后结果产生负面影响。这些发现支持使用标准化的围手术期抗凝管理方案，以确保及时手术并优化患者康复。建议进一步研究以在更广泛的临床环境中验证这些发现。
