[HIP FRACTURE SURGERY DELAY IN PATIENTS TREATED WITH ORAL ANTICOAGULANTS: RESULTS FROM SHEBA MEDICAL CENTER].

BACKGROUND

Hip fractures (HF) are a major cause of morbidity and mortality in the elderly population. Many factors are associated with HF post-operative prognosis, among them the admission to operation time (AOT) is a major factor. Delayed surgery (> 48 hours) is associated with increased morbidity and mortality. The use of anti-coagulants (OAC) often leads to surgery delay to prevent possible surgical bleeding.

OBJECTIVES

To test the association between the use of OAC and AOT.

METHODS

The study was a retrospective cohort of consecutive patients above 65 years of age admitted and operated for hip fracture at the Sheba Medical Center between the years 2014-2018. We compared AOT between OAC treated and non-treated patients. We conducted multi-variable analysis to examine the effect of OAC on AOT.

RESULTS

Overall, 1013 case patients were studied, among them 151 were treated with OAC (research group) and 865 patients without any anti-coagulation treatment (control group). Surgery delay over 48 hours was observed in 24.6% OAC treated patients compared to 12% in the non-treatment group (p=0.0001). Median AOT was 32 hours compared to 24.6 hours in treated vs non-treated patients, respectively, p=0.0001. Apixaban is the only drug found not to prolong AOT. In multivariate analysis OAC therapy was the only significant cause for surgical delay.

CONCLUSIONS

Patients with HF treated with anti-coagulants are experiencing delayed surgery compared to non-treated patients.