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Safety of urgent surgery for the patients with proximal femur fracture treated with platelet aggregation inhibitors: a propensity-score matching analysis

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Abstract

Introduction

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.

Methods

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).

Results

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.

Conclusion

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.

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The authors did not receive any outside funding or grants in support of their research or for the preparation of this work.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, Republic of Korea

    Chul-Ho Kim & Ji Wan Kim

  2. Department of Orthopedic Surgery, National Police Hospital, Seoul, Republic of Korea

    Jae Suk Chang

  3. Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea

    Yaeji Lim & Dongkyung Lim

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  1. Chul-Ho Kim
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Correspondence to Ji Wan Kim.

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The authors have no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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This study was approved by the Institutional Review Board of Asan Medical Center, which waived the requirement for written informed consent (IRB No. 2021–1070).

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This study was approved by the Institutional Review Board of Asan Medical Center and waiver was received for the need to provide written informed consent. Data collection was performed in accordance with relevant guidelines and regulations of the committee.

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Kim, CH., Chang, J.S., Lim, Y. et al. Safety of urgent surgery for the patients with proximal femur fracture treated with platelet aggregation inhibitors: a propensity-score matching analysis. Eur J Trauma Emerg Surg 50, 347–358 (2024). https://doi.org/10.1007/s00068-023-02368-9

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  • DOI: https://doi.org/10.1007/s00068-023-02368-9

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