The results of an observational study were presented at American Society of Anesthesiologists 2023 annual meeting.
In an analysis of more than 35,000 patients treated in the Kaiser Permanente system from 2009 to 2020, about 15% of the cohort used anticoagulants within 100 days prior to surgery.
Some surgeries were performed within 10 hours, while others were delayed as long as 48-72 hours.
Outcomes of interest were mortality at 30 and 90 days and at 1 year, plus 90-day incidence of pneumonia, VTE, and myocardial infarction.
There was a clear U-shaped curve for mortality and complications when plotted against time from admission for patients on anticoagulants.
While 30-day mortality approached 9% for anticoagulated patients who underwent surgery relatively early -- within about 10 hours -- it was less than 6% for those whose surgeries were around 20 hours, and followed by a gradual increase as delay extended past 30 hours. Likewise, 90-day mortality was lower by about 5 percentage points with this timing; 1-year mortality was also lower but to a smaller degree.
Similar patterns were seen for 90-day incidence of pneumonia, venous thromboembolism, and myocardial infarction in the anticoagulated patients.
Hip fracture repair is best started about 20 hours after presentation in elderly patients on blood thinners, not immediately and not more than a day later either, a researcher said here.
American Society of Anesthesiologists
Desai V, et al "Optimized time to surgery for hip fracture repair in the elderly to reduce postoperative mortality and complications" ASA 2023; Abstract A1098..
