Effect of early surgery in high surgical risk geriatric patients with femoral neck fracture and taking antiplatelet agents

Abstract

Aim: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture (FNF) and taking concomitant antiplatelet agents.

Methods: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery (ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics (45 cases) who had delayed surgery (DS group) after 72 h during an earlier 3-year period. Postoperative outcomes were followed for one year and compared.

Results: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality (P > 0.05 all). There were 2 patients (4%) in the DS group who died after surgery (P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome (P < 0.05 all).

Conclusion: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.

Keywords: Antiplatelet agents; Blood loss; Displaced femoral neck fracture; Early hip surgery; Elderly hip fracture; Hip arthroplasty.

Figure 1

Flow diagram of the study; patients in the early hip surgery protocol stopped the antiplatelet agents after admission and then were operated within 72 h after admission compared with the patients in the delayed hip surgery protocol who stopped the antiplatelet agents at least 5 d before the operation.