Abstract
BackgroundHip fracture is associated with high mortality. Cardiovascular disease and other comorbidities requiring long-term anticoagulant medication are common in these mostly elderly patients. The objective of our observational cohort study of patients undergoing surgery for hip fracture was to study the association between preoperative use of low-dose acetylsalicylic acid (LdAA) and intraoperative blood loss, blood transfusion and first-year all-cause mortality.MethodsAn observational cohort study was conducted on patients with hip fracture (cervical requiring hemiarthroplasty or pertrochanteric or subtrochanteric requiring internal fixation) participating in a randomized trial that found lack of efficacy of a compression bandage in reducing postoperative bleeding. The participants were 255 patients (≥50 years) of whom 118 (46%) were using LdAA (defined as ≤320 mg daily) preoperatively. Bleeding variables in patients with and without LdAA treatment at time of fracture were measured and blood transfusions given were compared using logistic regression. The association between first-year mortality and preoperative use of LdAA was analyzed with Cox regression adjusting for age, sex, type of fracture, baseline renal dysfunction and baseline cardiovascular and/or cerebrovascular disease.ResultsBlood transfusions were given postoperatively to 74 (62.7%) LdAA-treated and 76 (54%) non-treated patients; the adjusted odds ratio was 1.8 (95% CI 1.04 to 3.3). First-year mortality was significantly higher in LdAA-treated patients; the adjusted hazard ratio (HR) was 2.35 (95% CI 1.23 to 4.49). The mortality was also higher with baseline cardiovascular and/or cerebrovascular disease, adjusted HR 2.78 (95% CI 1.31 to 5.88). Patients treated with LdAA preoperatively were significantly more likely to suffer thromboembolic events (5.7% vs. 0.7%, P = 0.03).ConclusionsIn patients with hip fracture (cervical treated with hemiarthroplasty or pertrochanteric or subtrochanteric treated with internal fixation) preoperative use of low-dose acetylsalicylic acid was associated with significantly increased need for postoperative blood transfusions and significantly higher all-cause mortality during one year after surgery.
Highlights
Hip fracture is associated with high mortality
We performed a randomized controlled trial to assess the efficacy of a pneumatic compression bandage, applied to the hip immediately after hip fracture surgery, in reducing the need for blood transfusion and found that the bandage did not reduce the proportion of transfused patients or the amount of transfusion [9]
The inclusion criteria were patients 50 years or older with cervical fractures planned for hemiarthroplasty or pertrochanteric or subtrochanteric fractures planned for internal fixation with plate and gliding screw or twin hook or with proximal intramedullary nail
Summary
Hip fracture is associated with high mortality. Cardiovascular disease and other comorbidities requiring long-term anticoagulant medication are common in these mostly elderly patients. The objective of our observational cohort study of patients undergoing surgery for hip fracture was to study the association between preoperative use of low-dose acetylsalicylic acid (LdAA) and intraoperative blood loss, blood transfusion and firstyear all-cause mortality. We performed a randomized controlled trial to assess the efficacy of a pneumatic compression bandage, applied to the hip immediately after hip fracture surgery, in reducing the need for blood transfusion and found that the bandage did not reduce the proportion of transfused patients or the amount of transfusion [9] In this observational study of the trial participants we analyzed intraoperative blood loss, transfusions, postoperative complications and first-year all-cause mortality after surgery. Our hypothesis was that patients using LdAA before the hip fracture had higher need for blood transfusions and higher first-year mortality than those not using LdAA at the time of hip fracture
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