DOS 2020

DOS Kongressen 2020 · 175 The effect of Direct Oral Anticoagulants on time to surgery, post-operative complications and mortality in hip fracture patients - a retrospective study Nicolas Jones Pedersen , Maria Lovisa Jönsson, Kira Riber Mygind, Thomas Giver Jensen, Troels Haxholdt Lunn, Henrik Palm, Anna Maria Weronica Gaki Lindestrand- Hansen Department of Orthopaedic surgery , Bispebjerg Hospital ; Department of Anesthesiology, Bispebjerg Hospital Background: With aging populations, both hip fractures and patients in Direct Oral Anticoagulants (DOAC) are expected to increase. This constitutes a surgical chal- lenge as DOAC might increase the risk of intraoperative blood loss and postpone hip fracture surgery beyond the nationally recommended 24 hours. Few studies exam- ine Hip fracture patients receiving DOAC and there is no common guideline on how to treat this group when it comes to emergency surgery, which renders optimizing fast track regimes challenging. Purpose / Aim of Study: To examine time to surgery, postoperative complications, intraoperative blood loss and mortality in hip fracture patients receiving DOAC. Materials and Methods: All hip fracture patients from 2017 and partially 2018 at Bispebjerg Hospital were included. We retrospectively collected data from patient records. Findings / Results: 420 patients were included. The median age was 81,9 and 72,4% were female. Median time to surgery was 23 hours with a mean of 26,2 and 11,2% received DOAC. Excluding clopidogrel and VKA’s showed that the DOAC group had significantly longer time to surgery >24 hours, compared with the non-DOAC group (P ≤ .05) There was no statistically significant difference in post-operative complications between the DOAC and non-DOAC group, considering non-surgical infections, 30-day reoperation rate, 30-day readmission and acute kidney failure. 30,2% patients in the non-DOAC group received blood transfusion during admis- sion, compared with 33,3% in the DOAC group and was non-significant (P=0,8). When categorising intraoperative blood loss in 300 mL there was no significant difference in the DOAC and non-DOAC group. 30-day mortality was 6,7 % in the DOAC group compared with 6,4% in the non- DOAC grp and was non-significant (P=1). Neither was the 90-day mortality significantly different. Conclusions: Our study found that DOAC treatment delays time to surgery but pa- tients receiving DOAC do not suffer higher mortality or complication rates. It may be safe to perform surgery within 24 hours in patients receiving DOAC. We propose to formulate a protocol for hip fracture patients in DOAC to enable fast track regimes and reduce time to surgery. The study is ongoing and further data will be presented at DOS. 154.