It turns out there’s an optimal time for doctors to begin surgically repairing a hip fracture in people on blood thinners or anticoagulants. It’s about the 20-hour mark after the fracture occurs, according to a new study.
The surgery should not begin immediately after fracture and shouldn’t occur more than a day after the break, either, according to Chunyuan Qiu, MD, a researcher from Kaiser Permanente in Baldwin Park, CA. He presented the findings recently at the American Society of Anesthesiologists annual meeting.
Why the strict time frame? Complications such as venous thromboembolism (VTE) and pneumonia — as well as death — were minimized when surgery began at about the 20-hour mark after people arrived at the hospital (and were taking warfarin or other anticoagulants).
Qui looked at more than 35,000 people treated in the Kaiser Permanente system between 2009 and 2020. The researchers used a U-shape curve to investigate the optimal time for surgery, calling the “sweet spot” about 20 hours after admission, but no longer than a day after arriving at the hospital. When the researchers evaluated people who weren’t taking anticoagulants, a “sweet spot” time frame didn’t emerge.
The reason to wait in people on anticoagulants is because it lets the medication deplete so the person’s blood will clot properly.
The researchers looked at when people had surgery, as well as the incidence of death within 30 days of surgery, 90 days of surgery and a year after surgery. The researchers also evaluated the incidence of pneumonia, VTE and myocardial infarction.
In people on anticoagulants, death percentages were 8.3%, 16.3% and 30.5% at 30 days, 90 days and at one year after surgery, respectively. The death rates were about 50% higher in people on the medications compared to those who weren’t on the blood thinners.
For instance, 30-day mortality was almost 9% in people who had surgery at about 10 hours, but less than 6% in people who stuck to the 20-hour mark. Also, 90-day mortality was lower by about 5 percentage points in people who had delayed surgery, and that was about the same for the one-year mark.
