Correction to: Do direct oral anticoagulants (DOACs) cause delayed surgery, longer length of hospital stay, and poorer outcome for hip fracture patients?

Objectives: To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures. Design: Retrospective cohort study. Setting: A community hospital. Participants: Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125). Measurements: We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed. Results: The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period. Conclusion: This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.

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The independent patient factors that affect length of stay following hip fractures

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0068 ◽

2018 ◽

Vol 100 (7) ◽

pp. 556-562 ◽

Cited By ~ 4

Author(s):

T Richards ◽

A Glendenning ◽

D Benson ◽

S Alexander ◽

S Thati

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Hospital Stay ◽

Hip Fractures ◽

Length Of Hospital Stay ◽

Hospital Length ◽

Acute Hospital ◽

Hospital Length Of Stay ◽

Patient Factors ◽

Mobility Status

Introduction Management of hip fractures has evolved over recent years to drive better outcomes including length of hospital stay. We aimed to identify and quantify the effect that patient factors influence acute hospital and total health service length of stay. Methods A retrospective observational study based on National Hip Fracture Database data was conducted from 1 January 2014 to 31 December 2015. A multiple regression analysis of 330 patients was carried out to determine independent factors that affect acute hospital and total hospital length of stay. Results American Society of Anesthesiologists (ASA) grade 3 or above, Abbreviated Mental Test Score (AMTS) less than 8 and poor mobility status were independent factors, significantly increasing length of hospital stay in our population. Acute hospital length of stay can be predicted as 8.9 days longer when AMTS less than 8, 4.2 days longer when ASA grade was 3 or above and 20.4 days longer when unable to mobilise unaided (compared with independently mobile individuals). Other factors including total hip replacement compared with hemiarthroplasty did not independently affect length of stay. Conclusions Our analysis in a representative and generalisable population illustrates the importance of identifying these three patient characteristics in hip fracture patients. When recognised and targeted with orthogeriatric support, the length of hospital stay for these patients can be reduced and overall hip fracture care improved. Screening on admission for ASA grade, AMTS and mobility status allows prediction of length of stay and tailoring of care to match needs.

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Length of hospital stay for hip fracture falls by a day, audit shows

BMJ ◽

10.1136/bmj.e5940 ◽

2012 ◽

Vol 345 (sep04 1) ◽

pp. e5940-e5940 ◽

Cited By ~ 4

Author(s):

S. Mayor

Keyword(s):

Hip Fracture ◽

Hospital Stay ◽

Length Of Hospital Stay

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Should surgery be delayed in patients taking direct oral anticoagulants who suffer a hip fracture? A retrospective, case-controlled observational study at a UK major trauma centre

BMJ Open ◽

10.1136/bmjopen-2017-020625 ◽

2018 ◽

Vol 8 (4) ◽

pp. e020625 ◽

Cited By ~ 21

Author(s):

Barry Mullins ◽

Harold Akehurst ◽

David Slattery ◽

Tim Chesser

Keyword(s):

Hip Fracture ◽

Observational Study ◽

Major Trauma ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Trauma Centre ◽

Retrospective Case ◽

Major Trauma Centre

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Direct oral anticoagulants and delays to hip fracture repair

Anaesthesia ◽

10.1111/anae.15008 ◽

2020 ◽

Vol 75 (9) ◽

pp. 1139-1141

Author(s):

A. Mayor ◽

S. M. White

Keyword(s):

Hip Fracture ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Fracture Repair

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Direct Oral Anticoagulants and Timing of Hip Fracture Surgery

Journal of Clinical Medicine ◽

10.3390/jcm9072200 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2200

Author(s):

Seth M. Tarrant ◽

Michael J. Catanach ◽

Mahsa Sarrami ◽

Matthew Clapham ◽

John Attia ◽

...

Keyword(s):

Hip Fracture ◽

Primary Outcome ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Perioperative Outcomes ◽

Surgical Timing ◽

Serious Adverse Events ◽

Hip Fracture Surgery ◽

Geriatric Hip Fracture ◽

Secondary Outcomes

Timely surgical intervention in hip fracture has been linked to improved outcomes. Direct Oral Anticoagulants (DOACs) are an emerging class of anticoagulants without evidence-based guidelines on surgical timing. This study aims to investigate how DOACs affect surgical timing and hence perioperative outcomes. A retrospective database/registry review was conducted for geriatric hip fracture patients aged 65 and over between 2011 and 2018. Primary outcome was 30-day mortality. Secondary outcomes included serious adverse events (SAE), transfusion and postoperative day (POD) 1 haemoglobin (Hb) levels. From a cohort of 3264 patients, 112 admitted subjects were taking DOACs; the annual proportion on DOACs increased over time. Mean time to surgery from last dose (Ts) was 2.2 (±1.0 SD) days. The primary outcome, 30-day mortality, occurred in 16 (14%) patients with secondary outcomes of SAEs in 25 (22%) patients and transfusion in 30 (27%) patients. Ts (days) did not significantly affect 30-day mortality (odds ratio (OR): 1.37, 95% confidence interval (CI): 0.80–2.33; p = 0.248), SAE (hazard ratio (HR): 1.03, 95% CI: 0.70–1.52; p = 0.885), transfusion (OR: 0.72 95% CI: 0.45 to 1.16; p = 0.177) or POD 1 Hb (OR: 1.99, 95% CI: −0.59 to 4.57; p = 0.129). Timing of surgery does not influence common surgical outcomes such as 30-day mortality, SAE, transfusion, and POD1 Hb in patients taking DOACs on admission.

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