Published online Dec 18, 2015. doi: 10.5312/wjo.v6.i11.970
Peer-review started: May 21, 2015
First decision: September 17, 2015
Revised: September 30, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: December 18, 2015
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.
Core tip: In this cohort controlled study, a prospective study was conducted on geriatric femoral neck fracture patients, who took antiplatelet agents, and underwent hip replacement within 72 h which was compared with a retrospective case series of patients with similar characteristics who had delayed surgery. Our results supported the benefits of early surgery on these high surgical risk elderly patients in terms of significantly better postoperative complications, length of hospital stay, and 1-year functional outcome without significant difference in perioperative blood loss and postoperative mortality.