Key result
Among patients undergoing acute hip fracture surgery, having a bleeding disorder was not associated with increased short-term mortality (OR 0.947; 95% CI 0.866-1.036) or reoperation.
Why the study?
To compare short-term outcomes of acute hip fracture surgery between patients with and without bleeding disorders.
Does the presence of a bleeding disorder increase the risk of short-term mortality, readmission, reoperation, and complications in patients undergoing acute hip fracture surgery?
Observational (n=63,718)
Yes
Does the presence of a bleeding disorder increase the risk of short-term mortality, readmission, reoperation, and complications in patients undergoing acute hip fracture surgery?
Odds Ratio: 0.947 (95% CI 0.866–1.036)
In patients undergoing acute hip fracture surgery, the presence of a bleeding disorder is associated with increased risks of medical complications and readmission, but not short-term mortality or reoperation.
Suggests bleeding disorders need not alter mortality-focused risk assessment; observational data leaves open effects on complications and readmission.
OBJECTIVE: To compare short-term (≤30 days) outcomes of hip fracture between patients with and without bleeding disorders. DESIGN: Retrospective database review. SETTING: The study setting included hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS: Patients with acute hip fractures were identified from the National Surgical Quality Improvement Program database between 2016 and 2019. INTERVENTION: Open reduction internal fixation or hemiarthroplasty. MAIN OUTCOME MEASUREMENTS: Mortality, readmission, reoperation, length of stay, and complication were main outcome measurements. RESULTS: There were 63,718 patients undergoing hip surgery, and 16.0% had a bleeding disorder. After adjusting for confounders, multivariable regression models showed that cases with bleeding disorders were associated with higher rates of transfusion [odds ratio (OR) 1.404; confidence interval (CI), 1.335-1.479], myocardial infarction (OR 1.367; CI, 1.190-1.572), pneumonia (OR 1.193; CI, 1.078-1.321), renal failure (OR 1.843; CI, 1.363-2.491), surgical site infections (OR 1.429; CI, 1.185-1.175), sepsis (OR 1.25; CI, 1.034-1.511), and readmission (OR 1.314; CI, 1.224-1.408). However, bleeding disorders were not associated with mortality (OR 0.947; CI, 0.866-1.036) or reoperation (OR 1.061; CI, 0.925-1.220). CONCLUSIONS: Hip fracture surgery in patients with bleeding disorders is not associated with higher risks of short-term mortality or reoperation. However, special consideration should be taken when calculating preoperative risks of complications among bleeding disorder patients. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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A 2021 study conducted an observational in Acute hip fracture (n=63,718). Bleeding disorders vs. No bleeding disorders was evaluated on Mortality (OR 0.947, 95% CI 0.866-1.036). Among patients undergoing acute hip fracture surgery, having a bleeding disorder was not associated with increased short-term mortality (OR 0.947; 95% CI 0.866-1.036) or reoperation.
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