This study looks at patients with hip fractures who are taking direct oral anticoagulants (DOACs), a type of blood thinner. In many hospitals, surgery for these patients is delayed because of concerns about bleeding, but waiting longer can also increase risks such as complications and longer hospital stays. The purpose of this study is to find out whether operating within 24 hours is as safe as delaying surgery beyond 24 hours. Specifically, the investigators want to know if early surgery does not lead to a higher need for blood transfusions compared to delayed surgery.
Isolated hip fracture classified as AO/OTA 31A or 31B requiring surgical intervention.
Current DOAC use with the last dose taken ≤24 hours before emergency department (ED) presentation
Pathologic or periprosthetic hip fractures.
Fracture sustained >24 hours before ED presentation.
Inter-hospital transfer.
Hematologic disorders (e.g., thalassemia, sickle cell disease, aplastic anemia, myelodysplastic syndromes, leukemia).
Study participants will be selected from patients admitted with an isolated hip fracture to one of seven Dutch level 2 trauma centers. All patients are routinely treated according to local hospital protocols, which differ in surgical timing policies for patients on direct oral anticoagulants. This natural variation provides the basis for the study cohorts (\<24h vs \>24h to surgery).
Cohort
Retrospective
Not listed
Number of participants receiving a postoperative blood transfusion
Receiving one or more units of packed red blood cells in the postoperative period during hospitalization
Number of participants receiving a preoperative blood transfusion
Any administration of one or more units of packed red blood cells before hip fracture surgery during hospitalization.
Number of packed red blood cells administered postoperatively
Total number of packed red blood cell units administered after hip fracture surgery during hospitalization.
Number of packed red blood cells administered preoperatively
Total number of packed red blood cell units administered before hip fracture surgery during hospitalization.
Surgical duration in minutes
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