Case Control Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2015; 6(11): 970-976
Published online Dec 18, 2015. doi: 10.5312/wjo.v6.i11.970
Effect of early surgery in high surgical risk geriatric patients with femoral neck fracture and taking antiplatelet agents
Paphon Sa-ngasoongsong, Noratep Kulachote, Norachart Sirisreetreerux, Pongsthorn Chanplakorn, Sukij Laohajaroensombat, Nithiwut Pinsiranon, Patarawan Woratanarat, Viroj Kawinwonggowit, Chanyut Suphachatwong, Wiwat Wajanavisit
Paphon Sa-ngasoongsong, Noratep Kulachote, Norachart Sirisreetreerux, Pongsthorn Chanplakorn, Sukij Laohajaroensombat, Nithiwut Pinsiranon, Patarawan Woratanarat, Viroj Kawinwonggowit, Chanyut Suphachatwong, Wiwat Wajanavisit, Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Sa-ngasoongsong P and Chanplakorn P contributed equally to this work; Sa-ngasoongsong P and Chanplakorn P designed the research, analyzed the data and prepared the manuscript; Pinsiranon N collected the data; Kulachote N and Sirisreetreerux N contributed to the study design; Sa-ngasoongsong P, Kulachote N, Sirisreetreerux N, Kawinwonggowit V and Suphachatwong C were the surgeons who performed the surgery and reviewed the data critically; Laohajaroensombat S and Wajanavisit W assisted in preparation of the manuscript and reviewed the manuscript critically; and Woratanarat P reviewed data and performed statistical analysis; all authors read and approved the final manuscript.
Institutional review board statement: The study was approved by the ethical clearance committee of Human Rights Related to Research Involving Human Subjects of the Faculty of Medicine Ramathibodi Hospital, Mahidol University.
Informed consent statement: All study participants in the prospective cohort group provided informed written consent. According to ethical approval, no informed consent was necessary from individual patients in the retrospective group since all data were gathered retrospectively from medical records.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding authors at pongsthornc@yahoo.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pongsthorn Chanplakorn, MD, Assistant Professor, Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 999 Phuttamonthon 4 Road, Bangkok 10400, Thailand. pongsthornc@yahoo.com
Telephone: +66-2-2011589 Fax: +66-2-2011599
Received: May 20, 2015
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
Processing time: 211 Days and 4.3 Hours
Abstract

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.

Keywords: Early hip surgery; Blood loss; Elderly hip fracture; Antiplatelet agents; Displaced femoral neck fracture; Hip arthroplasty

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.