Bleeding and First-year Mortality Following Hip Fracture Surgery and Preoperative Use of Low-dose Acetylsalicylic Acid

An Observational Cohort Study

Annika M Kragh; Markus Waldén; Anna Apelqvist; Philippe Wagner; Isam Atroshi

BMC Musculoskelet Disord. 2011;12(254)

Conclusions

In patients with hip fracture (cervical treated with hemiarthroplasty or trochanteric treated with internal fixation) preoperative use of LdAA was associated with significantly increased need for postoperative blood transfusions and significantly higher all-cause mortality during one year after surgery.

1 2 3 4 5 6

Next Section

Authors' contributions
Conception and design of the study: AK, MW, AA, IA. Data collection: AA, AK, MW. Statistical analysis and interpretation: IA, PW, AK. Drafting of the manuscript: AK, IA, MW. Critical revision of the manuscript: MW, AA, PW. Approval of the final version of the manuscript: AK, MW, AA, PW, IA

Competing interests and funding
The authors have no competing interests to declare. The project was supported by independent research grants from Skåne County Council's Research and Development Foundation, the Swedish Society of Medicine and Hässleholm Hospital. The grant providers had no role in study design, data collection, statistical analysis, or manuscript preparation and submission. No financial or other support from other sources was received.

Acknowledgements
The authors thank Professor Sölve Elmståhl and Mats Pihlsgård, Institute of Health, Care and Society, Department of Geriatrics, Lund University, for their helpful advice. We also like to thank Hans Gren, Department of Anaesthesia, Kristianstad Hospital for valuable support.

Table 1. Characteristics of the patients according to preoperative use of low-dose acetylsalicylic acid (LdAA)
	LdAA (n = 118)	No LdAA (n = 137)	P value
Age, mean (SD)	84 (7.6)	80.8 (9.5)	< 0.01
Women, n (%)	82 (69.5)	108 (78.8)	0.11
Institutional residence, n (%)	29 (24.6)	31 (22.6)	0.77
Type of surgery (fracture), n (%)			0.07
Hemiarthroplasty (cervical)	51 (43.2)	43 (31.4) *
Fixation (subtrochanteric or pertrochanteric)	67 (56.8)	94 (68.6)
Time from admission to surgery (hrs)†	20.1	19.2	0.51
mean (SD)	(10.7)	(9.3)
Type of anesthesia, n (%)
Spinal	113 (95.8)	136 (99.3)	0.1
General	5 (4.2)	1 (0.7)	0.1
NSAID medication at fracture, n (%)	6 (5.1)	8 (5.8)	1.00
Medical history, n (%)
Cardiovascular disease	72 (61)	56 (41)	< 0.01
Cerebrovascular disease	16 (13.6)	3 (2.2)	< 0.01
Hypertension	46 (39)	33 (24.1)	0.01
Diabetes	17 (14.4)	12 (8.8)	0.17
Renal dysfunction (serum creatinine)‡	31 (26.3)	15 (11.0)	< 0.01
Pulmonary disease	8 (6.8)	15 (10.9)	0.28
Rheumatoid arthritis	2 (1.7)	8 (5.8)	0.11
Other disease	2 (1.7)	2 (1.5)	1
ASA score n (%)			0.02
I	7 (5.9)	15 (10.9)
II	54 (45.8)	81 (59.1)
III	52 (44.1)	38 (27.7)
IV	5 (4.2)	3 (2.2)
Compression bandage, n (%)	55 (47)	59 (43)	0.61

*Including 1 total arthroplasty † No data available for 15 patients receiving and 10 patients not receiving acetylsalicylic acid ‡ Defined as creatinine ≥105 μmol/L in males and ≥ 95 μmol/L in females ASA: American Society of Anesthesiologists; NSAID: non-steroidal anti-inflammatory drugs.

Table 2. Bleeding and transfusion-related data of the patients according to preoperative use of low-dose acetylsalicylic acid (LdAA)
	LdAA (n = 118)	No LdAA (n = 137)	Mean difference or odds ratio (95% CI) *	P value
Hemoglobin (g/L) at baseline	126 (15.8)	124 (14.2)		0.16
Platelet count (×10^9/L)	264 (125)	263 (90)		0.97
APTT	33.1 (5.9)	31.6 (4.1)		0.02
INR	1.07 (0.12)	1.04 (0.09)		0.01
Patients transfused pre-or intraoperatively	47 (39.8)	49 (35.8)	1.5 (0.78, 2.8)	0.23
Units transfused pre-or intraoperatively	0.7 (0.9)	0.7 (1.0)	0.1 (−0.1, 0.3)	0.27
Bleeding intraoperatively (mL)	363 (235)	316 (329)	45 (−27, 117)	0.22
Patients transfused postoperatively	74 (62.7)	76 (54)	1.8 (1.04, 3.3)	0.04
Units transfused postoperatively	1.3 (1.3)	1.1 (1.2)	0.3 (−0.01, 0.62)	0.06
Hemoglobin day 1 (g/L)	109 (11.1)	108 (10.4)	0.3 (−2.4, 3.0)	0.89
Hemoglobin day 5 (g/L)†	111 (10.7)	113 (9.5)	−1.9 (−4.5, 0.77)	0.11

Values are shown as mean (SD) except patients transfused shown as n (%)
*Logistic regression or ANCOVA adjusting for age, sex, baseline hemoglobin and type of surgery.
† No data were available for 7 patients using and 5 patients not using acetylsalicylic acid APTT: activated partial thromboplastin time; INR: international normalized ratio

Table 3. First-year mortality hazard ratios for baseline factors including preoperative use of low-dose acetylsalicylic acid (LdAA) in a Cox regression
Factors	Hazard ratio	95% CI	P value
Preoperative LdAA use	2.35	1.23 - 4.49	0.01
Age at fracture (per year)	1.08	1.03 - 1.13	< 0.01
Sex (men vs women)	0.85	0.44 - 1.63	0.62
Fracture type (cervical vs subtrochanteric or pertrochanteric	0.92	0.52 - 1.63	0.77
Cardiovascular or cerebrovascular disease	2.78	1.32 - 5.88	0.01
Renal dysfunction*	1.04	0.54 - 2	0.91

*Defined as creatinine ≥105 umol/L in males and ≥95 umol/L in females

Table 4. Early postoperative complications according to preoperative use of low-dose acetylsalicylic acid (LdAA)
	Events LdAA (n = 118)	No LdAA (n = 137)	P value
Cardiovascular	8 (6.8)	5 (3.6)	0.26
Cerebrovascular	2 (1.7)	0 (0)	0.13
Thromboembolic	6 (5.1)	1 (0.7)	0.03
Pulmonary infection	12 (10.2)	8 (5.8)	0.2
Lower urinary tract infection	23 (19.5)	25 (18.2)	0.8
Wound related	7 (5.9)	9 (6.6)	0.83
Reoperation	1 (0.8)	2 (1.5)	0.65
Other serious *	2 (1.7)	7 (5.1)	0.14
Any complication	54 (45.8)	48 (35.0)	0.08

* Kidney failure, gastrointestinal bleeding, septicemia (unknown origin), ileus, multiorgan failure, deep pressure ulcer.

processing....

Bleeding and First-year Mortality Following Hip Fracture Surgery and Preoperative Use of Low-dose Acetylsalicylic Acid

An Observational Cohort Study

Conclusions

Tables

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Email This

Feedback