Aims
No gold standard currently exists regarding the utilisation of pre-operative direct oral anticoagulant (DOAC) drug levels and appropriate DOAC-free period prior to emergency hip fracture surgery for older adults. Delayed surgery is associated with poor health outcomes (1). This review aims to assess adherence to a local DOAC protocol and evaluate post-operative outcomes.
Methods
A retrospective chart review of all fracture neck of femur patients aged ≥65 years admitted to Lyell McEwin Hospital from January to October 2022 was performed. Data was extracted from the Australian and New Zealand Hip Fracture Registry and case notes. Only patients taking DOAC pre-operatively were included. Primary outcomes: protocol adherence rate, barriers to adherence. Secondary outcomes: time to surgery (TTS), and post-operative outcomes including acute length of stay (LOS) and 120-day mortality.
Results
Of 203 patients, 37 were on DOAC. Protocol adherence rate was 29.7%. The remaining patients had timely surgery with drug levels outside recommended ranges (18.9%), delayed surgery due to delayed or suboptimal drug levels (18.9%), delayed surgery due to other factors irrespective of drug level (32.4%) including medical instability, theatre availability. The group that adhered to protocol had shorter average TTS (35 hours compared to 59.7 hours), acute LOS (5.5 days compared to 8.8 days) and reduced 120-day mortality (Table 1).