Clinical Outcomes and Surgical Complications Among Patients with Bleeding Disorders After Acute Hip Fracture Surgery.

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.