Auteur(s) : Keller Ludovic
Composante : MEDECINE
Date de création : 30-06-2022

Description : Médecine (anesthésie réanimation), La fracture de l’extrémité supérieure du fémur est une problématique mondiale. Une chirurgie précoce est recommandée afin de réduire la mortalité. Chez les patients traités par anticoagulants oraux directs, l’impact du délai entre l’admission et la chirurgie n’est pas connu. L’objectif de cette étude est de déterminer si une chirurgie précoce (-48h) sous anticoagulants oraux directs est associée à une mortalité post-opératoire plus faible à J30. Cette étude de cohorte rétrospective, menée au centre hospitalier universitaire de Strasbourg, a inclus 3429 patients admis pour fracture de l’extrémité supérieure du fémur. Parmi les 217 patients traités par anticoagulants oraux directs, la mortalité à J30 est plus faible (1,2%) dans le groupe chirurgie précoce que dans le groupe chirurgie tardive (5,9%). Une chirurgie précoce semble donc bénéfique, y compris chez les patients sous anticoagulants oraux directs, malgré un risque hémorragique accru avec un taux de transfusion supérieur., Importance: Hip fracture is responsible for significant morbidity and mortality worldwide. Early surgery is recommended in the general population to decrease mortality, however the effect of early hip fracture surgery in patient treated with direct oral anticoagulants is unknown. Objective : To determine whether early surgery, before 48h following hospital admission is associated with decreased postoperative mortality. We tested the hypothesis that early surgery was beneficial with regard for mortality in patient treated with direc oral anticoagulants. Design: retrospective cohort study. Adults admitted for Hip Fracture and discharged from Strasbourg University Hospital between January the 1st, 2015 and December 31, 2019 were considered. Setting: French University Hospital Participants: All consecutive patients were considered. Inclusion criteria included age ≥ 45 years, being a French resident. Exclusion criteria included associated severe trauma and not having undergoing hip fracture surgery during hospitalization. Main exposure: wait time for surgery defined as the total time, in hours, between hospital admission and surgery.Main Outcome: mortality within 30 days following for hip fracture surgery. Results : 3429 patients admissions were included in the analysis. The overall 30-d mortality is 4 %. In DOA + patients, the 30-d mortality rate in the early and delayed surgery was 1% and 6%, respectively. The probability that 30-d mortality in the group DOA+ delayed surgery is superior to the 30-d mortality in the group DOA+ early surgery is 96%. Conclusion and relevance : Early hip fracture surgery was associated with improved survival in patients treated with direct oral anticoagulants. Strategies to allow for early surgery for these patients may be investigated., Thèses et écrits académiques
Mots-clés libres : Fémur Fractures, 617.5, Anticoagulants oraux directs, Comorbidité, Intervention médicale précoce
Couverture : FR