Blood Transfusion Risk After Early vs. Delayed Surgery in Hip Fracture Patients on Direct Oral Anticoagulants A Natural Experiment

What this Trial Is About

This research investigates patients with hip fractures who are taking direct oral anticoagulants (DOACs), a type of blood thinner. The study aims to determine whether performing surgery within 24 hours of hospital admission is as safe as delaying surgery beyond 24 hours. This is important because surgery delays may reduce bleeding risks but can also increase complications, longer hospital stays, and mortality. The study is designed as a natural experiment comparing these two timing strategies across multiple hospitals in the Netherlands. The study compares outcomes between patients who receive hip fracture surgery within 24 hours of emergency department arrival (early surgery) and those who have surgery after 24 hours (delayed surgery). No additional procedures are performed beyond routine care, and the timing of surgery is based on hospital protocols. Data on blood transfusions, hemoglobin levels, complications, hospital stay, and functional recovery at three months are collected from electronic health records. Participants are monitored through information routinely recorded during hospital care, including blood transfusion needs after surgery and various postoperative complications. Data quality is ensured by standardized documentation and regular checks. The main measurement is whether patients require blood transfusions after surgery, observed until hospital discharge or up to 30 days. The total participation involves hospital stay from emergency presentation until discharge, with outcomes also assessed up to three months after surgery.

Hip Fracture Surgery Timing and Blood Transfusion Risk in Patients on DOACs