Safety of early minimally invasive surgical treatment of elderly patients with hip fractures without ceasing anti-platelet drugs / 第二军医大学学报

ABSTRACT

Objective To explore the safety of early minimally invasive surgery without stopping anti-platelet drugs in treatment of elderly patients with hip fractures. Methods Data of elderly patients with femoral intertrochanteric fractures treated with proximal femoral intramedullary nail between Jan. 2012 and Dec. 2013 were collected, in which 32 patients who took long-term oral anti-platelet drugs due to cardiovascular and cerebrovascular disorders received early closed reduction of minimally invasive intramedullary nail treatment without stopping anti-platelet drugs. Retrospective study was performed to analyze the clinical data of 32 patients, including gender, age, ASA score, fracture AO type, time from injured to surgery, pre-and post-operative hemoglobin, hospital stays, ICU stays, bleeding volume, post-operative blood transfusions, incision complications, systemic complications and intra-1-month and 1-year mortality. Results Thirty-two patients were aged 65-81 years old, with 11 males and 21 females. Twenty-five patients were taking only clopidogrel and 7 patients were taking both clopidogrel and aspirin. The mean time from injured to surgery was (4.8±2.5) d (range 2-13 d), and the mean operative time was (89.0±33.2) min. The mean inter-operation bleeding volume, post-operative drainage volume, post-operation hemoglobin and post-operative blood transfusions were (242.9±83.7) mL, (259.8±94.9) mL, (73±11) g/L, and (390.2±103.1) mL, respectively. The ICU stays was (1.7±0.9) d and the hospital stays was (12.5±2.5) d. Three patients experienced post-operative incision complications (9.4%), with 2 poor incision and 1 incisional hematoma. During the first month after surgery, acute cardiovascular event was found in 3 cases (9.4%), acute stroke in 2 cases (6.2%), pneumonia in 2 cases (6.2%), and pressure ulcer in 1 case (3.1%). Three patients (9.4%) died during the first month after surgery and 12 patients (37.5%) died in the first year. Conclusion Early minimally invasive surgery without stopping anti-platelet drugs in elderly patients with femoral intertrochanteric fractures will not increase the incidence of local and systemic complications within 1 year.