[HIP FRACTURE SURGERY DELAY IN PATIENTS TREATED WITH ORAL ANTICOAGULANTS: RESULTS FROM SHEBA MEDICAL CENTER].

BACKGROUND: Hip fractures (HF) are a major cause of morbidity and mortality in the elderly population. Many factors are associated with HF post-operative prognosis, among them the admission to operation time (AOT) is a major factor. Delayed surgery (> 48 hours) is associated with increased morbidity and mortality. The use of anti-coagulants (OAC) often leads to surgery delay to prevent possible surgical bleeding. OBJECTIVES: To test the association between the use of OAC and AOT. METHODS: The study was a retrospective cohort of consecutive patients above 65 years of age admitted and operated for hip fracture at the Sheba Medical Center between the years 2014-2018. We compared AOT between OAC treated and non-treated patients. We conducted multi-variable analysis to examine the effect of OAC on AOT. RESULTS: Overall, 1013 case patients were studied, among them 151 were treated with OAC (research group) and 865 patients without any anti-coagulation treatment (control group). Surgery delay over 48 hours was observed in 24.6% OAC treated patients compared to 12% in the non-treatment group (p=0.0001). Median AOT was 32 hours compared to 24.6 hours in treated vs non-treated patients, respectively, p=0.0001. Apixaban is the only drug found not to prolong AOT. In multivariate analysis OAC therapy was the only significant cause for surgical delay. CONCLUSIONS: Patients with HF treated with anti-coagulants are experiencing delayed surgery compared to non-treated patients.

Recurrent Ovarian Torsion: Risk Factors and Predictors for Outcome of Oophoropexy.

STUDY OBJECTIVE: To identify risk factors for recurrent ovarian torsion and evaluation of the efficacy of oophoropexy techniques. DESIGN: Case control study. SETTING: Tertiary university-affiliated medical center. PATIENTS: A total of 79 women with recurrent ovarian torsion (study group) were matched with 158 women with a single episode of ovarian torsion (control group). INTERVENTIONS: Laparoscopic detorsion and oophoropexy. MEASUREMENTS AND MAIN RESULTS: Demographic data, clinical characteristics, ultrasound characteristics, surgical findings, surgical procedures, and torsion recurrence rates were analyzed and compared between the 2 groups between 2001 to 2020. RESULTS: There was an inverse association between women's age and the risk of recurrent torsion (adjusted odds ratio [aOR], 0.89; 95% confidence interval [CI], 0.83-0.96, p = .003). Moreover, in women younger than 20 years, the risk of recurrent event was substantially higher (aOR, 5.0; 95% CI, 1.56-6.15, p = .007). In addition, the absence of ovarian pathology was associated with increased risk for recurrent torsion (aOR, 14.3; 95% CI, 6.15-33.42; p <.001). Oophoropexy was performed in 46 women in the study group. The risk of recurrent torsion after oophoropexy was 30%. A long duration of pain before admission was associated with oophoropexy failure (37.5 ± 6.3 hours vs 11.7 ± 6.0 hours, p = .003). No single fixation procedure was superior to the others in terms of therapeutic success. CONCLUSION: Recurrent ovarian torsion is more common in young women with a normal-appearing ovary. Oophoropexy is a safe procedure with a risk of retorsion in 30% of the patients. We found no advantage for one fixation technique over the others.