Dual Antiplatelet Therapy and Surgical Timing in Geriatric Hip Fracture.

OBJECTIVE: To determine how timing of surgery affects transfusion, major complications, and mortality in patients who sustain a geriatric hip fracture while taking dual antiplatelet therapy (DAPT; typically aspirin and clopidogrel). DESIGN: Retrospective cohort study. SETTING: University-affiliated Level 1 Trauma Center. PATIENTS: Patients 65 years of age or older on DAPT with a geriatric hip fracture were investigated at a single institution between 2002 and 2017. Demographic and perioperative data were collected from patient records, institutional databases, and national hip fracture registry. INTERVENTION: Fixation or arthroplasty. MAIN OUTCOME MEASUREMENT: Transfusion, major complications, and 30-day mortality. RESULTS: Of the 6724 patients sustaining a geriatric hip fracture, 122 patients were taking DAPT on admission. Timing of surgery did not influence transfused units (incidence rate ratio 1.00, 95% confidence interval: 0.87-1.15, P = 0.968) but did affect major complications (time modeled as quadratic term; odds ratios ranging from 0.20 to 7.91, ptime = 0.001, ptime*time<0.001) and 30-day mortality (odds ratio 1.32, 95% confidence interval: 1.03-1.68, P = 0.030). CONCLUSION: Surgical delay does not change the need for transfusion of hip fracture patients on DAPT, but it is associated with increased probabilities of major complications and 30-day mortality. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Quality of information on the Internet-has a decade made a difference?

BACKGROUND: While patients accessing the Internet can be a positive step towards health literacy and self-efficacy, these resources vary in quality. AIMS: In 2007, Kulasegarah et al. assessed the information available to patients on the Internet on three common ENT procedures (tonsillectomy, septoplasty, and myringoplasty), looking at the quality of the information in terms of completeness and accuracy. This is a follow-on study to examine how this information has changed after 10 years. METHODS: Following a Google search, the top 20 webpages on each of the three ENT procedures, tonsillectomy, septoplasty, and myringoplasty, were analyzed. RESULTS: Webpages gave on average 50.6% of the critical information a patient should know prior to undergoing surgery. This is a drop from 2007 (65.5%). Over 96.8% were found to have no inaccuracies identified on the available information provided on the websites. This was slightly higher than in 2007 (94.7%). YouTube (10%) and hospital webpages (10%) were among the new subcategories that were not present in the 2007 study. CONCLUSIONS: Due to the reduced completeness of information available to patients online, it is important that health professionals direct patients to appropriate websites if they wish to do their own research.