AB253. SOH26AB_0041. Direct oral anticoagulants are associated with surgical delay in hip fracture patients: a retrospective cohort study
Orthopaedic Posters

AB253. SOH26AB_0041. Direct oral anticoagulants are associated with surgical delay in hip fracture patients: a retrospective cohort study

Jensen Murphy1, Emily Cowie1, Aisling Bracken2, Khalid Merghani2, Eoin Sheehan2, Iain Feeley2

1Department of Medicine, School of Medicine, University of Limerick, Limerick, Ireland; 2Department of Surgery, Midlands Regional Hospital Tullamore, Tullamore, Ireland

Background: Timely hip fracture surgery reduces morbidity and mortality, with UK and Irish guidelines recommending intervention within 48 hours of admission regardless of anticoagulation status. However, patients on direct oral anticoagulants (DOACs) may face delays due to perioperative uncertainty. As DOAC use increases in older adults, understanding its effect on surgical timing is crucial. We aimed to assess DOAC use.

Methods: We retrospectively reviewed patients aged ≥60 years who underwent proximal femur fracture surgery at a tertiary Irish hospital (Midlands Regional Hospital Tullamore) between January and December 2024. Patients were grouped by anticoagulation status (DOAC, antiplatelet, and none). The primary outcome was time to surgery; secondary outcomes were delay >48 hours and anaesthesia type. Kruskal-Wallis and Chi-squared tests were used, with Dunn’s post-hoc tests and Holm’s correction. Significance was set at P>0.05.

Results: Of 257 patients (DOAC: 42; antiplatelet: 44; and none: 171), median age was 81 years (interquartile range, 72–87 years), and DOAC users were older (P=0.027). Sex and procedure type did not differ. Median time to surgery differed significantly (P<0.001), with DOAC patients waiting longest. Post-hoc tests confirmed longer delays for DOAC patients versus both other groups (P=0.036, P<0.001). Surgical delay >48 hours was more frequent in the DOAC group (53.7%) than in the none group (26.5%; odds ratio =0.31; 95% confidence interval: 0.15–0.67; P=0.001). No difference was found in anaesthesia type (P=0.4).

Conclusions: DOAC patients experienced longer surgical delays despite guidelines advising against postponement. As anaesthesia practice was similar, clinician caution or comorbidities may contribute. Clearer perioperative pathways and better documentation are needed to minimize avoidable delays.

Keywords: Anaesthetic; antiplatelets; direct oral anticoagulants (DOACs); hip fracture; surgery

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-26-ab253
Cite this abstract as: Murphy J, Cowie E, Bracken A, Merghani K, Sheehan E, Feeley I. AB253. SOH26AB_0041. Direct oral anticoagulants are associated with surgical delay in hip fracture patients: a retrospective cohort study. Mesentery Peritoneum 2026;10:AB253.

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