AB081. SOH22ABS076. Anticoagulant delay in time to surgery in neck of femur fracture

Background: Insufficient protocol exists with national institutions on the management of hip fractures admitted on anticoagulants/antiplatelet. We retrospectively analyzed whether hospital capacity had an impact on operation time (OT).

Methods: Data was taken from the Hospital Inpatient Enquiry Department. Data sources included Irish Hip Fracture Standards (IHFS), notes and 30-day postoperative dataset managed by an Orthopaedic clinical nurse specialist. A cohort of hip fractures was included from 1st Jan 2020–31st July of 2020 and 2021. We examined the IHFS time to surgery (<48 hours). Data was collected on demographics, time to surgery, average length of stay (ALOS), follow up status. In Patients with delayed OT due to anticoagulant/antiplatelet cessation, the agent and ALOS was recorded. The intervention was the opening of a trauma list in the Orthopaedic hospital (Croom) in 2021.

Results: In 2020 there were 170 hip fractures and 106 had surgery in under 48 hours (62%). Seventeen patients had surgery delayed due to anticoagulant/antiplatelet (Clopidogrel 59%). The ALOS for these 17 patients was 18.25 days compared to those not delayed (ALOS 12.5 days). In 2021 there were 158 hip fractures and 122 had surgery in under 48 hours (77%). Twelve patients had surgery delayed due to anticoagulant/antiplatelet. The most common agents were clopidogrel and rivaroxaban (4/12 each). The ALOS of these patients was 15.3 days compared to 12.8 days.

Conclusions: In 2021 there was expanded capacity in Croom which allowed ambulatory trauma to be taken out of University Hospital Limerick and increase access to high-risk cases such as hip fractures.

Keywords: Anticoagulation; antiplatelets; hip fracture; orthopaedics; time to surgery