Aims To assess the characteristics and outcomes of older adults (≥65 years) on a direct oral anticoagulant (DOAC) for atrial fibrillation (AF), undergoing surgery for neck of femur (NOF) fractures.
Methods This was a retrospective, observational study utilising data from the Wellington Hospital Australia New Zealand Hip Fracture Registry database from 2018 and 2023, and electronic patient records. Those on warfarin or a DOAC for an indication other than AF, delays due to medical illness and those not directly admitted to orthopaedics from ED were excluded. Primary outcome was time from admission to surgery. Secondary outcomes were acute length of stay (LOS), total LOS (including inpatient rehab stay), survival, change in discharge destination, rate of venous thromboembolism and bleeding complications.
Results A total of 266 patients were eligible for inclusion. DOAC usage was associated with an increased mean time to surgery of 13.8 hours (95% CI 6.1-20.4, p<0.001). Average total LOS was also increased by 11.4 days (95% CI 4.5-18.4, p<0.001). Both persisted after adjusting for age, comorbidity and frailty score. There was a trend of DOAC use and bleeding complications (odds ratio of 2.2, 95% CI 1 – 4.8, p=0.05). There were no statistically significant differences for other secondary outcomes.
Conclusion DOAC usage was associated with a significant delay to surgery for a NOF fracture. The longer total length of stay in the DOAC group might reflect the harms of surgical delay and subsequent poorer outcomes.