Impact of anticoagulation therapy on surgical timing, hospital stay, and postoperative outcomes in proximal femur fracture patients

Objective: This study aimed to evaluate the association between preoperative anticoagulant use and time to surgery, hospital length of stay, and 30-day postoperative complications in elderly patients with proximal femur fractures. Methods: This study included 572 patients with low-energy proximal femur fractures who required surgical treatment. Patients were categorized into two groups based on anticoagulation therapy use. The following data was collected and compered between the groups: time from hospitalization to surgery, hospital length of stay, percent changes in hemoglobin and other post-operative complications: death, cardiac complications, sepsis, deep venous thrombosis, pneumonia, urinary tract infection, surgical site infection, pressure ulcers, acute kidney injury and delirium. Multivariate regression analysis was performed to analyze possible confounders. Results: The median age of study participants was 83 years. 78.2% being female. Anticoagulation therapy was used by 19.9% of patients, predominantly non-vitamin K oral anticoagulants. Patients receiving anticoagulants experienced significantly longer hospital stays (median 9 vs. 7 days; P < .05) and surgical delays (median 3 vs. 2 days; P < .0001) compared to those without anticoagulation. Complication rates and hemoglobin level changes did not di!er significantly among the groups (P > .05). Multivariate analysis identified age, time to surgery, and hospital length of stay as independent predictors of 30-day postoperative complications, with age and hospital stay also significantly associated with 30-day mortality. Conclusion: Anticoagulation therapy did not directly increase 30-day postoperative complications or mortality but was associated with surgical delays and prolonged hospital stays, which negatively impacted outcomes. Delayed surgery and extended hospitalization emerged as key risk factors. These findings underscore the clinical importance of minimizing surgical delays in anticoagulated patients to improve postoperative outcomes. Level of Evidence: Level II, Prognostic study.