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Background: Percutaneous compression plating (PCCP) is used for the fixation of intertrochanteric hip fractures by a minimally invasive technique. While offering several advantages compared to classic open reduction and internal fixation, the technique does not allow direct hemostasis. We aimed to assess the effect of regular aspirin use on blood loss, transfusion requirements and wound complications in patients undergoing urgent fixation using this technique.
Methods: The study involved 326 patients who presented to our hospital with an intertrochanteric fracture. Parameters recorded included time to surgery, blood loss (assessed by pre and post operative hemoglobin concentrations), and transfusion requirements. The status of wound healing was evaluated, with specific reference to hematoma formation. The influence of regular pre-operative aspirin use was analyzed with respect to these outcome measures.
Results: 32% of patients were regular aspirin users, and were comparable to the non aspirin group. There was no significant difference between the aspirin and non aspirin groups in terms of preoperative hemoglobin concentrations, perioperative changes in hemoglobin levels, and transfusion requirements. The severity of wound hematoma and the number of drainage procedures was not significantly different between the two groups. In a multivariate logistic regression analysis (composite complications* versus no complications as the dependent variable. R2=0.108, P<
0.001), only delay to surgery was associated with a higher complication rate.
Composite complications defined as transfusion ≥3 units, abnormal wound hematoma and length of stay ≥ 10 days.
Conclusion: Regular aspirin use pre-operatively is not associated with increased blood loss, transfusion requirements and wound complications in patients treated with this percutaneous fixation technique. Rather, it is the delay to surgery that is associated with a composite bad outcome. Our data suggest that patients on aspirin can safely undergo urgent non-delayed fracture fixation using the PCCP.
