Early surgery of trochanteric femoral fractures in patients on direct oral anticoagulants (DOACs) reduces the length of stay (LOS) and the 1-year mortality rates without increasing the risk for revision surgery: a matched-pair analysis

Background: It remains unclear whether early surgical fixation of trochanteric femoral fractures in patients with direct oral anticoagulation (DOAC) therapy has an impact on the long-term outcome. Methods: A retrospective cohort study on patients with trochanteric femoral fractures and DOAC therapy between 2016 and 2024 was conducted. Patients were divided into two groups according to their time to surgery and matched with age and ASA score as covariates. The primary outcome of interest was the impact of early surgery on the long-term outcome. Results: Of 233 included patients, 102 patients were assigned in each group after propensity score matching. Patients with early surgery had lower in-hospital complication rates (16.0% vs. 26.3%; p = 0.077) and a significantly shorter median length of stay (LOS) (11.5 days (IQR 6) vs. 15 days (IQR 6); p < 0.001). No difference in the rates of revision surgery (9.8% vs. 5.9%; p = 0.298) was observed. Kaplan-Meier curves revealed a significant difference in the mortality rates during the follow-up period (p = 0.0057) with lower in-hospital (2.0% vs. 6.9%; p = 0.088), 30-day (3.9% vs. 9.8%; p = 0.097) and 1-year mortality rates (20.6% vs. 31.4%; p = 0.079). Conclusion: Early surgical fixation of trochanteric femoral fractures in patients on DOAC therapy leads to a significant reduction in the LOS without increasing the risk for peri- and postoperative complications or the risk for revision surgery. Furthermore, early surgery may positively influence the long-term outcome in this specific cohort of patients.