(1) Background: Little prospective data exist regarding the perioperative management and long-term prognosis of elderly patients receiving treatment with antithrombotic drugs and undergoing urgent surgery for a hip fracture. (2) Methods: The study included patients who required hip surgery and were receiving warfarin, DOAc or P2Y12 antiplatelet agents at the moment of trauma. Ongoing antithrombotic treatment was managed according to existing recommendations. The endpoints of the study were the time to surgery, perioperative bleeding, the need for transfusion and, finally, mortality, major cardiovascular events and re-hospitalization at 6 and 12 months. (3) Results: The study included a total of 138 patients. The mean age was 86 years; 75.4% were female. Eighty-two received DOAc, thirty-six received warfarin and twenty received P2Y12 inhibitors. The controls were 283 age- and sex-matched patients who did not receive antithrombotic treatment. A total of 38% of patients receiving warfarin underwent surgery <48 h, 52% receiving DOAc, 55% receiving P2Y12 inhibitors and, finally, 82% in the control group. Perioperative bleeding and the need for transfusion were not different between the four groups. Mortality at 6 months was higher in patients receiving warfarin and P2Y12 inhibitors (30% and 25%) in comparison to DOAc and the control group (11.6% and 10% p < 0.0001). Similarly, the other endpoints were more frequent in patients receiving warfarin and P2Y12 inhibitors. The trend was maintained for 12 months. No significant differences in mortality were found between early (48 h) surgery independent of the type of treatment. (4) Conclusions: Our study confirmed that anticoagulants delay surgery in patients with hip fractures; however, intervention > 48 h is not associated with a poorer prognosis. This finding is relevant as it underlines that, in patients at high risk of postoperative cardiovascular complications, the careful management of anticoagulation before surgery may compensate for the delay of surgery with a very low in-hospital mortality rate (<1%). One-year survival was significantly lower in patients receiving warfarin, probably related to their worse risk profile at the moment of trauma survival.

Cardiovascular complications are the main cause of early mortality in elderly patients after hip fracture surgery. Echocardiography, although suggested by guidelines to improve risk stratification, is frequently omitted for the risk to delay surgery. Aim of the study was to evaluate whether preoperative echocardiographic in patients with hip fracture effectively delays surgery and which echocardiographic abnormalities are associated with in-hospital mortality. The study included hip fracture patients aged > 70 years admitted in the period January 1, 2019, to December 31, 2024, to the Hip fracture Unit of a teaching tertiary hospital. Echocardiography was indicated according to clinical criteria (detection of heart murmur, pathological electrocardiographic changes, known heart disease and the presence of > 2 coronary risk factors). In the study entered 2272 patients, 1593 had indication for preoperative echocardiography that was performed in 1502. Mean age was significantly higher in ECHO than in NO-ECHO group (85.4 ± 8 vs. 80.5 ± 11 years, p < 0.0001). ECHO group patients had more frequently at least two comorbidities. In-hospital mortality was 7.3% in ECHO patients compared to 2.3% in NO-ECHO patients. At multivariate analysis showed decreased left ventricular ejection fraction and pulmonary hypertension other than age, anemia, reduced functional capacity expressed as lost BADL and cancer were independent predictors of in-hospital mortality. Echocardiography identifies a population at a high risk of in-hospital mortality, three times higher compared to the group of NO ECHO patients. A reduced left ventricular ejection fraction and an increase in pulmonary pressure are independent predictors of in hospital mortality.

Purpose . Lower-limb muscle thickness assessed by point-of-care ultrasound (POCUS) is emerging as a prognostic marker in older adults, but evidence in patients with hip fracture is limited. This study aimed to investigate whether POCUS of the vastus lateralis (VL) muscle could predict one-year all-cause mortality in older adults with hip fracture, and to identify the VL thickness cut-off with the highest prognostic performance. Methods . We conducted a prospective observational study involving patients ≥65 years hospitalized for proximal hip fracture at Careggi University Hospital, Florence, Italy, between January 2024 and July 2024 Participants underwent comprehensive geriatric assessment and VL POCUS within 24h of admission. The study outcome was one-year all-cause mortality. Predictive performance of VL thickness was assessed using ROC curve analysis and multivariate logistic regression. Results . Among 154 patients (mean age 86.5 years, 70.1% female), one-year mortality was 42.2%. Mortality was associated with older age, functional and motor impairment, frailty, malnutrition, and higher comorbidity burden. ROC analysis demonstrated good predictive ability of VL thickness (AUC=0.702), with a cut-off value of <1.12 cm providing the best discriminative performance (sensitivity 68%, specificity 64%). Patients with reduced VL thickness showed higher mortality (57.9% vs 26.9%, p <0.001). VL thickness <1.12 cm independently predicted mortality, after adjusting for age, nutritional status, pre-fracture functional level and comorbidity burden. Conclusions . In older adults hospitalized for hip fracture, VL thickness of <1.12 cm independently predicted one-year all-cause mortality, suggesting a potential role of muscle POCUS as a prognostic tool in the orthogeriatric setting.

Background: Cardiovascular complications are the main cause of early mortality in elderly patients after hip fracture surgery. Echocardiography, although suggested by guidelines to improve risk stratification, is frequently omitted due to the risk of delaying surgery. The aim of the study was to evaluate whether in a multidisciplinary hip fracture unit, echocardiography can be performed without a delay in surgery. The secondary endpoint was to research the possible association between echocardiographic abnormalities and in-hospital mortality. Methods: The study included hip fracture patients aged > 70 admitted in the period 1 January 2019 to 31 December 2024, to the hip fracture unit of a tertiary teaching hospital. Echocardiography was indicated according to clinical criteria (detection of heart murmur, pathological electrocardiographic changes, known heart disease and the presence of ≥3 coronary risk factors). In the study, there were 2272 patients; 1593 had indications for preoperative echocardiography, which was performed in 1502. Mean age was significantly higher in the ECHO group than in the NO ECHO group (85.4 ± 8 vs. 80.5 ± 11 years, p < 0.0001). ECHO group patients more frequently had at least two comorbidities and more severe functional impairment. In-hospital mortality was 7.3% in ECHO patients compared to 2.3% in NO ECHO patients. Results: Multivariate analysis showed that decreased left ventricular ejection fraction and pulmonary hypertension, as well as age, anemia, and reduced functional capacity expressed as lost BADL, were associated with in-hospital mortality. Conclusions: Echocardiography identifies a population at a high risk of in-hospital mortality, three times higher compared to the group of NO ECHO patients. In those who underwent echocardiography, a reduced left ventricular ejection fraction and an increase in pulmonary pressure were associated with in-hospital mortality.