The ubiquity of hip fractures pose a substantial burden on public health services worldwide. There is widespread geographical variation in mortality rates and length of stay after hip fractures. The current study investigates both the predictors of; (1) one-year mortality and (2) length of hospital stay (LOS) in adults aged 60 years or older. We aim to identify the risk factors and quantify the extent of influence they have on both outcomes. A retrospective multi-center cohort study identified consecutively documented hip fractures between January 2013 and September 2018. A multivariate regression analysis of 603 patients was performed to determine independent factors affecting mortality and total LOS. The study sample included 603 patients with a total one-year mortality rate of 20.6% (n = 124). Predictors of mortality included; longer LOS, increasing age, inability to return to baseline mobility and comorbid burden. The mean overall LOS was 15.1 days, and 22.6 days in the mortality group. Predictors of increased LOS included; previous hip fractures, comorbid burden; diabetic, cerebrovascular disease and smokers. Return to baseline mobility status was associated with reduced LOS. Patients with a longer length of stay, inability to return to baseline mobility status, higher ASA scores, previous hip fractures and longer time to surgery had a higher mortality rate. Determinants of a longer LOS include; increased time to surgery, impeded postoperative mobility status, fixation rather than joint replacement and comorbid burden. A multifaceted approach to preoperative optimization and postoperative recovery is crucial in order to address all possible modifiable factors.

Introduction: Venous thromboembolism (VTE) remains a major complication following orthopedic trauma and fracture surgery. Low-molecular-weight heparin (LMWH) is widely used for prophylaxis; however, aspirin (ASA) has emerged as a potential alternative due to its ease of administration and cost-effectiveness. This study aimed to compare the efficacy and safety of aspirin (ASA) versus low-molecular-weight heparin (LMWH) in orthopedic trauma patients. Methods: A systematic review and meta-analysis was conducted by searching PubMed, Cochrane Library, and Google Scholar. Randomized controlled trials and comparative observational studies evaluating aspirin (ASA) versus low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis in orthopedic trauma patients were included. Outcomes assessed included overall venous thromboembolism (VTE), deep-vein thrombosis (DVT), pulmonary embolism (PE), fatal PE, mortality, bleeding complications, wound site infection, and hematoma formation. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I(2) statistic. Results: Five studies comprising a heterogeneous orthopedic trauma population were included. No statistically significant difference between aspirin (ASA) and low-molecular-weight heparin (LMWH) in the incidence of venous thromboembolism (VTE) was noted (OR 0.52, 95% CI 0.02–12.25, p = 0.68). No significant differences were observed in the incidence of DVT between aspirin (ASA) and low-molecular-weight heparin (LMWH) (OR 1.00, 95% CI 0.46–2.16, p = 1.00). Pulmonary embolism (PE) (OR 0.96, 95% CI 0.72–1.28, p = 0.80), fatal PE (OR 0.55, 95% CI 0.18–1.65, p = 0.28), and mortality (OR 1.02, 95% CI 0.68–1.54, p = 0.91) were comparable between the two groups. Similarly, no significant differences were observed in bleeding complications (OR 0.95, 95% CI 0.86–1.05, p = 0.33) or wound complications (OR 1.05, 95% CI 0.81–1.37, p = 0.70). Hematoma formation showed a trend favoring aspirin (ASA) (OR 0.36, 95% CI 0.13–1.02, p = 0.05), although this did not reach statistical significance. Conclusions: Aspirin (ASA) may be a reasonable alternative to low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis in selected orthopedic trauma patients, with comparable outcomes for pulmonary embolism (PE), mortality, bleeding and wound complications. Larger high-quality randomized trials with standardized protocols in clearly defined orthopedic trauma populations are warranted to confirm these findings and guide clinical decision-making.