The impact of anticoagulant medications on fragility femur fracture care: The hip and femoral fracture anticoagulation surgical timing evaluation (HASTE) study.

INTRODUCTION: Due to their hypocoagulable state on presentation, anticoagulated patients with femoral fragility fractures typically experience delays to surgery. There are no large, multicentre studies previously carried out within the United Kingdom (UK) evaluating the impact of anticoagulant use in this patient population. This study aimed to evaluate the current epidemiology and compare the perioperative management of anticoagulated and non-anticoagulated femoral fragility fracture patients. METHODS: Data was prospectively collected through a collaborative, multicentre approach involving hospitals across the United Kingdom. Femoral fragility fracture patients aged ≥60 years and admitted to hospital between 1st May to 31st July 2023 were included. Main outcomes under investigation included time to surgery, receipt of blood transfusion between admission and 48 h following surgery, length of stay, and 30-day mortality. These were assessed using multivariable linear and logistic regression, and Cox proportional hazards models. Only data from hospitals ≥90 % case ascertainment with reference to figures from the National Hip Fracture Database (NHFD) were analysed. RESULTS: Data on 10,197 patients from 78 hospitals were analysed. 18.5 % of patients were taking anticoagulants. Compared to non-anticoagulated patients, time to surgery was longer by 7.59 h (95 %CI 4.83-10.36; p < 0.001). 42.41 % of anticoagulated patients received surgery within 36 h (OR 0.54, 95 %CI 0.48-0.60, p < 0.001). Differences in time to surgery were similar between countries however there was some variation across units. There were no differences in blood transfusion and length of stay between groups (OR 1.03, 95 %CI 0.88-1.22, p = 0.646 and 0.22 days, 95 %CI -0.45-0.89; p = 0.887 respectively). Mortality within 30 days of admission was higher in anticoagulated patients (HR 1.27, 95 %CI 1.03-1.57, p = 0.026). CONCLUSIONS: Anticoagulated femoral fragility fracture patients comprise a substantial number of patients, and experience relatively longer delays to surgery with less than half receiving surgery within 36 h of admission. This may have resulted in their comparatively higher mortality rate. Inclusion of anticoagulation status in the minimum data set for the NHFD to enable routine auditing of performance, and development of a national guideline on the management of this growing and emerging patient group is likely to help standardise practice in this area and improve outcomes.

Perceptions of interventional radiology amongst international medical graduates.

AIM: To determine perceptions of interventional radiology (IR) amongst international medical graduates (IMGs) in the UK. MATERIALS AND METHODS: A survey was undertaken of Trust-grade IMGs at a hospital in the UK. The data were collected using Google Forms and analysed using Microsoft Excel, with free-text responses grouped to mentorship, teaching, exposure, and taster-week themes. RESULTS: Thirty-two percent of the respondents were likely to pursue a career in IR. Eighty-four percent did not have a radiology rotation after graduation, with 20% having a taster week in radiology. Of those likely to pursue a career in IR, 31% had completed a taster week in radiology. Respondents described IR exposure as minimal at 54%. Mentorship, teaching, exposure, and taster week were the themes of the free-text responses. CONCLUSION: A targeted approach is needed to raise awareness and knowledge of IR as a career choice amongst IMGs. Trusts and departments must remove obstacles to organising taster weeks. IR needs to do a better job of educating IMGs and explaining the IR training pathway. Mentorship of IMGs is a simple tool for introducing and recruiting talent to the IR speciality.