Abstract
Aim: To evaluate the effect of Warfarin, the prevalence of acceptable level of INR by the anaesthetist, leading to delay of surgery in patients with fracture neck of femur and the outcome of such treatment.
Material and Methods: We retrospectively reviewed all patients admitted with fracture neck of femur who were on Warfarin in the year 2002. In total 9 out of 135 pt were on Warfarin.
Their entire medical records were scrutinised.
A control group of similar age, sex and pre- morbid conditions was identified.
A telephone survey was then conducted
In warfarin group average delay in surgery was 4 days (1 to 7) , needed 76% more blood test, total morphine 40mg and Codeine 960mg, 60% longer stay and after all 78% had General anaesthesia.
The six hospital survey showed the estimated number of such patients averaged 2 (1 to 4) per year, delay in surgery of 2 to 5 days and acceptable INR between 1.5 to under 3.
Conclusion: We found that we under estimate the number of patients on Warfarin. These patient had a significant delay in surgery requiring more analgesic both oral and parental, no significant post- op complications but a much longer hospital stay causing significant increase in morbidity, bed block and expenditure. We were surprised that there is no consistently acceptable level of INR to perform the surgery and type of anaesthesia.
Honorary Secretary Mr Bimal Singh. Correspondence should be addressed to BOSA (British Orthopaedic Specialists Association), c/o Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, London WC2A 3PE.
