Key result
Warfarin use in older hip fracture patients was associated with a significantly longer waiting time for surgery compared with nonusers (mean 23 vs 12 hours; P<0.001).
Why the study?
Does warfarin use delay time to surgery in older patients admitted with hip fractures?
Observational (n=1,192)
No
Does warfarin use delay time to surgery in older patients admitted with hip fractures?
Warfarin use in older patients with hip fractures is associated with a significant delay in time to surgery, which appears to be driven by a higher burden of comorbidities.
Answers are grounded in this paper and cite their sources.
Comorbidity-adjusted reversal protocols may mitigate delays; leaves open whether expedited surgery improves outcomes.
INTRODUCTION: Delay in surgery for hip fractures in older patients may affect mortality and the risk of delirium. Delay in surgery may occur as a result of several factors. It has not been established whether certain patient-related factors, such as a high international normalized ratio (INR) caused by warfarin treatment is associated with delay in surgery. The aim of this study was to explore the associations between warfarin treatment, INR, and time from admission to surgery. METHODS: This is an observational study based on data from a database of all hip fracture patients aged ≥ 65 years who were admitted to an orthogeriatric unit. The database included data from 1192 consecutive patients admitted from January 2007 to April 2010. Data were collected during routine work. Use of warfarin, patient characteristics, medical complications, length of stay, and time from admission to surgery were registered from the patients' records, and INR at admission in warfarin users. RESULTS: Warfarin was used by 117 (9.8%) patients at admission, which included more men (n = 42; 14.4%) than women (n = 75; 8.3%) (P = 0.003). The mean age was 85 years, with no difference between users and nonusers. Warfarin users had more comorbid diseases (mean, 2.1 vs 1.8; P = 0.003), poorer health status (American Society of Anesthesiologists score of 3-5 in 77.8% vs 51.0%), and longer waiting time for surgery compared with nonusers (mean, 23 vs 12 hours; P < 0.001). There was no difference in need for blood transfusions (28.2% of users compared with 25.3% of nonusers; P = 0.49). Length of stay was longer among warfarin users compared with nonusers (mean, 14.6 vs 11.7 days; P = 0.002). Warfarin users with an INR of ≥ 2 had a longer waiting time than those with an INR of < 2, but they had a longer waiting time than nonusers. CONCLUSION: Hip fracture patients who are using warfarin experience a longer waiting time for surgery, most likely due to more comorbidities. A more active approach to better management of comorbidities may reduce waiting time for surgery in warfarin users.
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Ranhoff et al. (2011) conducted an observational in Hip fracture (n=1,192). Warfarin use vs. Nonusers was evaluated on Waiting time for surgery (hours) (p=<0.001). Warfarin use in older hip fracture patients was associated with a significantly longer waiting time for surgery compared with nonusers (mean 23 vs 12 hours; P<0.001).
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