No abstract

Non-vitamin K antagonist oral anticoagulants (NOACs) may affect patient outcomes. We aimed to evaluate whether hip fracture patients admitted on warfarin or NOAC therapy were at risk of operative delay, prolonged length of stay, or increased mortality. Methods We collected data for 845 patients admitted to our centre between October 2014 and December 2016. Multivariable linear regression analysis was performed to test the association between warfarin and NOAC therapy on time to surgery and length of stay. Variables in the regression model were age, sex, admission AMTS, pre-fracture mobility, ASA score, fracture type, and operation type. Fisher's Exact Test was used to evaluate whether warfarin or NOAC therapy delayed surgery beyond 36 or 48 hours, or decreased 30-day, 6-month, or 12-month survival. Results Time to surgery was delayed in anticoagulated patients (p=0.028). NOAC therapy was independently associated with increased time to surgery beyond 36 hours (p=0.001), although not beyond 48 hours (p=0.355), whereas warfarin therapy was not associated with either. Anticoagulation did not increase length of stay (p=0.331). Warfarin therapy significantly reduced 30-day survival (p=0.007), but NOAC therapy did not (p=0.244). Neither warfarin nor NOAC therapy affected further survival. Conclusions NOAC therapy delays time to surgery beyond the NHS England 'Best Practice Tariff' in hip fracture patients. We aim to prospectively investigate long-term outcomes. Without a NOAC antidote, policy must change to ensure time-appropriate surgery for patients on NOACs. Preoperative involvement of the haematology team is essential.

This study showed that since ADM introduction to our centre, more breast reconstructions have been of the implant-only type with consequent reductions in the more complex and expensive autologous techniques. Implant-only procedures that incorporated ADM use had similar complication rates to those that did not.

We report the case of a Brodie abscess of the femoral capital epiphysis from which was isolated. This is to the best of our knowledge the first report of a Brodie abscess of the femoral capital epiphysis from which was isolated.