There are lots of ways of doing things. To me, there is no value in waiting to see how the INR dwindles down slowly- there are absolutely no advantages to the patient. The risk of FFP is low, and even vit K is too slow. Generally, it takes three-five days for the liver to start cranking up the clotting proteins, so perhaps in a day or two he will be ready. Why wait and see what happens when everyone knows he needs surgery?
At our institution we have a large volume practice, and work with a greater sense of urgency. Efficiency and productivity are critical, with good outcomes the most important issue. (the government and private insurance companies are never trying to pay more, only less and less for the same diagnosis and with more paperwork).
Of course, we are surgeons- kind of the fighter pilots of the medical community. The general personality type is confident, decisive, and impatient, and to those who don't share this attitude, probably viewed as arrogant and impulsive. Internists tend to be more cerebral, and either like to order lots of esoteric tests, or adopt a wait and see what happens mentality.
We used to admit all hip fracture patients to the medicine service, and typically saw that the surgery was delayed for a variety of reasons. When we switched to the patients being admitted to ortho, the data showed that the complications were less, the length of stay was shorter, and the outcomes were better. It did require greater attention and involvement on the part of the orthopaedists.
Again, this part of it is all personal opinion. The most important thing is that you are now able to be there for his surgery and to help both him and your mother through the next few days.
Good luck.
