Effect of Weekend Admission on Hip Fracture Mortality.

Abstract

Background: Weekend vs weekday hospital admission has been associated with poorer mortality rates for many conditions. Studies evaluating weekend admission for hip fractures have resulted in contradictory conclusions regarding outcomes.

Methods: We conducted a retrospective analysis of all patients who underwent surgery for a fragility hip fracture at a quaternary level teaching hospital during a 6-year period. A total of 1,164 patients were included: 796 weekday admissions (Monday through Friday) vs 368 weekend admissions (Saturday and Sunday). Patients were subdivided based on surgeon experience level (473 consultants vs 690 nonconsultants). Statistical tests included chi-square tests and logistic regression. Demographic data included age, sex, prior hip fracture, fracture type, operation, and American Society of Anesthesiologists grade. The primary outcome was 1-year mortality. Secondary outcomes were acute mortality (<24 hours), subacute mortality (1 to 30 days), change in mobility from baseline at 1 year, preoperative delay (>48 hours), and surgical duration.

Results: The weekend admission cohort had a higher 1-year mortality rate than the weekday admission cohort (30.4% vs 23.2%; P=0.029), while subacute mortality trended toward significance (P=0.083). No significant difference was seen in acute mortality (P=0.5). Hemiarthroplasty was associated with increased mortality at 12 months (P=0.012) compared to the other operative interventions. The median duration of surgery was lower in the weekend cohort vs the weekday cohort (1.15 hours [69 minutes] vs 1.23 hours [73.8 minutes]; P<0.001). Consultants performed surgeries 16.2 minutes faster than nonconsultants (P<0.001) and trended toward a lower 1-year mortality rate (22.1% vs 27.9%; P=0.058). No significant difference was seen in mobility change at 1 year in both the consultant vs nonconsultant analysis (P>0.9) and in the weekday vs weekend analysis (P>0.12).

Conclusion: A significantly increased 1-year mortality rate and a shorter surgical duration were observed among patients admitted on the weekends.