Comparing mortality risk of patients with acute hip fractures admitted to a major trauma centre on a weekday or weekend

Nandra, Rajpal; Pullan, J. M.; Bishop, Jonathan; Baloch, Khalid; Grover, Liam M.; Porter, Keith

doi:10.1038/s41598-017-01308-z

Cited by 14 publications

(15 citation statements)

References 32 publications

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“…Our results are in line with a recent single-center study by Nandra et al 14 However, this study was performed in a major tertiary referral center, providing high-level trauma care allied with 7-day working rotas. Pincus et al also found no relationship between the timing of surgical procedures for hip fracture and adverse outcomes.…”

Section: Discussionsupporting

confidence: 92%

Weekend Admission of Intracapsular Femoral Neck Fractures Not Associated With a Greater Rate of Mortality or Morbidity

Rezaie

Roukema

Meulebroucke

2018

Geriatr Orthop Surg Rehabil

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Introduction:For a number of emergency conditions, admission over the weekend has been associated with rising morbidity and mortality rates. However, different studies have provided conflicting results regarding the increased rates of mortality and morbidity for patients with intracapsular femoral fracture who were admitted over the weekend, compared to weekdays. This study investigated the effect of weekend admissions on the surgical outcomes of patients with intracapsular femoral neck fractures.Materials and Methods:We conducted a retrospective cohort study of all the patients who were admitted to our level-II trauma center with an intracapsular femoral neck fracture between January 2009 and June 2011. Admission was classified as at the weekend if it took place between 18:00 pm on Friday until midnight on Sunday or on bank holidays. We compared the mortality rates within 30 days and 6 months after surgery for weekday and weekend admissions. Secondary outcomes considered included length of hospital stay, postoperative complications, and reoperation rates. Statistical analysis was performed using logistic regression models, which were adjusted for patient and surgical characteristics.Results:In total, 315 patients met our inclusion criteria. The mean age of this group was 77.9 years (standard deviation ±13) and the female to male ratio was 5:2. The average follow-up period was 49 months. Under logistic regression analysis, weekend admission was not a significant independent risk factor for the 30-day mortality rate (odds ratio 1.85, 95% confidence interval, 0.74-4.62; P = .19). Seventy-seven patients admitted over the weekend were treated within 24 hours versus 125 patients for the weekday group (80.2% vs 57.9%; P = .005). There were no differences between the sample groups in relation to implant-related complications (24.9% vs 25.8%, respectively, P = .89) nor in relation to general complications (12% vs 18.6%, respectively, P = .06). The mean hospital stay of patients operated on during weekends or holidays was significantly shorter compared to patients operated on during weekdays (6.7 vs 8.5 days; P = .009).Conclusion:Patients with intracapsular femoral neck fractures who were admitted over the weekend at our trauma center did not have a higher risk of mortality or morbidity. Furthermore, temporary preoperative care provided over the weekend by an internal medical consultant can be safe and efficient even in the circumstances where there is a lack of dedicated geriatric support. The absence of an elective operating list at the weekend could be a potential factor in shortening waiting times for surgery for intracapsular femoral neck fracture at weekends and holidays.

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Section: Discussionsupporting

confidence: 92%

Weekend Admission of Intracapsular Femoral Neck Fractures Not Associated With a Greater Rate of Mortality or Morbidity

Rezaie

Roukema

Meulebroucke

2018

Geriatr Orthop Surg Rehabil

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“…In addition, discharge on a Sunday or out of hours was associated with a 51.5% and 17.4% increase in 30-day mortality, respectively. Although our study did not report mortality rate by days of the week and association of mortality with day of discharge, our findings of an absence of a 'weekend effect' in hip fracture patients is in agreement with that of Nandra et al [20], which showed a reduced mortality with weekend admissions compared with weekday. This study also reported a higher mortality risk in patients with cognitive decline and pre-existing co-morbidities.…”

Section: Strengths and Weaknesses In Relation To Other Studiessupporting

confidence: 92%

Hip fracture patients admitted to hospital on weekends are not at increased risk of 30-day mortality as compared with weekdays

Pang

Aqil²,

Mannan

et al. 2020

J Orthop Traumatol

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Background Hip fractures remain a major health concern owing to the increasing elderly population and their association with significant morbidity and mortality. The effects of weekend admission on mortality have been studied since the late 1970s. Despite most studies showing that mortality rates are higher for patients admitted on a weekend, the characteristics of the admitted patients have remained unclear. We aim to investigate this ‘weekend effect’ at our hospital in patients presenting with a hip fracture. Methods Patients undergoing acute hip fracture surgery were identified from the local National Hip Fracture Database. Patient demographics, fracture type, co-morbidities and admission blood parameters were examined. The outcome analysed was 30-day mortality. The data were analysed with regard to day of admission, i.e. weekday (Monday to Friday) or weekend (Saturday and Sunday). Results A total of 894 patients were included. Results demonstrated that 30-day mortality was similar on the weekend compared with the weekday (6.96% versus 10.39%, OR 0.65, 95% CI 0.36–1.14, p = 0.128) for patients who sustained an acute hip fracture. The total number of deaths within 30 days was 85 (69 weekday versus 16 weekend). This remained non-significant after adjusting for several variables: age and sex only (OR = 0.65, 95% CI 0.37–1.16, p = 0.146), age, sex, and care variables (OR = 0.59, 95% CI 0.33–1.06, p = 0.080), age, sex, and blood test results (OR = 0.62, 95% CI 0.35–1.12, p = 0.111), and all covariates (OR = 0.69, 95% CI 0.29–1.62, p = 0.392). In the fully adjusted model, the following variables were independent predictors of mortality: sex (male) (OR = 1.93, 95% CI 1.11–3.35, p = 0.019) and ASA > 2 (OR = 2.6, 95% CI 1.11–6.11, p = 0.028) and age (1.08, 95% CI 1.04–1.13, p < 0.001). Conclusion The evidence for a ‘weekend effect’ in patients with a hip fracture is absent in this study. However, we have shown other factors that are associated with increased mortality such as increased age, male sex and higher ASA grade. Level of evidence Level 3.

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“…They could not show a significant difference in the mortality for patients coming in on weekdays or weekends. There was a slightly higher mortality on weekdays than on weekends (10,2% vs. 9,7% on weekends), and specific in respect to day of the week (12,96% Monday vs. 8,06% Thursday) [16].…”

Section: Discussionmentioning

confidence: 99%

Influence of Weekday of Surgery on Operative Complications. An Analysis of 25.000 Surgical Procedures

Müller¹,

Strauchmann²,

Katou³

et al. 2017

Clin Res Trial

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Background: Surgical procedures need to be performed safely on every day and night of the week. Operations on certain weekdays have recently been shown to be associated with increased risk. Patient concerns about their safety have to be taken seriously when surgery needs to be planned. Many patients also believe in negative effects of lunar constellations or Friday 13 th . To establish a scientific basis for reassurement, we retrospectively analyzed surgical complications at a maximum care center, addressing these issues.

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Comparing mortality risk of patients with acute hip fractures admitted to a major trauma centre on a weekday or weekend

Cited by 14 publications

References 32 publications

Weekend Admission of Intracapsular Femoral Neck Fractures Not Associated With a Greater Rate of Mortality or Morbidity

Weekend Admission of Intracapsular Femoral Neck Fractures Not Associated With a Greater Rate of Mortality or Morbidity

Hip fracture patients admitted to hospital on weekends are not at increased risk of 30-day mortality as compared with weekdays

Influence of Weekday of Surgery on Operative Complications. An Analysis of 25.000 Surgical Procedures

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