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

Abstract

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.

RETRACTED: Admission on weekends does not increase mortality after hip fracture: a meta-analysis of 1.4 million patients

“…The 38 studies which were elected for full-text analysis underwent detailed examination by both reviewers and 14 were found to be appropriate based on the inclusion criteria. [12][13][14][17][18][19][20][21][22][23][24][25][26][27] The remaining 24 studies were excluded for reasons mentioned in Figure 1.…”

“…Contrastingly, some studies report no such weekend effect for hip fracture. 13,14 Given this uncertainty in the literature, there is a need for pooled evidence to best assess the actual effect of weekend admission on hip fracture mortality. Therefore, we performed the current systematic review and meta-analysis to pool data from the literature and examine if admission on weekends increases the mortality rates of hip fracture patients.…”

Risk Factors for 30-Days Mortality After Proximal Femoral Fracture Surgery, a Cohort Study

“…9,10,13 In line with previous literature the timing of the operation during the day and during the week was not associated with a higher 30-day mortality in this study. 6,32 Our study did not find an association between 30-day mortality and the type of anesthesia. This result aligns with a recent clinical trial of Li et.…”

Delayed mobilization following admission for hip fracture is associated with increased morbidity and length of hospital stay

“…Our findings differ from those of previous studies that found a socalled "weekend effect," 24 whereby patients who received surgery on a weekend were mobilized later, and had higher rates of postoperative complications and higher mortality rates than patients who had their surgery on a weekday. [24][25][26] It is likely that our findings are a result of the majority of patients on our ward being mobilized by nurses, who are present on weekends, instead of physiotherapists. Future research should test this question in a ward where the majority of mobilization is done by physiotherapists.…”