Abstract
BackgroundHip 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.MethodsPatients 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).ResultsA 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).ConclusionThe 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 evidenceLevel 3.
Highlights
Hip fractures remain a major health concern owing to the increasing elderly population and association with significant morbidity and mortality
These results demonstrated that 30-day mortality was similar in the weekend cohort compared with the weekday cohort (6.96% versus 10.39%, odds ratios (OR) 0.65, 95% confidence intervals (95% CI) 0.36– 1.14, p = 0.128), with no statistical significance
American Society of Anesthesiologists (ASA) grade > 2 showed similar mortality rates between the two groups (69.88% versus 71.74%, OR 1.09, 95% CI 0.78–1.52, p = 0.595)
Summary
Hip fractures remain a major health concern owing to the increasing elderly population and association with significant morbidity and mortality. A study by Walker et al [9] showed that biochemical and haematological blood results explained 33% of the excess mortality on Saturday and 52% on Sunday, thereby reducing the size of the ‘weekend effect’ [9] This explained the ‘weekend effect’ as being due to the higher proportion of admissions that were categorised as high risk and having a higher average risk of mortality compared with a weekday cohort of patients. Fragility hip fracture patients are less likely to be subjected to such initial presentation bias owing to the nature and severity of their injury. As such they form an ideal cohort to assess a true ‘weekend effect’. We aim to investigate this ‘weekend effect’ at our hospital in patients presenting with a hip fracture
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