Published online Sep 18, 2020. doi: 10.5312/wjo.v11.i9.391
Peer-review started: May 12, 2020
First decision: May 24, 2020
Revised: June 2, 2020
Accepted: August 24, 2020
Article in press: August 24, 2020
Published online: September 18, 2020
The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented. With respect to hip fractures, however, there is no consensus about the presence of a so-called “weekend effect”. This study sought to determine the effects, if any, of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital. It was hypothesized that geriatric hip fracture patients admitted on a weekend would have longer times to medical optimization and surgery and increased complication and mortality rates relative to those admitted on a weekday.
To determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay.
A retrospective chart review of operative geriatric hip fractures treated from 2015-2017 at a large tertiary care hospital was conducted. Two cohorts were compared: patients who arrived at the emergency department on a weekend, and those that arrived at the emergency department on a weekday. Primary outcome measures included mortality rate, complication rate, transfusion rate, and length of stay. Secondary outcome measures included time from emergency department arrival to surgery, time from emergency department arrival to medical optimization, and time from medical optimization to surgery.
There were no statistically significant differences in length of stay (P = 0.2734), transfusion rate (P = 0.9325), or mortality rate (P = 0.3460) between the weekend and weekday cohorts. Complication rate was higher in patients who presented on a weekend compared to patients who presented on a weekday (13.3% vs 8.3%; P = 0.044). Time from emergency department arrival to medical optimization (22.7 h vs 20.0 h; P = 0.0015), time from medical optimization to surgery (13.9 h vs 10.8 h; P = 0.0172), and time from emergency department arrival to surgery (42.7 h vs 32.5 h; P < 0.0001) were all significantly longer in patients who presented to the hospital on a weekend compared to patients who presented to the hospital on a weekday.
This study provided insight into the “weekend effect” for geriatric hip fractures and found that day of presentation has a clinically significant impact on delivered care.
Core Tip: This is a retrospective review of operative geriatric hip fractures admitted to a large, tertiary care center between 2015-2017. Patients who presented on a weekend were compared to patients who presented on a weekday. Geriatric hip fracture patients that presented on a weekend experienced a higher complication rate and longer times from emergency department arrival to medical optimization, from medical optimization to surgery, and from emergency department arrival to surgery. This is important for orthopaedic surgeons to know so they can mitigate this increased morbidity accordingly.