Published online Oct 18, 2016. doi: 10.5312/wjo.v7.i10.678
Peer-review started: March 1, 2016
First decision: March 21, 2016
Revised: July 29, 2016
Accepted: August 17, 2016
Article in press: August 18, 2016
Published online: October 18, 2016
To compare mortality and time-to-surgery of patients admitted with hip fracture to our teaching hospital on weekdays vs weekends.
Data was prospectively collected and retrospectively analysed for 816 hip fracture patients. Multivariate logistic regression was carried out on 3 binary outcomes (time-to-surgery < 36 h; 30-d mortality; 120-d mortality), using the explanatory variables time-of-admission; age; gender; American Society of Anesthesiologist (ASA) grade; abbreviated mental test score (AMTS); fracture type; accommodation admitted from; walking ability outdoors; accompaniment outdoors and season.
Baseline characteristics were not statistically different between those admitted on weekdays vs weekends. Weekend admission was not associated with an increased time-to-surgery (P = 0.975), 30-d mortality (P = 0.842) or 120-d mortality (P = 0.425). Gender (P = 0.028), ASA grade (P < 0.001), AMTS (P = 0.041) and accompaniment outdoors (P = 0.033) were significant co-variates for 30-d mortality. Furthermore, age (P < 0.001), gender (P = 0.011), ASA grade (P < 0.001), AMTS (P < 0.001) and accompaniment outdoors (P = 0.033) all significantly influenced mortality at 120 d. ASA (P < 0.001) and season (P = 0.014) had significant effect on the odds of undergoing surgery in under 36 h.
Weekend admission was not associated with increased time-to-surgery or mortality in hip fracture patients. Demographic factors affect mortality in accordance with previous published reports.
Core tip: The weekend effect is gaining academic and political interest. It is important to consider departmental set ups that avoid potentially increased mortality in sick patients admitted on the weekend. Here we evaluate hip fracture patients admitted to a United Kingdom teaching hospital prior to the recent media and political interest, in a centre that had been commended for its care of hip fracture patients. There is no increased mortality in those admitted on a weekend - confirming that it is possible to negate a “weekend effect” with the appropriate infrastructure for hip fracture patients.