Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2016; 7(10): 678-686
Published online Oct 18, 2016. doi: 10.5312/wjo.v7.i10.678
Is there a weekend effect in hip fracture patients presenting to a United Kingdom teaching hospital?
John Abraham Mathews, Madhavi Vindlacheruvu, Vikas Khanduja
John Abraham Mathews, Madhavi Vindlacheruvu, Vikas Khanduja, Department of Orthopaedics, Addenbrooke’s Hospital, Cambridge CB2 0QQ, United Kingdom
Author contributions: Mathews JA, Vindlacheruvu M and Khanduja V contributed to study conception and design, as well as analysis and data interpretation; all contributed to editing, reviewing and final approval of the article.
Institutional review board statement: The National Hip Fracture Database has ethical approval by the NHS England HRA Confidentiality Advisory Group (CAG) to collect patient data without consent under Section 251 exemption (this approval was formerly administered under the NIGB-ECC/PIAG).
Informed consent statement: The National Hip Fracture Database is approved by the NHS England HRA Confidentiality Advisory Group (CAG) to collect patient data without consent under Section 251 exemption (this approval was formerly administered under the NIGB-ECC/PIAG).
Conflict-of-interest statement: None of the authors have any conflicting interests to declare (including but not limited to commercial, personal, political, intellectual or religious interests).
Data sharing statement: Technical appendix, statistical code, and dataset available from corresponding author at vikaskhanduja@aol.com. Ethical approval was not obtained to collect data without consent under Section 251 exemption. The presented data are anonymised and the risk of identification is negligible.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vikas Khanduja, FRCS (Orth), Consultant Surgeon, Department of Orthopaedics, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom. vikaskhanduja@aol.com
Telephone: +44-1223-245151
Received: March 1, 2016
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
Processing time: 225 Days and 8.7 Hours
Abstract
AIM

To compare mortality and time-to-surgery of patients admitted with hip fracture to our teaching hospital on weekdays vs weekends.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Weekend; Hip; Fracture; Mortality; Season

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.