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
Processing time: 125 Days and 6.9 Hours
In the United States, more than 300000 people aged 65 and older are hospitalized for hip fractures annually. Despite hip fractures accounting for less than 20% of all osteoporotic fractures, they cause the majority of fracture-related mortality in patients over the age of 50. A potential non-modifiable risk factor for geriatric hip fractures is day of presentation. 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, the literature is not so clear. The purpose of this study was to determine the effects, if any, of weekend admission on care of geriatric hip fractures treated operatively at a large tertiary care hospital.
There is currently no consensus regarding the presence of a so-called “weekend effect” for geriatric hip fractures. Much of the literature on this topic involves large database studies. While these studies include a large number of patients, they are accompanied by all of the inherent limitations of database studies. This study sought to determine the effects of weekend admission on the morbidity, mortality, and times to medical optimization and surgery for geriatric hip fractures at a single, tertiary care institution.
In this study, we compared length of stay, blood transfusion rate, complication rate, mortality rate, time from emergency department arrival to medical optimization, time from medical optimization to surgery, and time from emergency department arrival to surgery between hip fracture patients who presented to the hospital on a weekday and those who presented on a weekend.
A retrospective chart review of geriatric hip fractures treated operatively at our large, tertiary care institution from 2015-2017 was performed. Patients who presented to the hospital from 12:00 AM Monday to 11:59 PM Thursday comprised the weekday cohort. Patients who presented to the hospital from 12:00 AM Friday to 11:59 PM Sunday comprised the weekend cohort. Holidays were considered weekend days, and thus patients who presented to the hospital on a holiday were included in the weekend cohort.
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.
Geriatric hip fracture patients that presented to the hospital 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.
The findings of this study are of utility to Orthopaedic surgeons, optimization physicians, and patients alike. Additionally, they may be of use to hospitals and their administrators to guide resource and personnel allocation, so that delays to surgery and in-hospital complications can be minimized.