Morbidity and In-Hospital Mortality after Hip Fracture Surgery on Weekends versus Weekdays

Kent, Steven John; Adie, Sam; Stackpool, Gregory

doi:10.1177/230949901602400111

Cited by 7 publications

(7 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A Norwegian study of over 61000 hip fractures found that day of admission did not affect 30 d mortality rate, but that early morning admissions and weekend discharges were associated with an increased 30 d mortality rate[ 20 ]. A single-institution retrospective review of femoral neck fractures found that surgeries performed on weekends were associated with an increased in-hospital mortality rate, but not an increased complication rate[ 21 ]. Another retrospective study from a single institution found that weekend admission of intracapsular femoral neck fractures was not associated with an increased complication rate[ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of weekend admission on geriatric hip fractures

Pasternack

Ciminero

Silver

et al. 2020

WJO

View full text Add to dashboard Cite

BACKGROUND 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. AIM To determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay. METHODS 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. RESULTS 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. CONCLUSION 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.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of weekend admission on geriatric hip fractures

Pasternack

Ciminero

Silver

et al. 2020

WJO

View full text Add to dashboard Cite

show abstract

“…A third mechanism that can explain seasonal variations in surgical outcomes is staff and resource shortage during vacation periods. Several studies have demonstrated worse outcomes for procedures performed on Fridays [10], on weekends [11] or during vacation or holiday periods [12], regardless of the specific month in which they take place worldwide [30,31]. During holidays, hospital systems are significantly disrupted, as significant segments of the staff are off work and care capacity is usually delivered by less experienced/occasional staff and with less overall resource availability.…”

Section: Discussionmentioning

confidence: 99%

Seasonal variations in pancreatic surgery outcome A retrospective time-trend analysis of 2748 Whipple procedures

et al. 2020

View full text Add to dashboard Cite

Background Observing cyclic patterns in surgical outcome is a common experience. We aimed to measure this phenomenon and to hypothesize possible causes using the experience of a high-volume pancreatic surgery department. Methods Outcomes of 2748 patients who underwent a Whipple procedure at a single high-volume center from January 2000 to December 2018 were retrospectively analyzed. Three different hypotheses were tested: the effect of climate changes, the “July effect” and the effect of vacations. Results Clavien-Dindo ≥ 3 morbidity was similar during warm vs. cold months (22.5% vs. 19.8%, p = 0.104) and at the beginning of activity of new trainees vs. the rest of the year (23.5 vs. 22.5%, p = 0.757). Patients operated when a high percentage of staff is on vacation showed an increased Clavien-Dindo ≥ 3 morbidity (22.3 vs. 18.5%, p = 0.022), but similar mortality (2.3 vs. 1.8%, p = 0.553). The surgical waiting list was also significantly longer during these periods (37 vs. 27 days, p = 0.037). Being operated in such a period of the year was an independent predictor of severe morbidity (OR 1.271, CI 95% 1.086–1.638, p = 0.031). Conclusion Being operated when more staff is on vacation significantly affects severe morbidity rate. Future healthcare system policies should prevent the relative shortage of resources during these periods.

show abstract

“…In addition to reduced staff quantity at weekends, the weekend medical staff can be less experienced and less familiar with the patients on the ward (Kent et al 2016). Less experienced staffing could cause a delay in preparation of hip fracture patients for the theatre as well.…”

Section: Mortality and Reoperationsmentioning

confidence: 99%

“…To ensure that hip fractures are treated within the time limits given in several recommendations, there is a need to operate these fractures also during weekends (Ranhoff et al 2019). Several studies have reported higher mortality for hip fracture patients operated during weekends (Thomas et al 2014, Kent et al 2016, Kristiansen et al 2016. Other studies have not found any weekend effect for hip fracture patients (Foss and Kehlet 2006, Boylan et al 2015, Nandra et al 2017, Sayers et al 2017, Asheim et al 2018.…”

mentioning

confidence: 99%

“…Early surgery for hip fracture patients has been shown to be associated with better outcome, but at weekends there may be less staffing, lower efficiency at the hospitals, longer waiting time, and surgeons with less experience (Daugaard et al 2012, Mathews et al 2016, Authen et al 2018. Another aspect is that medical staff at weekends often may be less familiar with the patients under their care (Kent et al 2016). Weekend admission and weekend surgery may therefore be a risk factor for increased mortality for hip fracture patients.…”

mentioning

confidence: 99%

See 1 more Smart Citation