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. 2018 Dec;89(6):610-614.
doi: 10.1080/17453674.2018.1533769. Epub 2018 Nov 6.

Time of admission and mortality after hip fracture: a detailed look at the weekend effect in a nationwide study of 55,211 hip fracture patients in Norway

Andreas Asheim  1   2 , Sara Marie Nilsen  1 , Marlen Toch-Marquardt  3 , Kjartan Sarheim Anthun  3   4 , Lars Gunnar Johnsen  5   6 , Johan Håkon Bjørngaard  3
Affiliations

Time of admission and mortality after hip fracture: a detailed look at the weekend effect in a nationwide study of 55,211 hip fracture patients in Norway

Andreas Asheim et al. Acta Orthop. 2018 Dec.

Abstract

Background and purpose - There are numerous studies on the weekend effect for hip fracture patients, with conflicting results. We analyzed time of admission and discharge, and the association with mortality and length of hospital stay in more detail. Patients and methods - We used data from 61,211 surgically treated hip fractures in 55,211 patients, admitted to Norwegian hospitals 2008-2014. All patients were aged 50 years or older. Data were analyzed with Cox and Poisson regression. Results - Mortality within 30 days did not differ substantially by day of admission, although admissions on Sundays and holidays had a slightly increased mortality. The hazard ratios were 1.1 (95% confidence interval [CI] 0.97-1.2) for Sundays, and 1.2 (CI 0.98-1.4) for holidays, relative to Mondays. For patients admitted between 6:00 am and 7:00 am the hazard ratio was 1.4 (CI 1.1-1.8) relative to patients admitted between 2:00 pm and 3:00 pm. Discharges during weekends and holidays were associated with a substantial higher mortality than weekday discharges. Patients admitted from Friday to Sunday generally stayed in hospital for a shorter time than patients admitted during other days. Interpretation - Our results indicate that the discussion on weekday versus weekend admission effects might have distracted attention from other important factors, such as time of day of admission, and day of discharge from hospital treatment.

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Figures

Figure 2.
Figure 2.
Day and time of admission (left panel) and discharge (right panel).
Figure 2.
Figure 2.
Day and time of admission (left panel) and discharge (right panel).
Figure 3.
Figure 3.
Mortality within 30 days after admission, by day of admission and discharge. Relative change in hazard ratios with 95% confidence interval is displayed. Number of admissions and discharges per category are displayed on the left and right, respectively. Adjusted for sex, age, admission hour, day-after-holiday, month, and year.
Figure 4.
Figure 4.
Mortality within 30 days after admission, by hour of admission. Relative change in hazard ratios with 95% confidence interval is displayed. Number of admissions per hour is displayed on the left. Adjusted for sex, age, day-of-the-week, day-after-holiday, month, and year.
Figure 5.
Figure 5.
Estimated length of hospitalization according to day of admission, with 95% margins. Number of admissions per category in the data are displayed on the left. Adjusted for sex, age, admission hour, day-after-holiday, month, and year.
See this image and copyright information in PMC

References

    1. NOMESCO Bay-Nielsen H. Classification of Surgical Procedures: Nordic Medico-Statistical Committee (NOMESCO); 2010. [Available from: https://norden.diva-portal.org/smash/get/diva2:970547/FULLTEXT01.pdf].
    1. Boylan M R, Rosenbaum J, Adler A, Naziri Q, Paulino C B. Hip fracture and the weekend effect: does weekend admission affect patient outcomes? Am J Orthop 2015; 44(10): 458–64. - PubMed
    1. Bray B D, Cloud G C, James M A, Hemingway H, Paley L, Stewart K, Tyrrell P J, Wolfe C D A, Rudd A G. Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care. Lancet 2016; 388(10040): 170–7. - PubMed
    1. Cloyd J M, Chen J, Ma Y, Rhoads K F. Association between weekend discharge and hospital readmission rates following major surgery. JAMA Surg 2015; 150(9): 849–56. - PubMed
    1. Daugaard C L, Jorgensen H L, Riis T, Lauritzen J B, Duus B R, van der Mark S. Is mortality after hip fracture associated with surgical delay or admission during weekends and public holidays? A retrospective study of 38,020 patients. Acta Orthop 2012; 83(6): 609–13. - PMC - PubMed

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