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. 2022 Apr;48(2):709-719.
doi: 10.1007/s00068-021-01804-y. Epub 2021 Oct 7.

The consequences of out-of-hours hip fracture surgery: insights from a retrospective nationwide study

Maximilian Peter Forssten  1   2 , Ahmad Mohammad Ismail  1   2 , Tomas Borg  1   2 , Yang Cao  3 , Per Wretenberg  1   2 , Gary Alan Bass  2   4 , Shahin Mohseni  5   6
Affiliations

The consequences of out-of-hours hip fracture surgery: insights from a retrospective nationwide study

Maximilian Peter Forssten et al. Eur J Trauma Emerg Surg. 2022 Apr.

Abstract

Purpose: The study aimed to investigate the association between out-of-hours surgery and postoperative mortality in hip fracture patients. Furthermore, internal fixation and arthroplasty were compared to determine if a difference could be observed in patients operated with these techniques at different times during the day.

Methods: All patients above 18 of age years in Sweden who underwent hip fracture surgery between 2008 and 2017 were eligible for inclusion. Pathological fractures, non-operatively managed fractures, or cases whose time of surgery was missing were excluded. The cohort was subdivided into on-hour (08:00-17:00) and out-of-hours surgery (17:00-08:00). Poisson regression with adjustments for confounders was used to evaluate the association between out-of-hours surgery and both 30-day and 90-day postoperative mortality.

Results: Out-of-hours surgery was associated with a 5% increase in the risk of both 30-day [adj. IRR (95% CI) 1.05 (1.00-1.10), p = 0.040] and 90-day [adj. IRR (95% CI) 1.05 (1.01-1.09), p = 0.005] mortality after hip fracture surgery compared to on-hour surgery. There was no statistically significant association between out-of-hours surgery and postoperative mortality among patients who received an internal fixation. Arthroplasties performed out-of-hours were associated with a 13% increase in 30-day postoperative mortality [adj. IRR (95% CI) 1.13 (1.04-1.23), p = 0.005] and an 8% increase in 90-day postoperative mortality [adj. IRR (95% CI) 1.08 (1.01-1.15), p = 0.022] compared to on-hour surgery.

Conclusion: Out-of-hours surgical intervention is associated with an increase in both 30- and 90-day postoperative mortality among hip fracture patients who received an arthroplasty, but not among patients who underwent internal fixation.

Keywords: Arthroplasty; Hip fracture; Internal fixation; Mortality; On hour; Out of hours; Surgery; Time of day.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Histogram depicting the distribution of all types of hip fracture surgery based on the time of day. P values are calculated using Pearson’s chi-squared test
See this image and copyright information in PMC

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