Comparing mortality risk of patients with acute hip fractures admitted to a major trauma centre on a weekday or weekend
Rajpal Nandra1, Jack Pullan2, Jonathan Bishop3
1Orthopaedic Specialist Trainee, West Midlands Deanery, Birmingham, UK. rajpalnandra@nhs.net.
Insights
Weekend hospital admissions for proximal femoral fractures do not increase mortality risk. Careful planning ensures a consistent seven-day service, mitigating the
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Public Health
Background:
- Proximal femoral fractures pose significant public health challenges, with high associated costs and mortality risks.
- The 'weekend effect' in healthcare, concerning potential disparities in care quality based on admission day, is a subject of ongoing debate.
Purpose of the Study:
- To investigate the impact of weekend admission on patient outcomes for proximal femoral fractures.
- To determine if a 'weekend effect' influences key performance indicators and mortality rates.
Main Methods:
- A single-center, multi-surgeon review of 2060 patients with proximal femoral fractures.
- Comparison of patient and treatment variables between weekday and weekend admissions.
- Binary regression analysis to identify factors influencing mortality risk.
Main Results:
- Fewer patients met performance indicators for time to surgery and geriatric review during weekend admissions.
- Weekend admission showed marginally lower 30-day mortality (9.7% vs. 10.2%), though not statistically significant.
- Increasing age, female gender, comorbidities, and confusion were identified as significant mortality risk factors, independent of admission day.
Conclusions:
- No significant 'weekend effect' on 30-day mortality was found after accounting for patient factors.
- Effective workforce planning and resource management enable a seven-day service for hip fractures without compromising patient outcomes.
Abstract:
Proximal femoral fractures are a major public health concern with estimated annual direct and social costs amounting to £2 billion and average 30-day mortality risk of 7.5%. In response to the recent debate over out-of-hours hospital provision we investigated the 'weekend effect' at a major trauma centre, caring for acute injuries. A single centre, multi-surgeon review of 2060 patients performed. The distribution of patient and treatment variables compared in patients admitted on a weekday or the weekend. Fewer patients met performance indicators during weekend admission, time to surgery (63 vs. 71%) and time to geriatric review (86 vs. 91%). Weekend admission 30-day mortality was marginally lower than weekday (9.7% vs. 10.2%, OR 0.94, 95% CI 0.67 to 1.32, p = 0.7383). Increasing age, female gender, co-morbidities and confusion increased mortality risk. Binary regression analysis including these variables found no significant 'weekend effect'. Despite the unit observing an increasing workload in the last five years, with meticulous workforce planning, senior doctor provisions and careful use of resources, it is possible to provide a seven-day fracture neck of femur service with no variation in thirty-day mortality by the day of admission.
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