Daytime versus after-hours surgery outcomes in hip fracture patients: a systematic review and meta-analysis

Several studies found that hip fracture patient outcome is greatly influenced by the time from admission to surgery. To avoid surgical delay, surgery for hip fracture may be performed at night or weekends. However, after-hours surgery may lead to a reduction in support staff and to surgeon fatigue, which ultimately increases mortality and complications. Therefore, we wanted to compare the outcomes of daytime and after-hours surgery in hip fracture patients.

A literature search was performed in the Cochrane Library, and the Web of Science, PubMed, Embase, and Springer databases from inception to December 2019. Relevant studies comparing the results of operations performed at different time periods were included. The main clinical outcomes included total complications, mortality, blood loss, surgical time, and length of hospitalization. Data were pooled, and a meta-analysis was completed.

Nine retrospective cohort studies and one randomized controlled trial met the inclusion criteria; the studies included a total of 583,290 patients. We found no significant differences in mortality, surgical time or blood loss between daytime and after-hours surgery in hip fracture patients (P > 0.05). Of note, the patients who underwent after-hours surgery had fewer surgical complications (P < 0.001) and a shorter length of hospitalization (P = 0.021) than those who underwent daytime surgery.

After-hours surgery for hip fracture is safe. To avoid surgical delay, after-hours surgery is still a viable and even necessary option.