Is There a "Weekend Effect" in Intertrochanteric Fracture Surgery?

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Health Services Research

Background:

• The
• weekend effect
• conceptually linked to poorer patient outcomes after hospital admission.
• Previous studies suggest adverse outcomes for weekend admissions, but evidence in specific surgical populations is varied.
• Older patients with intertrochanteric fractures represent a vulnerable group where admission timing may influence outcomes.

Purpose of the Study:

• To investigate the association between weekend or off-hour admission and adverse outcomes in elderly patients undergoing intertrochanteric fracture surgery.
• To identify factors contributing to all-cause mortality in this patient cohort.

Main Methods:

• Retrospective cohort study of patients aged 65 years and older with intertrochanteric fractures.
• Data extracted from computerized medical records with long-term follow-up.
• Statistical analyses included 3-group comparison, correlation analyses, univariate analysis, and multivariate Cox proportional-hazard models to assess the weekend effect and mortality predictors.

Main Results:

• No significant evidence of a weekend effect on adverse outcomes, including mortality rates, length of stay, hospital costs, transfusion rates, pain scores, functional outcomes, or specific complications (all p > 0.05).
• A minor delay in surgery (0.5 days) was observed for patients admitted on Fridays (p = 0.013).
• Age (HR 1.43) and surgical delay (HR 1.05) were the only significant predictors of all-cause mortality.

Conclusions:

• Weekend or holiday admission does not adversely affect mortality or other outcomes for older patients with intertrochanteric fractures.
• Collaborative, multidisciplinary team care is effective and efficient for managing these patients regardless of admission day.
• Focus should remain on patient-specific factors like age and surgical delay rather than admission timing.