Research ArticleORIGINAL RESEARCH
Open Access

Effect of Weekend Admission on Hip Fracture Mortality

Nicholas L. Newcomb, Marlena Urvater, Ian E. Doig, Michael Mullen and Cameron M. Cooke
Ochsner Journal March 2025, 25 (1) 2-10; DOI: https://doi.org/10.31486/toj.24.0017

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Tables

  • Table 1.

    Patient Demographics Overall and by Hospital Admission Time Point

    Hospital Admission Time Point
    VariableAll Patients, n=1,164Weekday,a n=796Weekend,b n=368P Value
    Age, years0.1
     ≤84683 (58.7)480 (60.3)203 (55.2)
     ≥85481 (41.3)316 (39.7)165 (44.8)
    Age, years, median [IQR]83 [73, 88]82 [73, 88]83 [74, 87]0.5
    Sex0.5
     Female792 (68.0)537 (67.5)255 (69.3)
     Male372 (32.0)259 (32.5)113 (30.7)
    Prior hip fracture0.2
     No1,024 (89.4)698 (88.6)326 (91.3)
     Yes121 (10.6)90 (11.4)31 (8.7)
     Unknown19811
    Fracture type>0.9
     Displaced intracapsular405 (34.8)273 (34.3)132 (35.9)
     Nondisplaced intracapsular513 (44.1)351 (44.2)162 (44.0)
     Intertrochanteric166 (14.3)115 (14.5)51 (13.9)
     Subtrochanteric79 (6.8)56 (7.0)23 (6.3)
     Unknown110
    Operation type0.8
     Cannulated screws42 (3.6)27 (3.4)15 (4.1)
     Dynamic hip screws87 (7.5)58 (7.3)29 (7.9)
     Hemiarthroplasty368 (31.6)258 (32.4)110 (29.9)
     Intramedullary nail531 (45.6)365 (45.9)166 (45.1)
     Total hip arthroplasty136 (11.7)88 (11.1)48 (13.0)
    ASA grade0.2
     <3206 (17.8)148 (18.7)58 (16)
     ≥3948 (82.2)642 (81.3)306 (84)
     Unknown1064
    ASA grade, median [IQR]3.00 [3.00, 3.00]3.00 [3.00, 3.00]3.00 [3.00, 3.00]0.1

    • ↵aWeekday admissions occurred on Monday through Friday.

    • ↵bWeekend admissions occurred on Saturday and Sunday.

    • Notes: Data are presented as n (%) unless otherwise indicated. P values for variables reported as n (%) were determined with the Pearson chi-square test; P values for variables reported as median [IQR] were determined with the Mann-Whitney test.

    • ASA, American Society of Anesthesiologists; IQR, interquartile range.

  • Table 2.

    Patient Demographics Overall and by Surgeon Experience Level

    Surgeon Experience Level
    VariableAll Patients, n=1,163aNonconsultant,b n=690aConsultant,c n=473aP Value
    Age, years0.2
     ≤84682 (58.6)393 (57.0)289 (61.1)
     ≥85481 (41.4)297 (43.0)184 (38.9)
    Age, years, median [IQR]83 [73, 88]83 [73, 88]82 [74, 87]0.7
    Sex0.6
     Female791 (68.0)473 (68.6)318 (67.2)
     Male372 (32.0)217 (31.4)155 (32.8)
    Prior hip fracture0.6
     No1,023 (89.4)601 (89.0)422 (90.0)
     Yes121 (10.6)74 (11.0)47 (10.0)
     Unknown19154
    Fracture type<0.001
     Displaced intracapsular405 (34.9)185 (26.9)220 (46.5)
     Nondisplaced intracapsular512 (44.1)352 (51.1)160 (33.8)
     Intertrochanteric166 (14.3)105 (15.2)61 (12.9)
     Subtrochanteric79 (6.8)47 (6.8)32 (6.8)
     Unknown110
    Operation type<0.001
     Cannulated screws42 (3.6)33 (4.8)9 (1.9)
     Dynamic hip screws87 (7.5)54 (7.8)33 (7.0)
     Hemiarthroplasty368 (31.6)196 (28.4)172 (36.4)
     Intramedullary nail530 (45.6)363 (52.6)167 (35.3)
     Total hip arthroplasty136 (11.7)44 (6.4)92 (19.5)
    ASA grade0.081
     <3206 (17.9)133 (19.5)73 (15.5)
     ≥3947 (82.1)549 (80.5)398 (84.5)
     Unknown1082
    ASA grade, median [IQR]3.00 [3.00, 3.00]3.00 [3.00, 3.00]3.00 [3.00, 3.00]0.2
    Hospital admission time point0.2
     Weekday795 (68.4)482 (69.9)313 (66.2)
     Weekend368 (31.6)208 (30.1)160 (33.8)

    • ↵aSurgeon experience level was not available for 1 patient.

    • ↵bNonconsultants are surgeons still in training such as fellows, principal house officers, and registrars (residents).

    • ↵cConsultants are attending-level surgeons (senior medical officers and specialists).

    • Notes: Data are presented as n (%) unless otherwise indicated. P values for variables reported as n (%) were determined with the Pearson chi-square test; P values for variables reported as median [IQR] were determined with the Mann-Whitney test.

    • ASA, American Society of Anesthesiologists; IQR, interquartile range.

  • Table 3.

    Outcomes by Hospital Admission Time Point

    Hospital Admission Time Point
    OutcomeWeekday,a n=796Weekend,b n=368P Value
    Mortality at 1 year0.029
     No436 (76.8)176 (69.6)
     Yes132 (23.2)77 (30.4)
     Unknown228115
    Acute mortality (<24 hours)0.5
     No771 (97.0)354 (96.2)
     Yes24 (3.0)14 (3.8)
     Unknown10
    Subacute mortality (1 to 30 days)0.083
     No603 (93.3)274 (90.1)
     Yes43 (6.7)30 (9.9)
     Unknown15064
    Mobility at 1 year0.13
     Improved62 (14.3)17 (9.7)
     No change142 (32.6)51 (29.0)
     Declined231 (53.1)108 (61.4)
     Unknown361192
    Change in mobility at 1 year, median [IQR]–1.00 [–3.00, 0.00]–1.00 [–3.00, 0.00]0.12
    Preoperative delay (>48 hours)0.9
     No656 (82.4)302 (82.1)
     Yes140 (17.6)66 (17.9)
    Surgical duration, hours, median [IQR]1.23 [0.95, 1.60]1.15 [0.85, 1.46]<0.001
     Unknown105

    • ↵aWeekday admissions occurred on Monday through Friday.

    • ↵bWeekend admissions occurred on Saturday and Sunday.

    • Notes: Data are presented as n (%) unless otherwise indicated. Mortality data at 1 year were available for 70.5% (n=821) of patients, while mobility data were available for 52.5% (n=611) of patients. P values for variables reported as n (%) were determined with the Pearson chi-square test; P values for variables reported as median [IQR] were determined with the Mann-Whitney test.

    • IQR, interquartile range.

  • Table 4.

    Outcomes by Surgeon Experience Level

    Surgeon Experience Level
    OutcomeNonconsultant,a n=690Consultant,b n=473P Value
    Mortality at 1 year0.058
     No343 (72.1)268 (77.9)
     Yes133 (27.9)76 (22.1)
     Unknown214129
    Acute mortality (<24 hours)0.2
     No663 (96.2)461 (97.5)
     Yes26 (3.8)12 (2.5)
     Unknown10
    Subacute mortality (1 to 30 days)0.2
     No512 (91.4)364 (93.6)
     Yes48 (8.6)25 (6.4)
     Unknown13084
    Mobility at 1 year0.2
     Improved40 (11.6)38 (14.3)
     No change119 (34.6)74 (27.8)
     Declined185 (53.8)154 (57.9)
     Unknown346207
    Change in mobility at 1 year, median [IQR]–1.00 [–3.00, 0.00]–1.00 [–3.00, 0.00]>0.9
    Preoperative delay (>48 hours)0.017
     No583 (84.5)374 (79.1)
     Yes107 (15.5)99 (20.9)
    Surgical duration, hours, median [IQR]1.30 [1.03, 1.68]1.03 [0.79, 1.38]<0.001
    Unknown132

    • ↵aNonconsultants are surgeons still in training such as fellows, principal house officers, and registrars (residents).

    • ↵bConsultants are attending-level surgeons (senior medical officers and specialists).

    • Notes: Surgeon experience level was not available for 1 patient. Data are presented as n (%) unless otherwise indicated. P values for variables reported as n (%) were determined with the Pearson chi-square test; P values for variables reported as median [IQR] were determined with the Mann-Whitney test.

    • IQR, interquartile range.

  • Table 5.

    Logistic Regression Analysis of Clinical Outcomes by Hospital Admission Time Point and Surgeon Experience Level

    Hospital Admission Time Point
    OutcomeNumber of PatientsOdds Ratio (95% CI)P Value
    Mortality at 1 year8211.45 (1.04, 2.01)0.029
    Acute mortality (<24 hours)1,1631.27 (0.63, 2.45)0.5
    Subacute mortality (1 to 30 days)9501.54 (0.94, 2.49)0.085
    Preoperative delay (>48 hours)1,1640.98 (0.71, 1.35)0.9
    Surgeon Experience Level
    OutcomeNumber of PatientsaOdds Ratio (95% CI)P Value
    Mortality at 1 year8200.73 (0.53, 1.01)0.058
    Acute mortality (<24 hours)1,1620.66 (0.32, 1.30)0.2
    Subacute mortality (1 to 30 days)9490.73 (0.44, 1.20)0.2
    Preoperative delay (>48 hours)1,1630.69 (0.51, 0.94)0.017

    • ↵aSurgeon experience level was not available for 1 patient.

    • Note: Binomial logistic regression was performed on each binary clinical outcome to determine odds ratios.

  • Table 6.

    Logistic Regression Analysis of 1-Year Mortality by Surgeon Experience Level and Type of Operation

    VariableNumber of PatientsOdds Ratio (95% CI)P Value
    Surgeon experience level
     Consultant4730.76 (0.54, 1.07)0.12
    Type of operation
     Cannulated screws41——
     Dynamic hip screws863.35 (0.82, 22.7)0.13
     Hemiarthroplasty3676.61 (1.89, 41.9)0.012
     Intramedullary nail5293.99 (1.15, 25.2)0.064
     Total hip arthroplasty1351.35 (0.32, 9.19)0.7

    • Notes: Significance was determined using multivariate binomial logistic regression. One-year mortality by consultant status was analyzed and adjusted for type of operation to assess for confounding. Because of the low frequency of cannulated screws surgeries, mortality at 1 year could not be assessed. Data were unavailable for 6 patients.

  • Table 7.

    Logistic Regression Analysis of Preoperative Delay by Surgeon Experience Level and Type of Operation

    VariableNumber of PatientsOdds Ratio (95% CI)P Value
    Surgeon experience level
     Consultant4730.72 (0.53, 0.99)0.043
    Type of operation
     Cannulated screws41——
     Dynamic hip screws861.18 (0.48, 2.80)0.7
     Hemiarthroplasty3671.68 (0.75, 3.52)0.2
     Intramedullary nail5291.77 (0.80, 3.63)0.14
     Total hip arthroplasty1351.13 (0.48, 2.53)0.8

    • Notes: Significance was determined using a multivariate binomial logistic regression. Preoperative delay by consultant status was analyzed and adjusted for type of operation to assess for confounding. Because of the low frequency of cannulated screws surgeries, preoperative delay could not be assessed. Data were unavailable for 6 patients.

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