Time of admission and mortality after hip fracture – a detailed look at the weekend effect in a nationwide study of 55 211 hip fracture patients in Norway

Abstract

Background and purpose: There are numerous studies on the weekend effect for hip fracture patients, with conflicting results. We analyzed time of admission and discharge, and the association with mortality and length of hospital stay in more detail. Material and methods: We used data from 61 211 surgically treated hip fractures, 55 211 patients, admitted to Norwegian hospitals 2008-2014. All patients were aged 50 years or older. Data were analyzed with Cox’ and Poisson regression. Results: Mortality within 30 days did not differ substantially by day of admission, although admissions on Sundays and holidays had a slightly increased mortality. The hazard ratios were 1.08 (95% confidence interval (CI) 0.97-1.20) for Sundays, and 1.18 (CI 0.98-1.41) for holidays, relative to Mondays. For patients admitted between 6:00 am and 7:00 am the hazard ratio was 1.41 (CI 1.10-1.80) relative to patients admitted between 2:00 pm and 3:00 pm. Discharges during weekends and holidays were associated with a substantial higher mortality than weekday discharges. Patients admitted from Friday to Sunday generally stayed shorter in hospital than patients admitted during other days. Interpretation: Our results indicate that the discussion on weekday versus weekend admission effects might have distracted attention from other important factors, such as time of day of admission, and day of discharge from hospital treatment.