Hip Fracture and the Weekend Effect: Does Weekend Admission Affect Patient Outcomes?

Abstract

Reduced hospital staffing on weekends is a hypothesized risk factor for adverse health outcomes--commonly referred to as the weekend effect. We conducted a study on the effect of weekend admission on short-term outcomes among US hip fracture patients. We selected Nationwide Inpatient Sample (1998-2010) patients with a principal diagnosis of femoral neck fracture and grouped them by day of admission (weekend or weekday). We used multivariate logistic and linear regression analyses, controlling for age, race, sex, number of comorbidities, and other risk factors, to calculate odds ratios (ORs) of mortality and perioperative complications as well as mean difference in length of hospital stay. Our study population included 96,892 weekend and 248,097 weekday admissions. Compared with patients admitted on weekdays, patients admitted on weekends had lower mortality (OR, 0.94; 95% confidence interval [CI], 0.89-0.99) and shorter mean hospital stay (estimate, 3.74%; 95% CI, 3.40-4.08) but did not differ in risk of perioperative complications (OR, 1.00; 95% CI, 0.98-1.02). Weekend admission did not predict death, perioperative complications, longer hospital stay, or other adverse short-term outcomes. Our study data do not support a weekend effect among hip fracture admissions in the United States.