The weekend effect in hip fracture: The critical role of resource management

Abstract

Introduction and objectives: The "weekend effect" refers to patients admitted at the end of the week who cannot undergo surgery until the beginning of the following week. The objective is to study the relationship between admission on a specific day of the week and the time to surgery.

Material and methods: A retrospective analytical study was conducted, including consecutive patients over 65 years old with a diagnosis of hip fracture admitted to Miguel Servet University Hospital from March 1 to October 31, 2023. Data such as admission day, age, sex, type of fracture, anticoagulant or antiplatelet therapy, and time to surgery were collected. A multivariate analysis was performed to investigate the factors influencing the time to surgery.

Results: A total of 348 patients were included. The average time to surgery for patients admitted on Monday was 2.04 days; Tuesday, 2.06; Wednesday, 2.14; Thursday, 2.94; Friday, 3.24; Saturday, 2.91; and Sunday, 2.17. The multivariate analysis showed that admission on Thursday (p<0.001), Friday (p<0.001), or Saturday (p<0.001) increased the time to surgery compared to admission on Monday. Treatment with vitamin K antagonists (p=0.006) and direct oral anticoagulants (p<0.001) also delayed surgery. Subcapital fractures were treated later than basicervical (p=0.039), pertrochanteric (p=0.018), and subtrochanteric (p=0.028) fractures.

Conclusion: In our center, admission on Thursday, Friday, or Saturday significantly increased the time to surgery compared to Monday. This may increase hospital costs and the potential complications related to surgical delay.

Keywords: Anticoagulación; Anticoagulation; Demora quirúrgica; Fractura de cadera; Hip fracture; Mortalidad; Mortality; Surgery delay.