Is mortality after hip fracture associated with surgical delay or admission during weekends and public holidays?

Figures & data

Figure 1. The selection process.

Table 1. Patient characteristics and mortality

	In-hospital mortality			30-day mortality
	Alive	Dead	p-value	Alive	Dead	p-value
n	36,326	1,694	NA	34,210	3,810	NA
Women, n (%)	26,959 (74.2)	969 (57.2)	< 0.001	25,671 (75.0)	2,257 (59.2)	< 0.001
Age, years ^a	82.5 (7.7)	86.2 (7.2)	< 0.001	82.3 (7.6)	86.1 (7.4)	< 0.001
Length of stay (days) ^b	9 (2–23)	6 (2–20)	< 0.001	9 (2–23)	5 (2–18)	< 0.001
Time to operation, hours ^b	22.1 (4.5–64.4)	24.5 (4.6–74.8)	< 0.001	22.1 (4.5–64.4)	23 (4.5–69.9)	0.003
ASA, n (%)			< 0.001			< 0.001
ASA 1	3,591 (9.9)	47 (2.8)		3,529 (10.3)	109 (2.9)
ASA 2	19,068 (52.5)	514 (30.3)		18,334 (53.6)	1,248 (32.8)
ASA 3	12,054 (33.2)	831 (49.1)		11,025 (32.2)	1,860 (48.8)
ASA 4	1,594 (4.4)	290 (17.1)		1,309 (3.8)	575 (15.1)
ASA 5	19 (0.1)	12 (0.7)		13 (0.04)	18 (0.5)
Type of fracture, n (%)			< 0.001			< 0.001
Femoral neck fracture	18,783 (51.7)	766 (45.2)		17,847 (52.2)	1,702 (44.7)
Pertrochanteric fracture	14,975 (41.2)	781 (46.1)		13,976 (40.9)	1,780 (46.7)
Subtrochanteric fracture	2,568 (7.1)	147 (8.7)		2,387 (7.0)	328 (8.6)

^a Values are mean (SD).

^b Values are median (range).

ASA score, 1–5: ASA 1, normal healthy patient; ASA 2, mild systemic disease; ASA 3, severe systemic disease; ASA 4, severe systemic disease that is a constant threat to life; ASA 5, a moribund patient who is not expected to survive more than 24 h with or without an operation.

NA: not applicable.

Table 2. Odds ratios for in-hospital mortality and 30-day mortality

	In-hospital mortality OR (95% CI)	30-day mortality OR (95% CI)
Time to operation, per 24 h	1.32 (1.25–1.39)	1.24 (1.19–1.30)
Age, per 5 years	1.43 (1.38–1.48)	1.46 (1.49–1.42)
Sex, male vs.female	2.23 (2.00–2.47)	2.26 (2.09–2.43)
ASA, per score increment	2.28 (2.13–2.45)	2.32 (2.21–2.44)
Length of stay, per day	0.91 (0.90–0.92)	0.88 (0.87–0.89)
Type of fracture, per type increment	1.25 (1.16–1.35)	1.31 (1.24–1.39)

Types of fracture: type 1, femoral neck fracture; type 2, pertrochanteric fracture; type 3, subtrochanteric fracture. We have included ASA score 1–5.

Figure 2. OR for in-hospital mortality related to five different variables for the 3 types of hip fractures. TTOP: time to operation; LOS: length of stay.

Figure 3. OR for 30-day mortality related to five different variables for the 3 types of hip fractures. TTOP: time to operation; LOS: length of stay.

Table 3. In-hospital mortality and 30-day mortality according to month of admission, day of admission, and holiday admission

	In-hospital mortality (%)	30-day mortality (%)
Month of admission
January	4.8	10.8
February	4.8	10.6
March	4.6	9.9
April	5.0	10.4
March	3.9	9.2
June	4.1	9.5
July	3.9	9.2
August	4.1	9.6
September	4.6	10.4
October	4.5	10.1
November	4.4	9.6
December	4.7	10.6
Day of admission
Monday	4.2	10.0
Tuesday	4.6	9.6
Wednesday	4.6	9.9
Thursday	4.2	9.4
Friday	4.8	10.8
Saturday	4.5	10.4
Sunday	4.2	10.2
Public holiday (PH) admission
Outside PH	4.5	10.0
During PH	4.3	10.1

PH: public holiday.