Nina Sahlertz Kristiansen1, Pia Kjær Kristensen2, Bente Mertz Nørgård3, Jan Mainz4, Søren Paaske Johnsen5. 1. Centre for Quality, Region of Southern Denmark, Middelfart, Denmark Institute of Public Health, University of Southern Denmark, Odense, Denmark. 2. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Department of Orthopaedic Surgery, Hospital Horsens, Horsens, Denmark. 3. Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. 4. Aalborg Psychiatric University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark. 5. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Abstract
OBJECTIVE: Higher risks of adverse outcomes have been reported for patients admitted acutely during off-hours. However, in relation to hip fracture, the evidence is inconsistent. We examined whether time of admission influenced compliance with performance measures, surgical delay and 30-day mortality in patients with hip fracture. DESIGN: Cohort study. SETTING: Data from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries. PARTICIPANTS: Danish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N = 25 305). EXPOSURE: Off-hours: weekday evenings and nights, and weekends. MAIN OUTCOME MEASURES: Meeting specific performance measures, surgical delay and mortality. RESULTS: No differences were found in patient characteristics or in meeting performance measures (RRs from 0.99 [95% CI: 0.98-1.01] to 1.01 [95% CI: 0.99-1.02]. When comparing admission on weekdays (evenings and nights vs. days), off-hours admission was associated with a lower risk of surgical delay (adjusted OR 0.75 [95% CI: 0.66-0.85]) while no differences in 30-day mortality was found (adjusted OR 0.91 [95% CI: 0.80-1.04]. When comparing admission during weekends with admission during weekdays, off-hours admission was associated with a higher risk of surgical delay (adjusted OR 1.19 [95% CI: 1.05-1.37]) and a higher 30-day mortality risk (adjusted OR 1.13 [95% CI: 1.04-1.23]. The risk of surgical delay appeared not to explain the excess 30-day mortality. CONCLUSIONS: Patients admitted off-hours and on-hours received similar quality of care. The risk of surgical delay and 30 days mortality was higher among patients admitted during weekends; explanations need to be clarified.
OBJECTIVE: Higher risks of adverse outcomes have been reported for patients admitted acutely during off-hours. However, in relation to hip fracture, the evidence is inconsistent. We examined whether time of admission influenced compliance with performance measures, surgical delay and 30-day mortality in patients with hip fracture. DESIGN: Cohort study. SETTING: Data from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries. PARTICIPANTS: Danish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N = 25 305). EXPOSURE: Off-hours: weekday evenings and nights, and weekends. MAIN OUTCOME MEASURES: Meeting specific performance measures, surgical delay and mortality. RESULTS: No differences were found in patient characteristics or in meeting performance measures (RRs from 0.99 [95% CI: 0.98-1.01] to 1.01 [95% CI: 0.99-1.02]. When comparing admission on weekdays (evenings and nights vs. days), off-hours admission was associated with a lower risk of surgical delay (adjusted OR 0.75 [95% CI: 0.66-0.85]) while no differences in 30-day mortality was found (adjusted OR 0.91 [95% CI: 0.80-1.04]. When comparing admission during weekends with admission during weekdays, off-hours admission was associated with a higher risk of surgical delay (adjusted OR 1.19 [95% CI: 1.05-1.37]) and a higher 30-day mortality risk (adjusted OR 1.13 [95% CI: 1.04-1.23]. The risk of surgical delay appeared not to explain the excess 30-day mortality. CONCLUSIONS:Patients admitted off-hours and on-hours received similar quality of care. The risk of surgical delay and 30 days mortality was higher among patients admitted during weekends; explanations need to be clarified.
Authors: Stephen A Smith; Jennifer M Yamamoto; Derek J Roberts; Karen L Tang; Paul E Ronksley; Elijah Dixon; W Donald Buie; Matthew T James Journal: Med Care Date: 2018-02 Impact factor: 2.983
Authors: Andreas Asheim; Sara Marie Nilsen; Marlen Toch-Marquardt; Kjartan Sarheim Anthun; Lars Gunnar Johnsen; Johan Håkon Bjørngaard Journal: Acta Orthop Date: 2018-11-06 Impact factor: 3.717