The association between the day of the week of milestones in the care pathway of patients with hip fracture and 30-day mortality: findings from a prospective national registry - The National Hip Fracture Database of England and Wales

• Published in: BMC medicine 2017-03, Vol.15 (1), p.62-62, Article 62
• Main Authors: Sayers, Adrian, Whitehouse, Michael R, Berstock, James R, Harding, Karen A, Kelly, Michael B, Chesser, Timothy J
• Format: Article
• Language: English
• Subjects: Admission; Aged; Arches; Best practice; Biocompatibility; Biomedical materials; Birth defects; Clinical trials; Coding; Complexity; Complications; Congenital defects; Correlation; Correlation analysis; Data acquisition; Data collection; Data processing; Databases, Factual; Day of the week; Death; Delivery of Health Care - methods; Demographics; Demography; Documents; England - epidemiology; Epidemiology; Evaluation; Female; Femur; Fractures; Health care; Heterogeneity; Hip; Hip fracture; Hip Fractures - mortality; Hip Fractures - surgery; Hip joint; Hospital Mortality; Hospitals; Humans; Male; Mathematical models; Middle Aged; Mortality; Night; Osteoporosis; Population studies; Prospective Studies; Registries; Regression analysis; Resource allocation; Risk; Seasonal variations; Splines; Statistical analysis; Surgery; Surgical implants; Tariffs; Time Factors; Trauma; Wales - epidemiology; Weekend effect
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-017-0825-5

Recent publications indicate increased mortality in patients admitted to hospital at the weekend, but these findings may be subject to inadequate adjustment for case-mix and the complexities of resource provision. Hip fractures generally occur in a frail comorbid population with a consistent diagnosis precipitating admission as an emergency. We therefore aimed to examine the association between the day of the week of milestones in the care pathway and 30-day mortality in this population. Using data from a prospective national database of hip fractures, we investigated the association between day of the week of admission, surgery, inpatient stay, and discharge (care pathway milestones) and 30-day mortality using generalised linear models. Data was collected between January 1, 2011, and December 31, 2014, on 241,446 patients. An incremental case-mix adjustment strategy was performed using patient characteristics, non-surgical interventions, surgical interventions and discharge characteristics. The day of admission was not associated with 30-day mortality. Sunday surgery (OR, 1.094; 95% CI, 1.043-1.148; P