Nijland Leontien M G, Karres Julian, Simons Anouk E, Ultee Jan M, Kerkhoffs Gino M M J, Vrouenraets Bart C
Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands.
Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Injury. 2017 Jul;48(7):1536-1541. doi: 10.1016/j.injury.2017.05.017. Epub 2017 May 15.
Increased mortality rates have been reported for emergency admissions during weekends and outside office hours. Research on the weekend effect in hip fracture patients is however limited and demonstrates conflicting results. The aim of this study was to determine the effect of weekend admission and weekend surgery on 30-day and 1-year mortality following hip fracture surgery.
All patients who underwent hip fracture surgery in our hospital between 2004 and 2015 were included in this retrospective study. Patient characteristics including age, gender, fracture type, American Society of Anesthesiologists (ASA) score, Nottingham Hip Fracture Score (NHFS), Charlson Comorbidity Index (CCI) and length of stay were collected. Information on admission and surgery date and time of day was recorded, as were in-hospital, 30-day and 1-year mortality. Multivariable logistic regression analysis was performed to identify independent predictors of 30-day and 1-year mortality.
A total of 1803 patients were included, 546 patients (30.3%) were admitted during the weekend. Patient characteristics did not differ between weekday and weekend admissions. Surgical delay was less frequent in patients undergoing weekend surgery. Multivariable analysis demonstrated that older age, higher ASA score, higher NHFS and increased surgical delay were independently associated with 30-day mortality. One-year mortality was associated with age, gender, ASA score, CCI and surgical delay. Weekend admission and weekend surgery were not associated with increased 30-day or 1-year mortality.
There was no weekend effect for hip fracture patients in our study. These results indicate an adequate level of perioperative care outside weekday office hours within our health care system.
据报道，周末及非办公时间的急诊入院患者死亡率有所上升。然而，关于髋部骨折患者周末效应的研究有限，且结果相互矛盾。本研究的目的是确定周末入院和周末手术对髋部骨折手术后30天和1年死亡率的影响。
本回顾性研究纳入了2004年至2015年间在我院接受髋部骨折手术的所有患者。收集了患者的特征，包括年龄、性别、骨折类型、美国麻醉医师协会（ASA）评分、诺丁汉髋部骨折评分（NHFS）、Charlson合并症指数（CCI）和住院时间。记录了入院和手术日期及时间，以及住院期间、30天和1年的死亡率。进行多变量逻辑回归分析以确定30天和1年死亡率的独立预测因素。
共纳入1803例患者，其中546例（30.3%）在周末入院。工作日和周末入院患者的特征无差异。周末手术患者的手术延迟情况较少见。多变量分析表明，年龄较大、ASA评分较高、NHFS较高和手术延迟增加与30天死亡率独立相关。1年死亡率与年龄、性别、ASA评分、CCI和手术延迟有关。周末入院和周末手术与30天或1年死亡率增加无关。
在我们的研究中，髋部骨折患者不存在周末效应。这些结果表明，在我们的医疗保健系统中，非工作日办公时间的围手术期护理水平足够。
