From the Department of Orthopaedic Surgery, NYU Langone Health (Dr. Boylan, Dr. Riesgo, and Dr. Tejwani), and the Department of Orthopaedic Surgery, SUNY Downstate Medical Center College of Medicine (Dr. Paulino), New York, NY.
J Am Acad Orthop Surg. 2019 Jan 1;27(1):e33-e40. doi: 10.5435/JAAOS-D-17-00143.
The transition to bundled payment reimbursement for geriatric hip fractures has incentivized the identification of avoidable inefficiencies in the cost and quality of care. Although a "weekend effect" has been described with regard to hip fracture mortality, measures of efficiency according to the day of hip fracture admission are currently unclear.
We identified 62,303 patients aged 65 years or older with a primary diagnosis of femoral neck or intertrochanteric hip fracture in the New York Statewide Planning and Research Cooperative System between 2009 and 2014. Outcome measures included preoperative delay, postoperative length of stay (LOS), and cost of admission.
Preoperative delay was longer for weekend admissions, but shorter for admissions on Wednesday, Thursday, and Friday. Postoperative LOS was longer for admissions on Tuesday, Wednesday, and Thursday. Discharge rates varied considerably according to the day of admission, ranging from 12% to 43% by hospital day 4 and 53% to 72% by hospital day 6. No differences in cost according to day of admission were found once preoperative delay and postoperative LOS were accounted for.
Notable variation exists in hospitalizations for geriatric hip fracture depending on the day of admission. Our data suggest the presence of a weekend effect, in which changes in staffing of surgical, medical, and ancillary services lead to increased waiting times for surgery for new admissions and delays in discharge of early- and mid-week admissions.
Level III, retrospective study.
老年髋部骨折的捆绑式支付报销制度的转变激励了对医疗成本和质量方面的可避免的低效的识别。尽管已经描述了髋部骨折死亡率的“周末效应”，但根据髋部骨折入院日的效率衡量标准目前尚不清楚。
我们在 2009 年至 2014 年期间，在纽约州规划和研究合作系统中确定了 62303 名年龄在 65 岁或以上的患有股骨颈或转子间髋部骨折的患者。结果测量包括术前延迟、术后住院时间（LOS）和入院费用。
周末入院的术前延迟时间较长，但星期三、星期四和星期五入院的术前延迟时间较短。星期二、星期三和星期四入院的术后 LOS 较长。根据入院日，出院率差异很大，从入院后第 4 天的 12%到 43%，到第 6 天的 53%到 72%。一旦考虑到术前延迟和术后 LOS，入院日与费用之间没有差异。
老年髋部骨折的住院治疗因入院日而异存在显著差异。我们的数据表明存在周末效应，即手术、医疗和辅助服务人员的变化导致新入院患者的手术等待时间延长，以及早期和中期周入院患者的出院时间延迟。
III 级，回顾性研究。
