Off-hours admission and quality of hip fracture care: a nationwide cohort study of performance measures and 30-day mortality

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.