No ‘weekend effect’ for the elderly suffering from broken hips in the NHS

No ‘weekend effect’ for the elderly suffering from broken hips in the NHS

New research has found NHS patients admitted to hospital at the weekend with a hip fracture are at no greater risk of death compared to weekdays.

In fact, the risk of death during the hospital stay was lower at the weekend than in the week. Only a delay to surgery; undergoing surgery on a Sunday, when provision for operations in many hospitals is less; being discharged from hospital on a Sunday; or out of hours were associated with an increased risk of death at 30 days.

Using data collected by the National Hip Fracture Database (NHFD) of England, Wales and Northern Ireland, researchers from the University of Bristol and North Bristol NHS Trust investigated the chances of dying in a quarter of a million NHS patients with a broken hip between 2011 and 2014.

Contrary to recent reports of a weekend effect across the NHS, they demonstrate that there is no ‘weekend admission effect’ for patients with a hip fracture in the NHS. They have highlighted important events in the care pathway of patients including: a delay to surgery of more than 24 hours (associated with a ten per cent increased risk of mortality); Sunday surgery (associated with a ten per cent increased risk of mortality); discharge from hospital on a Sunday (associated with a 52 per cent increased risk of mortality) and out of hours discharge (associated with a 17 per cent increased risk of mortality) which were associated with an increased risk of dying in the 30 days following a hip fracture.

Mr Tim Chesser, Consultant Trauma and Orthopaedic Surgeon at North Bristol NHS Trust and clinical lead of the research project, reported: “Despite the previously published suggestions that there is an increased risk of a patient admitted to hospital at the weekend dying when compared to those admitted during the week, there is no increased risk for patients who have suffered from a broken hip. This is reassuring because elderly patients who suffer from a hip fracture are often very frail, with multiple medical problems, so the lack of an increased risk reflects the excellent care they receive under the current structures and medical staffing.

“However, this research illustrates that significant events, such as the timing of surgery and timing of discharge from the hospital may be very important events in the treatment of the elderly with broken hips and require further research.”

 

Source: University of Bristol

Reference: Adrian Sayers and others. 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. BMC Medicine, 2017; 15 (1) DOI: 10.1186/s12916-017-0825-5

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