Short-term mortality in hip fracture patients admitted during weekends and holidays

Background. Acute surgical admission during weekends, with reduced staffing levels, has been associated with increased risk of mortality, but the effect of longer vacation/holiday periods has not been studied. We therefore examined early postoperative mortality in hip fracture patients admitted during weekends and holiday periods, compared with normal weekdays. Methods. Prospective, descriptive study in 600 consecutive hip fracture patients treated with a well-defined multimodal care plan, in a specialized hip fracture unit between September 2002 and July 2004. Patients were stratified according to admission on a weekday or during weekends/holiday periods. Results were analysed with univariate and multivariate analyses. Results. Three hundred and thirty-two patients were admitted during weekdays, 118 during weekends and 150 during holiday periods. Both 5- and 30-day postoperative mortality were significantly higher in patients admitted during holiday periods than during weekends and weekdays, 8.0% vs 2.5% and 1.8%, respectively (P=0.01) and 19.3% vs 12.7% and 11.1%, respectively (P=0.05). In a multivariate analysis, admission during holiday periods was still a significant independent risk factor for both 5-day (4.34, 95% CI 1.74-10.8) and 30-day mortality (1.84, 95% CI 1.08-3.12). Conclusion. Staff reduction during holiday periods in units that care for acute surgical patients may adversely influence postoperative outcome. This may have important consequences both for outcome analysis of interventions and the planning of resource management in surgical units.