Limited impact of weekend admissions on hip fracture outcomes in elderly patients: A study from a Japanese nationwide medical claims database

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Abstract

Aim

The effectiveness of early surgery in preventing complications in elderly Japanese hip fracture patients and the impact of weekend hospitalization need further investigation. The purpose of this study was to determine whether weekend hospitalization affects the incidence of various sequelae and death during hospitalization in elderly hip fracture patients using a comprehensive Japanese hip fracture case database.

Methods

We retrospectively analyzed the Japanese National Administrative DPC (Diagnosis Procedure Combination) database from April 2016 to March 2022. During this period, approximately 1100 DPC‐affiliated hospitals consistently provided medical records with consent for the study. The study focused on weekend hospitalizations and investigated the associations with postoperative pneumonia, pulmonary embolism, myocardial infarction, urinary tract infection, acute renal dysfunction, dementia, and in‐hospital mortality after propensity score matching. Owing to the large population size of the study, significance levels were strictly enforced, and a P‐value < 0.001 was considered statistically significant.

Results

After performing propensity score matching based on age, sex, and comorbidities, 111 035 patient pairs were identified, comparing those admitted on weekends versus weekdays. The analysis showed no heightened risk of sequelae for those admitted during the weekend compared with weekdays. Additionally, there was a slight trend toward higher mortality risk during weekend hospital stays; however, the increase was insignificant, with a hazard ratio of 1.071 (95% confidence interval: 1.005–1.140, P = 0.03).

Conclusion

The results of this study indicate that weekend hospitalization for elderly patients with hip fractures is not definitively associated with an increase in various sequelae or in‐hospital mortality and that the importance of early surgery for elderly patients with hip fractures may be recognized and promoted in Japan. Geriatr Gerontol Int 2025; 25: 75–81.

Abstract

This study indicates that weekend hospitalization for elderly patients with hip fractures is not definitively associated with an increase in various sequelae or in‐hospital mortality.

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Most cited references 29

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Estimating hip fracture morbidity, mortality and costs.

R. Braithwaite, Nananda F Col, John B. Wong (2003)

To estimate lifetime morbidity, mortality, and costs from hip fracture incorporating the effect of deficits in activities of daily living. Markov computer cohort simulation considering short- and long-term outcomes attributable to hip fractures. Data estimates were based on published literature, and costs were based primarily on Medicare reimbursement rates. Postacute hospital facility. Eighty-year-old community dwellers with hip fractures. Life expectancy, nursing facility days, and costs. Hip fracture reduced life expectancy by 1.8 years or 25% compared with an age- and sex-matched general population. About 17% of remaining life was spent in a nursing facility. The lifetime attributable cost of hip fracture was $81,300, of which nearly half (44%) related to nursing facility expenses. The development of deficits in ADLs after hip fracture resulted in substantial morbidity, mortality, and costs. Hip fractures result in significant mortality, morbidity, and costs. The estimated lifetime cost for all hip fractures in the United States in 1997 likely exceeded $20 billion. These results emphasize the importance of current and future interventions to decrease the incidence of hip fracture.

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Timing Matters in Hip Fracture Surgery: Patients Operated within 48 Hours Have Better Outcomes. A Meta-Analysis and Meta-Regression of over 190,000 Patients

Lorenzo Moja, Alessandra Piatti, Valentina Pecoraro … (2012)

Background To assess the relationship between surgical delay and mortality in elderly patients with hip fracture. Systematic review and meta-analysis of retrospective and prospective studies published from 1948 to 2011. Medline (from 1948), Embase (from 1974) and CINAHL (from 1982), and the Cochrane Library. Odds ratios (OR) and 95% confidence intervals for each study were extracted and pooled with a random effects model. Heterogeneity, publication bias, Bayesian analysis, and meta-regression analyses were done. Criteria for inclusion were retro- and prospective elderly population studies, patients with operated hip fractures, indication of timing of surgery and survival status. Methodology/Principal Findings There were 35 independent studies, with 191,873 participants and 34,448 deaths. The majority considered a cut-off between 24 and 48 hours. Early hip surgery was associated with a lower risk of death (pooled odds ratio (OR) 0.74, 95% confidence interval (CI) 0.67 to 0.81; P<0.000) and pressure sores (0.48, 95% CI 0.38 to 0.60; P<0.000). Meta-analysis of the adjusted prospective studies gave similar results. The Bayesian probability predicted that about 20% of future studies might find that early surgery is not beneficial for decreasing mortality. None of the confounders (e.g. age, sex, data source, baseline risk, cut-off points, study location, quality and year) explained the differences between studies. Conclusions/Significance Surgical delay is associated with a significant increase in the risk of death and pressure sores. Conservative timing strategies should be avoided. Orthopaedic surgery services should ensure the majority of patients are operated within one or two days.

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Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression.

Toshiya Shiga, Zen'ichiro Wajima, Yoko Ohe (2008)

Mortality associated with hip fracture is high in elderly patients. Surgical repair within 24 hr after admission is recommended by The Royal College of Physicians' guidelines; however, the effect of operative delay on mortality remains controversial. The objective of this study was to determine whether operative delay increases mortality in elderly patients with hip fracture. Published English-language reports examining the effect of surgical delay on mortality in patients who underwent hip surgery were identified from electronic databases. The primary outcome was defined as all-cause mortality at 30 days and at one year. Effect sizes with corresponding 95% confidence intervals were calculated by using a DerSimonian-Laird randomeffects model. Sixteen prospective or retrospective observational studies (257,367 patients) on surgical timing and mortality in hip fracture patients were selected. When a cut-off of 48 hr from the time of admission was used to define operative delay, the odds ratio for 30-day mortality was 1.41 (95% CI = 1.29-1.54, P < 0.001), and that for one-year mortality was 1.32 (95% CI = 1.21-1.43, P < 0.001). In hip fracture patients, operative delay beyond 48 hr after admission may increase the odds of 30-day all-cause mortality by 41% and of one-year all-cause mortality by 32%. Potential residual confounding factors in observational studies may limit definitive conclusions. Although routine surgery within 48 hr after admission is hard to achieve in most facilities, anesthesiologists must be aware that an undue delay may be harmful to hip fracture patients, especially those at relatively low risk or those who are young.

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Author and article information

Contributors

Yu Mori:

ORCID: https://orcid.org/0000-0002-8225-4690

yu-mori@med.tohoku.ac.jp

Journal

Journal ID (nlm-ta): Geriatr Gerontol Int

Journal ID (iso-abbrev): Geriatr Gerontol Int

Journal ID (doi): 10.1111/(ISSN)1447-0594

Journal ID (publisher-id): GGI

Title: Geriatrics & Gerontology International

Publisher: John Wiley & Sons Australia, Ltd (Kyoto, Japan )

ISSN (Print): 1444-1586

ISSN (Electronic): 1447-0594

Publication date (Electronic): 04 December 2024

Publication date (Print): January 2025

Volume: 25

Issue: 1 ( doiID: 10.1111/ggi.v25.1 )

Pages: 75-81

Affiliations

[ ¹ ] Department of Orthopaedic Surgery Tohoku University Graduate School of Medicine Sendai Japan

[ ² ] Department of Health Administration and Policy Tohoku University Graduate School of Medicine Sendai Japan

[ ³ ] Department of Radiology Akita University Graduate School of Medicine Akita Japan

[ ⁴ ] Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School of Medicine and Dental Sciences Tokyo Japan

Author notes

[*] [* ] Correspondence

Yu Mori, MD, PhD, Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1‐1 Seiryo‐machi, Aoba‐Ku, Sendai, Miyagi 980‐8574, Japan. Email: yu-mori@ 123456med.tohoku.ac.jp

Author information

Yu Mori https://orcid.org/0000-0002-8225-4690

Kunio Tarasawa https://orcid.org/0000-0002-7442-7926

Naoko Mori https://orcid.org/0000-0002-8700-9731

Kiyohide Fushimi https://orcid.org/0000-0002-1894-0290

Article

Publisher ID: GGI15041

DOI: 10.1111/ggi.15041

PMC ID: 11711070

PubMed ID: 39632542

SO-VID: feb76549-661c-412c-86fa-f6797203dcc7

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date revision received : 30 October 2024

Date received : 09 May 2024

Date accepted : 22 November 2024

Page count

Figures: 3, Tables: 3, Pages: 7, Words: 4800

Custom metadata

source-schema-version-number 2.0

cover-date January 2025

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.5.2 mode:remove_FC converted:08.01.2025

Keywords: hip fracture,mortality,osteoporosis,sequlae,weekend admission

Data availability:

Keywords: hip fracture, mortality, osteoporosis, sequlae, weekend admission

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Limited impact of weekend admissions on hip fracture outcomes in elderly patients: A study from a Japanese nationwide medical claims database

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Fracture and Structural Integrity

Most cited references 29

Estimating hip fracture morbidity, mortality and costs.

Timing Matters in Hip Fracture Surgery: Patients Operated within 48 Hours Have Better Outcomes. A Meta-Analysis and Meta-Regression of over 190,000 Patients

Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression.

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