# Weekend discharge after hip fracture surgery is associated with increased 30-day mortality. A retrospective observational study of 35,138 hip fractures reported to the Norwegian Hip Fracture Register

## TL;DR

Hip fracture patients discharged on weekends had higher 30-day and 1-year mortality rates compared to those discharged on weekdays, according to a study of over 35,000 patients in Norway.

## Contribution

This study is the first to show a significant link between weekend discharge timing and increased mortality after hip fracture surgery.

## Key findings

- Weekend discharge was associated with a 40% higher 30-day mortality risk compared to weekday discharge.
- Mortality risk was elevated across all age groups and health conditions except for those aged 65–74.
- No significant difference in 30-day readmission risk was found between weekend and weekday discharges.

## Abstract

To investigate whether discharge time from hospital influences mortality and readmission risk after hip fracture surgery.

Discharge on weekends was associated with increased 30-day and 1-year mortality, but no difference in 30-day readmission risk compared to discharge on weekdays.

Our study highlights the need for enhanced attention during weekend discharges of hip fracture patients.

The influence of discharge timing after hip fracture surgery has been sparsely investigated. We aimed to investigate whether time of discharge influence 30-day mortality, and secondarily 1-year mortality and 30-day readmission risk after hip fracture surgery.

Data from 35,138 hip fracture patients aged ≥ 65 and with length of stay (LoS) ≤ 14 days reported to the Norwegian Hip Fracture Register 2008 to 2018 were analyzed. Cox regression analyses, adjusted for age groups, sex, ASA class, cognitive function, fracture type, and type of surgery were used to calculate mortality risk after discharge on weekdays compared to weekends (Friday 18:00 to Monday 08:00). Patients were grouped by age, cognitive function, ASA class, and discharge destination.

Mean age was 83 years, 71% were women, and 61% had ASA class ≥ 3. Patients discharged on weekends were marginally older, more often ASA class ≥ 3, cognitively impaired, and had shorter LoS than patients discharged on weekdays. Weekend discharge was associated with increased 30-day mortality (HRR 1.4, 95% CI 1.3–1.6; p < 0.001) and 1-year mortality (HRR 1.2, CI 1.2–1.3; p < 0.001) compared to weekday discharge. Sub-analyses showed increased 30-day mortality for all age groups except 65–74 years, all ASA groups, patients with and without cognitive impairment, patients discharged to nursing homes and the most common surgical methods. No statistically significant difference in 30-day readmission risk was found after weekend discharged compared to weekday discharge.

Weekend discharge for hip fracture patients was associated with increased 30-day and 1-year mortality, but did not influence overall 30-day readmission risk.