Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.