Outcomes for patients with acute illnesses may be affected by the day of the week they present to hospital. Policy makers state this ‘weekend effect’ to be the main reason for pursuing a change in consultant weekend working patterns. However, it is uncertain whether such a phenomenon exists for elective orthopaedic surgery.

This study investigated whether a ‘weekend effect’ contributed to adverse outcomes in patients undergoing elective hip and knee replacements.

Retrospectively collected data was obtained from our institutions electronic patient records. Using univariate analysis, we examined potential risk factors including; Age, Sex, ASA Grade, Comorbidities, as well as the day of the week, hospital admission and surgery occurred. Subsequent multivariate analyses identified covariate- adjusted risk factors, associated with prolonged hospital stays. 30-day mortality data was assessed according to the day of the week surgery was performed.

892 patients underwent arthroplasty surgery from 01/09/2014 till the 31/08/2015. 457 patients had a total hip and 435 had a total knee replacement. 814 patients (91.3%) underwent surgery during the week, while 78 (8.7%) had surgery on a Saturday. There was no difference in the average Length of Stay (LOS) between groups (5.0, 2.6 versus 5.0, 3.4, p=0.95), and weekend surgery was not associated with a LOS greater than 4 days. The two variables found to be associated with a prolonged LOS were; increasing age (RR) 1.02 (95% CI: 1.01–1.03, p<0.001) and an ASA score of 2, (RR) 1.6 (95% CI: 1.15 − 2.20, p=0.005). There was one death in a patient who was ASA III, and who underwent surgery on a Monday.

There is no ‘weekend effect’ for elective orthopaedic surgery. Changes in consultant weekend working patterns are unlikely to have any effect on mortality or LOS for elective orthopaedic patients.

Introduction

A fractured hip is the commonest cause of injury related death in the UK. Prompt surgery has been found to improve pain scores and reduce the length of hospital stay, risk of decubitus ulcer formation and mortality rates. The hip fracture Best Practice Tariff (BPT) aims to improve these outcomes by financially compensating services, which deliver hip fracture surgery within 36 hours of admission. Ensuring that delays are reserved for patients with conditions which compromise survival, but are responsive to medical optimisation, would facilitate enhanced outcomes and help to achieve the 36-hour target.

We aimed to identify medical conditions associated with patients failing to achieve the 36-hour cut off, and evaluated whether these were justified by calculating their associated mortality risk.