Introduction: Hip fractures are a common source of morbidity, mortality, and cost burden for elderly patients. We conducted a retrospective analysis of patients with hip fracture treated during the day or night at a rural level I academic trauma center and compared the postoperative outcomes and resource utilization for both groups.
Methods: Patients aged ≥55 years with hip fractures treated with definitive surgical fixation from April 2011 to April 2013 were included in this study. Patients who underwent surgery between 7 am and 5 pm were included in the day cohort, while those who underwent surgery between 5 pm and 7 am were included in the night cohort. A total of 441 patients met the study inclusion criteria.
Results: Comparison of the baseline characteristics of the two cohorts did not demonstrate significant variance. Although postoperative outcomes and resource utilization trends varied between the day and night cohort, only in-hospital cost was significantly higher in the day cohort (P = 0.04). Postoperative variables, including blood loss, ∆hematocrit level, length of surgery, length of stay, time to surgery, in-hospital mortality, and 30-day readmission, did not vary significantly.
Conclusion: Our study demonstrates a significantly higher cost associated with hip fracture procedures performed between 7 am and 5 pm. In addition, perioperative blood loss and length of surgery were used as markers of physician fatigue; however, no statistically significant difference among these variables was found between hip fracture intervention performed during the day versus at night.
Level of Evidence: III, retrospective observational study