Association between additional weekend rehabilitation and in-hospital mortality in patients with hip fractures

Takahisa Ogawa; Ryo Onuma; Morten T Kristensen; Toshitaka Yoshii; Takeo Fujiwara; Kiyohide Fushimi; Atsushi Okawa; Tetsuya Jinno

doi:10.1302/0301-620X.105B8.BJJ-2022-0890.R3

Association between additional weekend rehabilitation and in-hospital mortality in patients with hip fractures

Bone Joint J. 2023 Aug 1;105-B(8):872-879. doi: 10.1302/0301-620X.105B8.BJJ-2022-0890.R3.

Authors

Takahisa Ogawa¹, Ryo Onuma², Morten T Kristensen³, Toshitaka Yoshii¹, Takeo Fujiwara⁴, Kiyohide Fushimi⁵, Atsushi Okawa¹, Tetsuya Jinno^{1

6}

Affiliations

¹ Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
² Department of Rehabilitation, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
³ Department of Physical and Occupational Therapy, Department of Clinical Medicine, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark.
⁴ Global Health Promotion, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
⁵ Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
⁶ Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Tokyo, Japan.

PMID: 37525626
DOI: 10.1302/0301-620X.105B8.BJJ-2022-0890.R3

Abstract

Aims: The aim of this study was to investigate the association between additional rehabilitation at the weekend, and in-hospital mortality and complications in patients with hip fracture who underwent surgery.

Methods: A retrospective cohort study was conducted in Japan using a nationwide multicentre database from April 2010 to March 2018, including 572,181 patients who had received hip fracture surgery. Propensity score matching was performed to compare patients who received additional weekend rehabilitation at the weekend in addition to rehabilitation on weekdays after the surgery (plus-weekends group), as well as those who did not receive additional rehabilitation at the weekend but did receive weekday rehabilitation (weekdays-only group). After the propensity score matching of 259,168 cases, in-hospital mortality as the primary outcome and systemic and surgical complications as the secondary outcomes were compared between the two groups.

Results: The plus-weekends group was significantly associated with lower in-hospital mortality rates compared with the weekdays-only group (hazard ratio 0.86; 95% confidence interval 0.8 to 0.92; p < 0.001). Systemic complications such as acute coronary syndrome, heart failure, renal failure, and sepsis were significantly lower in the plus-weekends group, whereas urinary tract infection (UTI) and surgical complications such as surgical site infection and haematoma were significantly higher in the plus-weekends group.

Conclusion: Additional weekend rehabilitation was significantly associated with lower in-hospital mortality, as well as acute coronary syndrome, heart failure, renal failure, and sepsis, but was also significantly associated with a higher risk of UTI and surgical complications. This result can facilitate the effective use of the limited rehabilitation resources at the weekend and improve the clinical awareness of specific complications. To establish more robust causal associations between additional rehabilitation over the weekend and clinical outcomes, further prospective studies or randomized controlled trials with larger sample sizes are warranted.

MeSH terms

Acute Coronary Syndrome*
Hip Fractures* / surgery
Hospital Mortality
Humans
Patient Admission
Prospective Studies
Renal Insufficiency*
Retrospective Studies