PDF herunterladen
The Journal of Hip Surgery 2023; 07(03): 133-140
DOI: 10.1055/s-0043-1771247
Original Article

Weekend versus Weekday Procedures for Total Hip Arthroplasties

Shawn Okpara
1   Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
,
Abdullah Ghali
1   Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
,
David Momtaz
2   Department of Neurosurgery, UT Health San Antonio, San Antonio, Texas
,
Tucker Cushing
1   Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
,
Travis Kotzur
2   Department of Neurosurgery, UT Health San Antonio, San Antonio, Texas
,
Albert Han 
1   Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
,
Parker Mitchell
1   Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
,
Adam Pearl 
3   Department of Orthopaedics, John D. Dingell VA Medical Center Detroit, Detroit, Michigan
,
Varun Bora
2   Department of Neurosurgery, UT Health San Antonio, San Antonio, Texas
,
Ali Seifi
2   Department of Neurosurgery, UT Health San Antonio, San Antonio, Texas
,
Khaled J. Saleh
3   Department of Orthopaedics, John D. Dingell VA Medical Center Detroit, Detroit, Michigan
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

Abstract

The “weekend effect” is the phenomenon that claims increased adverse outcomes for weekend procedures compared to weekday procedures. However, there is significant controversy regarding such disparities in elective orthopaedic surgeries. With the increasing demand for hip arthroplasty projected over the next 20 years, it is important to investigate a possible “weekend effect” to optimize outcomes and cost-effectiveness. In this study, we investigate the association between weekday versus weekend total hip arthroplasty (THA) and postoperative outcomes using the Healthcare Cost and Utilization Project (HCUP) data. We performed a retrospective analysis of the HCUP database between 2002 and 2020 comparing THAs done Monday to Friday versus THAs done Saturday to Sunday. Data collected included patient demographics and comorbidities, hospital length of stay, admission to procedure time, discharge disposition, mortality, and outcome data through postoperative day 30. THAs performed on weekends were associated with significantly increased length of stay, total charges, admission-to-procedure time, and mortality compared to those on weekdays. Our findings suggest that the development of nationwide programs to standardize care and weekend case management for THA patients can potentially help reduce health care costs, improve operative outcomes, and reduce the discrepancy between weekend and weekday surgeries.

Keywords

total hip arthroplasty - weekend effect - weekday


Publikationsverlauf

Eingereicht: 01. März 2023

Angenommen: 07. Juni 2023

Artikel online veröffentlicht:
24. Juli 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Best MJ, McFarland EG, Anderson GF, Srikumaran U. The likely economic impact of fewer elective surgical procedures on US hospitals during the COVID-19 pandemic. Surgery 2020; 168 (05) 962-967
    CrossrefPubMedSuche in Google Scholar
  • 2 Best MJ, Aziz KT, McFarland EG, Anderson GF, Srikumaran U. Economic implications of decreased elective orthopaedic and musculoskeletal surgery volume during the coronavirus disease 2019 pandemic. Int Orthop 2020; 44 (11) 2221-2228
    CrossrefPubMedSuche in Google Scholar
  • 3 Maradit Kremers H, Larson DR, Crowson CS. et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 2015; 97 (17) 1386-1397
    CrossrefPubMedSuche in Google Scholar
  • 4 American Joint Replacement Registry (AJRR): 2022 Annual Report. American Academy of Orthopaedic Surgeons (AAOS); 2022
    Suche in Google Scholar
  • 5 Price C, Savitz L. Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection. Houston, TX: Agency for Healthcare Research and Quality;; 2012
    Suche in Google Scholar
  • 6 Wolford ML, Palso K, Bercovitz A. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000-2010. NCHS Data Brief 2015; (186) 1-8
    PubMedSuche in Google Scholar
  • 7 Singh JA, Yu S, Chen L, Cleveland JD. Rates of total joint replacement in the United States: future projections to 2020-2040 using the National Inpatient Sample. J Rheumatol 2019; 46 (09) 1134-1140
    CrossrefPubMedSuche in Google Scholar
  • 8 Mathew A, Fyyaz SA, Carter PR, Potluri R. The enigma of the weekend effect. J Thorac Dis 2018; 10 (01) 102-105
    CrossrefPubMedSuche in Google Scholar
  • 9 Freemantle N, Ray D, McNulty D. et al. Increased mortality associated with weekend hospital admission: a case for expanded seven day services?. BMJ 2015; 351: h4596
    CrossrefPubMedSuche in Google Scholar
  • 10 Smith SA, Yamamoto JM, Roberts DJ. et al. Weekend surgical care and postoperative mortality: a systematic review and meta-analysis of cohort studies. Med Care 2018; 56 (02) 121-129
    CrossrefPubMedSuche in Google Scholar
  • 11 Zapf MAC, Kothari AN, Markossian T. et al. The “weekend effect” in urgent general operative procedures. Surgery 2015; 158 (02) 508-514
    CrossrefPubMedSuche in Google Scholar
  • 12 Aylin P, Alexandrescu R, Jen MH, Mayer EK, Bottle A. Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics. BMJ 2013; 346: f2424
    CrossrefPubMedSuche in Google Scholar
  • 13 Galyfos G, Sigala F, Bazigos G, Filis K. Weekend effect among patients undergoing elective vascular surgery. J Vasc Surg 2019; 70 (06) 2038-2045
    CrossrefPubMedSuche in Google Scholar
  • 14 McIsaac DI, Bryson GL, van Walraven C. Elective, major noncardiac surgery on the weekend: a population-based cohort study of 30-day mortality. Med Care 2014; 52 (06) 557-564
    CrossrefPubMedSuche in Google Scholar
  • 15 Dubois L, Vogt K, Vinden C. et al; Surgical Investigators Group at ICES Western. Association between day of the week of elective surgery and postoperative mortality. CMAJ 2017; 189 (08) E303-E309
    CrossrefPubMedSuche in Google Scholar
  • 16 Al-Ashqar M, Aqil A, Phillips H. et al. There is no ‘weekend effect’ in elective orthopaedic surgery. Ann R Coll Surg Engl 2018; 100 (07) 551-555
    CrossrefPubMedSuche in Google Scholar
  • 17 Nijland LMG, Karres J, Simons AE, Ultee JM, Kerkhoffs GMMJ, Vrouenraets BC. The weekend effect for hip fracture surgery. Injury 2017; 48 (07) 1536-1541
    CrossrefPubMedSuche in Google Scholar
  • 18 Higgins M, Nightingale J, Sehat K. Is there a ‘weekend effect’ in elective lower limb arthroplasty?. Ann R Coll Surg Engl 2021; 103 (02) 110-113
    CrossrefPubMedSuche in Google Scholar
  • 19 Hunt LP, Blom A, Wilkinson JM. An analysis of 30-day mortality after weekend versus weekday elective joint arthroplasty in England and Wales: a cohort study using the National Joint Registry Dataset. Bone Joint J 2017; 99-B (12) 1618-1628
    CrossrefPubMedSuche in Google Scholar
  • 20 Mohammed MA, Sidhu KS, Rudge G, Stevens AJ. Weekend admission to hospital has a higher risk of death in the elective setting than in the emergency setting: a retrospective database study of national health service hospitals in England. BMC Health Serv Res 2012; 12 (01) 87
    CrossrefPubMedSuche in Google Scholar
  • 21 Boutera A, Dybvik E, Hallan G, Gjertsen JE. Is there a weekend effect after hip fracture surgery? A study of 74,410 hip fractures reported to the Norwegian Hip Fracture Register. Acta Orthop 2020; 91 (01) 63-68
    CrossrefPubMedSuche in Google Scholar
  • 22 Bhattacharyya T, Iorio R, Healy WL. Rate of and risk factors for acute inpatient mortality after orthopaedic surgery. J Bone Joint Surg Am 2002; 84 (04) 562-572
    CrossrefPubMedSuche in Google Scholar
  • 23 Zikos D, Shrestha A, Colotti T, Fegaras L. A Supervised pattern analysis of the length of stay for hip replacement admissions. Healthcare (Basel) 2019; 7 (02) 58
    CrossrefPubMedSuche in Google Scholar
  • 24 Briggs TW, Perera J. Improving the quality of orthopaedic care within the National Health Service in England: “Getting it Right the First Time.”. Br Orthop Assoc News 2011;50
    PubMed
  • 25 Otero JE, Gholson JJ, Pugely AJ, Gao Y, Bedard NA, Callaghan JJ. Length of hospitalization after joint arthroplasty: does early discharge affect complications and readmission rates?. J Arthroplasty 2016; 31 (12) 2714-2725
    CrossrefPubMedSuche in Google Scholar
  • 26 Gan HW, Wong DJN, Dean BJF, Hall AS. Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the “NHS Services, Seven Days a Week” project 2013-2016. BMC Health Serv Res 2017; 17 (01) 552
    CrossrefPubMedSuche in Google Scholar
  • 27 Newman JM, Szubski CR, Barsoum WK, Higuera CA, Molloy RM, Murray TG. Day of surgery affects length of stay and charges in primary total hip and knee arthroplasty. J Arthroplasty 2017; 32 (01) 11-15
    CrossrefPubMedSuche in Google Scholar
  • 28 National Health Expenditure Data. CMS.Gov.. Accessed July 10, 2023, at: www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData
    PubMed
  • 29 Salas-Vega S, Chakravarthy VB, Winkelman RD. et al. Late-week surgery and discharge to specialty care associated with higher costs and longer lengths of stay after elective lumbar laminectomy. J Neurosurg Spine 2021; 34 (06) 1-7
    CrossrefPubMedSuche in Google Scholar
  • 30 Osborne JD, Bush CJ, Koueiter DM, Michael Wiater J. Length of stay in total shoulder arthroplasty: does day of surgery matter?. J Shoulder Elb Arthroplast 2019; 3: 2471549219832151
    PubMedSuche in Google Scholar
  • 31 Keswani A, Beck C, Meier KM, Fields A, Bronson MJ, Moucha CS. Day of surgery and surgical start time affect hospital length of stay after total hip arthroplasty. J Arthroplasty 2016; 31 (11) 2426-2431
    CrossrefPubMedSuche in Google Scholar
  • 32 Lilly R, Siljander M, Koueiter DM, Verner J. Day of surgery affects length of hospitalization for patients undergoing total joint arthroplasty discharged to extended care facilities. Orthopedics 2018; 41 (02) 82-86
    CrossrefPubMedSuche in Google Scholar
  • 33 Muppavarapu RC, Chaurasia AR, Schwarzkopf R, Matzkin EG, Cassidy CC, Smith EL. Total joint arthroplasty surgery: does day of surgery matter?. J Arthroplasty 2014; 29 (10) 1943-1945
    CrossrefPubMedSuche in Google Scholar
  • 34 Martino J, Peterson B, Thompson S, Cook JL, Aggarwal A. Day of week and surgery location effects on stay length and cost for total joint arthroplasty: academic versus orthopaedic-specific hospital. J Knee Surg 2018; 31 (09) 815-821
    Thieme ConnectPubMedSuche in Google Scholar
  • 35 Bolnick HJ. Designing a world-class health care system. N Am Actuar J 2003; 7 (02) 1-23
    CrossrefPubMedSuche in Google Scholar
  • 36 Vos T, Lim SS, Abbafati C. et al; GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396 (10258): 1204-1222
    Suche in Google Scholar