Short-term mortality in hip fracture patients
Editor—We read with interest the paper by Foss and Kehlet1 investigating the effect on early mortality in hip fracture patients admitted during weekends and holidays. There are many similarities between the UK and Denmark in the management of these patients, although this study demonstrated a perhaps more standardized pattern of care than in our own unit. We therefore thought it would be useful to look at our data from the Great Western Hospital, Swindon, to see if their findings were reproducible.We looked, retrospectively, at the outcome of 342 consecutive hip fracture patients from April 1, 2005 and March 31, 2006. They were categorized according to their day of admission, as in the Danish study. The holiday periods were defined as ‘Summer’—8 weeks starting from July 9, 2005 till September 4, 2005 and ‘Christmas’—16 days between December 21, 2005 and January 3, 2006.
Results are shown in Table 1. These were analysed by 
2-test. There were no significant differences between the groups for 5 day mortality (P>0.1) or 30 day mortality (P>0.5). Admission during a holiday period or weekend appears not to affect postoperative outcome in our hospital.
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It was suggested that the increase in mortality in the study1 may be related to reduced staffing levels, particularly on the hip fracture ward. We therefore thought it would be of value to compare our nursing levels. Our hip fracture ward is a 36-bedded unit; therefore, to enable comparison we have calculated number of nurses per 14 beds (Table 2).
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Although our staffing levels are slightly lower during the normal working week there is less variation throughout the day and during the holiday periods. This may account for the similar mortality rates irrespective of time of admission in our hospital. Physiotherapy cover is also reduced over the weekend period but not over the holiday periods as in the study, this may also contribute to our findings. The introduction of an orthogeriatrician to the management of these patients has also led to improvements in survival.
Swindon, UK
*E-mail: neil.campbell{at}smnhst.swest.nhs.uk
Reference
1 Foss NB and Kehlet H. Short-term mortality in hip fracture patients admitted during weekends and holidays. Br J Anaesth 2006; 96:450–4
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