Limited impact of weekend admissions on hip fracture outcomes in elderly patients: A study from a Japanese nationwide medical claims database

Aim

The effectiveness of early surgery in preventing complications in elderly Japanese hip fracture patients and the impact of weekend hospitalization need further investigation. The purpose of this study was to determine whether weekend hospitalization affects the incidence of various sequelae and death during hospitalization in elderly hip fracture patients using a comprehensive Japanese hip fracture case database.

Methods

We retrospectively analyzed the Japanese National Administrative DPC (Diagnosis Procedure Combination) database from April 2016 to March 2022. During this period, approximately 1100 DPC-affiliated hospitals consistently provided medical records with consent for the study. The study focused on weekend hospitalizations and investigated the associations with postoperative pneumonia, pulmonary embolism, myocardial infarction, urinary tract infection, acute renal dysfunction, dementia, and in-hospital mortality after propensity score matching. Owing to the large population size of the study, significance levels were strictly enforced, and a P-value < 0.001 was considered statistically significant.

Results

After performing propensity score matching based on age, sex, and comorbidities, 111 035 patient pairs were identified, comparing those admitted on weekends versus weekdays. The analysis showed no heightened risk of sequelae for those admitted during the weekend compared with weekdays. Additionally, there was a slight trend toward higher mortality risk during weekend hospital stays; however, the increase was insignificant, with a hazard ratio of 1.071 (95% confidence interval: 1.005–1.140, P = 0.03).

Conclusion

The results of this study indicate that weekend hospitalization for elderly patients with hip fractures is not definitively associated with an increase in various sequelae or in-hospital mortality and that the importance of early surgery for elderly patients with hip fractures may be recognized and promoted in Japan. Geriatr Gerontol Int 2025; 25: 75–81.