title: Effect of Time of Operation on Hip Fracture Outcomes: A Retrospective Analysis.
abstract: BACKGROUND
  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, [INCREMENT]hematocrit level, length of surgery, length of stay, time to surgery, in-hospital mortality, and 30-day readmission, did not vary significantly.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  III, retrospective observational study.
authors.affiliation: From the Division of Orthopaedics and Rehabilitation (Dr. Barinaga, Mr. Wright, Dr. Cagle, and Dr. Anoushiravani) and the Department of Surgery (Mr. Sayeed and Dr. Chambers), Southern Illinois University School of Medicine, Springfield, IL, and the Department of Orthopaedics and Sports Medicine, Detroit Medical Center, Detroit, MI (Dr. El-Othmani and Dr. Saleh).
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Barinaga
authors.forename: Erik
authors.initials: E
authors.lastname: Wright
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Cagle
authors.forename: Afshin A
authors.initials: AA
authors.lastname: Anoushiravani
authors.forename: Zain
authors.initials: Z
authors.lastname: Sayeed
authors.forename: Monique C
authors.initials: MC
authors.lastname: Chambers
authors.forename: Mouhanad M
authors.initials: MM
authors.lastname: El-Othmani
authors.forename: Khaled J
authors.initials: KJ
authors.lastname: Saleh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors