Weekend open reduction and internal fixation of distal radius fractures associated with higher complication and readmission rates: a nationwide analysis of two hundred and sixty six thousand, three hundred and seventy eight patients.

PURPOSE: The "weekend effect" suggests that patients operated upon weekends may experience worse outcomes. This study evaluates whether the day of the week impacts outcomes and costs of open reduction and internal fixation (ORIF) surgery for distal radius fractures (DRF) in a large nationwide cohort.

METHODS

A retrospective cohort study was conducted using data from the PearlDiver Mariner M165Ortho dataset, which covers a U.S. population of over 165 million from 2010 to 2022. Patients who underwent ORIF surgery for DRF were categorized into weekday and weekend groups. Demographics, comorbidities, and adverse outcomes within six months and two years post-surgery were analyzed.

RESULTS

Of the 266,378 patients who underwent ORIF for DRF with at least two years of follow-up, 252,866 had surgery on weekdays, while 13,512 had surgery on weekends. The weekend group exhibited higher rates of surgical site infection (SSI) (OR: 2.29[95%CI = 1.51-3.48], P < 0.001), hardware failure (OR: 5.80[95%CI = 1.13-31.25], P = 0.042), and readmissions (OR: 2.48[95%CI = 2.12-2.91], P < 0.001) at six months post-operatively. At two years post-operatively, the weekend group continued to show higher rates of complications including SSI (OR: 1.66[95%CI = 1.16-2.36], P = 0.005), malunion (OR: 1.44[95% CI = 1.06-1.93], P = 0.017), and readmission (OR: 1.55[95%CI = 1.39-1.74], P < 0.001). Mean total surgical costs were 16.4% higher in the weekend group ($2,394.85 vs. $2,057.88, P < 0.001).

CONCLUSIONS

This nationwide analysis demonstrates a significant "weekend effect" in ORIF surgery for DRF, with weekend surgeries associated with substantially higher complication rates, readmissions, and costs. These findings highlight the need for systemic changes to ensure consistent quality of care throughout the week, including improved weekend staffing, standardized protocols, and resource allocation.

LEVEL OF EVIDENCE: III (Retrospective cohort).