(P 87) ACUTE PATHOLOGICAL LONG BONE FRACTURES: WEEKEND VERSUS WEEKDAY VARIATIONS AND THEIR CLINICAL IMPACT

Objective: Complete pathological fractures due to metastatic bone disease are time-sensitive emergencies in orthopedic oncology. Emerging evidence suggests the timing of hospital admission may influence outcomes. This study investigates the impact of weekday versus weekend admission on clinical outcomes in patients undergoing surgical management for acute pathological long bone fractures.

Methods: A retrospective cohort study was conducted using data from 1,642 patients who underwent surgery for metastatic long bone lesions from 1999 to 2023. Patients were categorized by admission day (weekend vs. weekday) and fracture type: complete pathologic fracture (n=883) or impending pathologic fracture (n=759). Outcomes included in-hospital complications, 30-day complications, and mortality. Logistic regression was used to adjust for age, sex, comorbidities, and fracture type.

Results: Weekend admissions (n=186 were more likely to present with complete pathologic fractures (71.0%) than weekday admissions (51.6%). In-hospital complications were higher for weekend admissions (47.3% vs. 27.1%, P< 0.001), particularly among patients with complete pathologic fractures. At 30 days, complication rates remained elevated for weekend patients (28.0% vs. 21.8%, P=0.021). One-year mortality was also higher (71.0% vs. 60.9%, P=0.001). Weekend admission was independently associated with increased odds of in-hospital complications for both complete pathologic fractures (OR 2.20, P=0.001) and impending pathologic fractures (OR 2.34, P=0.001).

Conclusion: Complete pathologic fractures were more prevalent on weekends, and these patients experienced higher complication rates regardless of admission day. These findings suggest that the observed “weekend effect” may result from differences in case mix rather than care quality. Accurate classification and adjusted analysis are essential for interpreting outcome variation by admission timing.

Table 1. Summary of Weekend vs Weekday Outcomes for Pathologic Long Bone Fractures