BACKGROUND: Hospital admissions over weekends have been associated with worse outcomes in different patient populations. The cause of this difference in outcomes remains unclear; however, different staffing patterns over weekends have been speculated to contribute. We evaluated outcomes in patients on maintenance dialysis therapy admitted over weekends using a national database. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: We included nonelective admissions of adult patients (≥18 years) on maintenance dialysis therapy (n = 3,278,572) identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for 2005-2009 using the Nationwide Inpatient Sample database. PREDICTOR: Weekend versus weekday admission. OUTCOMES: The primary outcome measure was all-cause in-hospital mortality. Secondary outcomes included mortality by day 3 of admission, length of hospital stay, time to death, and discharge disposition. MEASUREMENTS: We adjusted for patient and hospital characteristics, payer, year, comorbid conditions, and primary discharge diagnosis common to maintenance dialysis patients. RESULTS: There were an estimated 704,491 admissions over weekends versus 2,574,081 over weekdays. Unadjusted all-cause in-hospital mortality was 40,666 (5.8%) for weekend admissions in comparison to 138,517 (5.4%) for weekday admissions (P < 0.001). In a multivariable model, patients admitted over weekends had higher all-cause in-hospital mortality (OR, 1.06; 95% CI, 1.01-1.10) in comparison to those admitted over weekdays and higher mortality during the first 3 days of admission (OR, 1.18; 95% CI, 1.10-1.26). Patients admitted over weekends were less likely to be discharged to home, had longer hospital stays, and had shorter times to death compared with those admitted over weekdays on adjusted analysis. LIMITATIONS: Use of ICD-9-CM codes to identify patients, defining weekend as midnight Friday to midnight Sunday. CONCLUSIONS: Maintenance dialysis patients admitted over weekends have increased mortality rates and longer lengths of stay compared with those admitted over weekdays. Further studies are needed to identify the reasons for worse outcomes for weekend admissions in this patient population.
BACKGROUND: Hospital admissions over weekends have been associated with worse outcomes in different patient populations. The cause of this difference in outcomes remains unclear; however, different staffing patterns over weekends have been speculated to contribute. We evaluated outcomes in patients on maintenance dialysis therapy admitted over weekends using a national database. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: We included nonelective admissions of adult patients (≥18 years) on maintenance dialysis therapy (n = 3,278,572) identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for 2005-2009 using the Nationwide Inpatient Sample database. PREDICTOR: Weekend versus weekday admission. OUTCOMES: The primary outcome measure was all-cause in-hospital mortality. Secondary outcomes included mortality by day 3 of admission, length of hospital stay, time to death, and discharge disposition. MEASUREMENTS: We adjusted for patient and hospital characteristics, payer, year, comorbid conditions, and primary discharge diagnosis common to maintenance dialysis patients. RESULTS: There were an estimated 704,491 admissions over weekends versus 2,574,081 over weekdays. Unadjusted all-cause in-hospital mortality was 40,666 (5.8%) for weekend admissions in comparison to 138,517 (5.4%) for weekday admissions (P < 0.001). In a multivariable model, patients admitted over weekends had higher all-cause in-hospital mortality (OR, 1.06; 95% CI, 1.01-1.10) in comparison to those admitted over weekdays and higher mortality during the first 3 days of admission (OR, 1.18; 95% CI, 1.10-1.26). Patients admitted over weekends were less likely to be discharged to home, had longer hospital stays, and had shorter times to death compared with those admitted over weekdays on adjusted analysis. LIMITATIONS: Use of ICD-9-CM codes to identify patients, defining weekend as midnight Friday to midnight Sunday. CONCLUSIONS: Maintenance dialysis patients admitted over weekends have increased mortality rates and longer lengths of stay compared with those admitted over weekdays. Further studies are needed to identify the reasons for worse outcomes for weekend admissions in this patient population.
Authors: Tamara B Horwich; Adrian F Hernandez; Li Liang; Nancy M Albert; Kenneth A Labresh; Clyde W Yancy; Gregg C Fonarow Journal: Am Heart J Date: 2009-08-04 Impact factor: 4.749
Authors: Hyungjin Myra Kim; Daniel Eisenberg; Dara Ganoczy; Katherine Hoggatt; Karen L Austin; Karen Downing; John F McCarthy; Mark Ilgen; Marcia Valenstein Journal: Health Serv Res Date: 2010-10 Impact factor: 3.402
Authors: David J Magid; Yongfei Wang; Jeph Herrin; Robert L McNamara; Elizabeth H Bradley; Jeptha P Curtis; Charles V Pollack; William J French; Martha E Blaney; Harlan M Krumholz Journal: JAMA Date: 2005-08-17 Impact factor: 56.272
Authors: Thomas S Valley; Brahmajee K Nallamothu; Michael Heung; Theodore J Iwashyna; Colin R Cooke Journal: Crit Care Med Date: 2018-02 Impact factor: 7.598
Authors: Shirley L Shih; Marisa Flavin; Richard Goldstein; Chloe Slocum; Colleen M Ryan; Aneesh Singhal; Jason Frankel; Ross Zafonte; Jeffrey C Schneider Journal: Am J Phys Med Rehabil Date: 2020-01 Impact factor: 3.412
Authors: Sai Zhang; Hal Morgenstern; Patrick Albertus; Brahmajee K Nallamothu; Kevin He; Rajiv Saran Journal: PLoS One Date: 2019-08-15 Impact factor: 3.240
Authors: Debra T Choi; Amy Puenpatom; Xian Yu; Kevin F Erickson; Fasiha Kanwal; Hashem B El-Serag; Jennifer R Kramer Journal: Antiviral Res Date: 2019-12-17 Impact factor: 10.103