Matthew C Langston1, Keshab Subedi2, Carly Fabrizio3, Neil J Wimmer3, Usman I Choudhry4, Luis E Urrutia5. 1. Department of Medicine, ChristianaCare Health System, Newark, DE, United States. Electronic address: Matthew.Langston@ChristianaCare.org. 2. The Value Institute, ChristianaCare Health System, Newark, DE, United States. 3. Department of Medicine, ChristianaCare Health System, Newark, DE, United States; Division of Cardiovascular Disease, ChristianaCare Health System, Newark, DE, United States. 4. Department of Medicine, ChristianaCare Health System, Newark, DE, United States; Division of Cardiovascular Disease, ChristianaCare Health System, Newark, DE, United States; Division of Advanced Heart Failure, ChristianaCare Health System, Newark, DE, United States; Critical Care Medicine, ChristianaCare Health System, Newark, DE, United States. 5. Department of Medicine, ChristianaCare Health System, Newark, DE, United States; Division of Cardiovascular Disease, ChristianaCare Health System, Newark, DE, United States; Critical Care Medicine, ChristianaCare Health System, Newark, DE, United States.
Abstract
BACKGROUND: Recent interest in the 'weekend effect' has been expanded to cardiovascular intensive care units, yet the impact of off-hours admission on mortality and cardiovascular ICU (CICU) length of stay remains uncertain. OBJECTIVES: We examine the association between CICU admission day and time with mortality. Additionally, length-of-stay was also evaluated in relation to admission time. METHODS: A single-center, retrospective cohort study was conducted including 10,638 adult patients admitted to a CICU in a tertiary-care academic medical center from July 1, 2012 to June 30, 2019. ICU mortality and length-of-stay were assessed by admission day and time adjusting for comorbid conditions and other clinical variables. We used logistic regression models to evaluate the factors associated with mortality and a generalized linear model (GLM) with log link function and gamma distribution was used to evaluate the factors associated with ICU length of stay. RESULTS: Compared to weekday-day admissions, we observed an increased mortality for weekend-day for all admissions (6.5 vs 9.6%, Adjusted OR: 1.32 (1.03-1.72)), and for medical CICU admissions (7.6 vs 9.9%, Adjusted OR: 1.35 (1.02-1.79)). Additionally, compared to weekday-day, weekday-night admission was associated with 7% longer ICU length of stay in surgical ICU patients, 7% shorter length of stay in medical ICU patients. CONCLUSION: Admission to this open-model CICU during weekend hours (Saturday 08:00-Sunday 17:59) versus nights or weekdays is associated with increased mortality. ICU staffing care models should not significantly change based on the day of the week.
BACKGROUND: Recent interest in the 'weekend effect' has been expanded to cardiovascular intensive care units, yet the impact of off-hours admission on mortality and cardiovascular ICU (CICU) length of stay remains uncertain. OBJECTIVES: We examine the association between CICU admission day and time with mortality. Additionally, length-of-stay was also evaluated in relation to admission time. METHODS: A single-center, retrospective cohort study was conducted including 10,638 adult patients admitted to a CICU in a tertiary-care academic medical center from July 1, 2012 to June 30, 2019. ICU mortality and length-of-stay were assessed by admission day and time adjusting for comorbid conditions and other clinical variables. We used logistic regression models to evaluate the factors associated with mortality and a generalized linear model (GLM) with log link function and gamma distribution was used to evaluate the factors associated with ICU length of stay. RESULTS: Compared to weekday-day admissions, we observed an increased mortality for weekend-day for all admissions (6.5 vs 9.6%, Adjusted OR: 1.32 (1.03-1.72)), and for medical CICU admissions (7.6 vs 9.9%, Adjusted OR: 1.35 (1.02-1.79)). Additionally, compared to weekday-day, weekday-night admission was associated with 7% longer ICU length of stay in surgical ICU patients, 7% shorter length of stay in medical ICU patients. CONCLUSION: Admission to this open-model CICU during weekend hours (Saturday 08:00-Sunday 17:59) versus nights or weekdays is associated with increased mortality. ICU staffing care models should not significantly change based on the day of the week.
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