Weekend Hospital Admissions Have 20% Higher Mortality. (And What's With July?)

Does Weekend Hospital Admission Portend Higher Patient Mortality?

http://response.jwatch.org/t?r=3963&c=3311&l=2&ctl=22F7B:B79A8C01EB71785AC601E8D7DAB38C5F&?query=etoc_jwgenmed&jwd=000003014730&jspc=GP

[SUMMARY AND COMMENT | HOSPITAL MEDICINE, GENERAL MEDICINE]

Michele Sundar, MD and Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Pauls LA et al. J Hosp Med 2017 Sep .

        

Meta-analysis of observational studies showed nearly 20% higher mortality for weekend admissions.

Whether mortality is more likely after weekend hospital admissions than after weekday admissions is unclear. In a meta-analysis of 97 observational studies, researchers evaluated worldwide data on >51 million inpatients for in-hospital, 7-day, or 30-day mortality; admissions were categorized as weekend or weekday.

Patients admitted on weekends had significantly higher mortality at 30 days than did patients admitted on weekdays (4.3% vs. 3.6%), but substantial study heterogeneity was noted. Prespecified subgroup analyses did not demonstrate a link between excess mortality associated with weekend admissions and any hospital or patient factors that differed between weekday and weekend admissions — including hospital staffing, patients' illness severity, rates of procedure interventions, or time delay to interventions.

Comment

Despite this meta-analysis's shortcomings — varying measures of mortality (in-hospital vs. 7-day or 30-day), variable definitions of “weekend,” and substantial heterogeneity between studies — the association between weekend hospital admissions, compared with weekday hospital admissions, and mortality was impressive. Factors contributing to this “weekend effect” could not be delineated clearly in this investigation and could be related to selection bias; however, further investigation could define whether changes in processes of care or infrastructure (e.g., improving weekend procedure capabilities, raising weekend staffing levels) would lower weekend mortality effectively.

Editor Disclosures at Time of Publication

Disclosures for Daniel D. Dressler, MD, MSc, SFHM, FACP at time of publication

    Royalties McGraw-Hill

    Editorial boards Journal of Hospital Medicine (Frontline); Principles and Practice of Hospital Medicine (McGraw-Hill)

Citation(s):

    Pauls LA et al. The weekend effect in hospitalized patients: A meta-analysis. J Hosp Med 2017 Sep; 12:760. < http://response.jwatch.org/t?r=3963&c=3311&l=2&ctl=22F86:B79A8C01EB71785AC601E8D7DAB38C5F& >

    Quinn KL and Bell CM.Does the week-end justify the means? J Hosp Med 2017 Sep; 12:779. < http://response.jwatch.org/t?r=3963&c=3311&l=2&ctl=22F87:B79A8C01EB71785AC601E8D7DAB38C5F& >

Why You Are 12% More Likely To Die In A Hospital During The Month Of July

https://www.menshealth.com/health/why-hospital-death-rates-rise-in-july