Previous work has suggested that healthcare interventions on weekends may be associated with increased mortality, but findings have been inconsistent. In this matched cohort study, 318,202 adult patients admitted to acute care hospitals who underwent a non-cardiac, non-obstetric surgical procedures were studied to compare all-cause mortality within 30 days of hospital admission in patients who were admitted on a weekend versus those who were admitted on a weekday. The weekend was defined as Saturday or Sunday, and weekdays included Tuesday to Thursday. Only patients who had a surgery during the same weekend or week of admission were eligible. Patients with weekend admissions were classified by day of surgery and matched directly (1:1) to patients with a weekday admission and surgery. Patients admitted on weekends were more likely to be male, to be admitted to a non-teaching hospital, and to have a longer interval between hospital admission and surgery (all p<0.001). Among weekend admissions, patients who had their surgery performed on the same weekend were more likely to be younger, be female, be admitted to a hospital urgently, live in a lower income neighborhood, have a lower resource utilization band score (high scores are associated with higher overall morbidity and resource use), and have a higher Charlson Comorbidity Index. After adjusting for confounding factors, researchers found that there was an increased odds of 30-day all-cause mortality for patients admitted on weekends compared to those admitted on weekdays (2.6% vs. 2.5%, OR 1.05, 95% CI 1.00 to 1.11, p=0.03). When admissions were classified by the day of surgery (weekend versus weekday), there was no difference in the odds of 30-day all-cause mortality for patients who were had surgery on the weekend compared with patients who had surgery on a subsequent weekday (2.3% vs. 3.0% respectively, OR 1.04, 95% CI 0.97 to 1.11, p=0.3). Elective admissions on weekends had an increased risk of death when surgery was performed on the weekend (OR 3.30, 95% CI 1.98 to 5.49, p<0.001) or on a subsequent weekday (OR 2.70, 95% CI 1.81 to 4.03, p<0.001) when compared to elective admissions on weekdays. An important limitation of the study is the lack of data regarding the reason for admission. Overall, this study suggests that patients who are admitted on weekends and subsequently undergo surgery are at an increased risk of 30-day all-cause mortality, although there is significant heterogeneity in outcomes depending on the urgency of the surgery and when the surgery was performed.
Click to read the study in PLOS Medicine
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