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Abstract

Introduction: Previous studies have implicated that patients with emergent medical conditions like acute myocardial infarction, subarachnoid hemorrhage and pulmonary embolism have worse outcome if admitted over the weekend. However, outcomes of patients admitted with cardiac arrest over the weekend are not well established. Hypothesis: Cardiac arrest patients have higher mortality rate when admitted over the weekend as compared to weekdays. Methods: We performed a retrospective analysis using the Nationwide Inpatient Sample database from 2000 to 2009. All discharges with diagnosis of cardiac arrest were identified using - ICD-9-CM codes of 427.5. Weekend admissions were defined as admissions between midnight on Friday through midnight on Sunday. Primary outcome measured was all-cause in-hospital mortality. Multivariate logistic regression was used to estimate odds ratios. The model was adjusted for patient demographics, hospital characteristics, severity of acute illness and Charlson’s co-morbidity index. Results: Of the 1,293,071 estimated discharges with cardiac arrest, 24.3% of patients were admitted on a weekend. Patients admitted on a weekend had significantly increased all-cause in-hospital mortality (67.7% vs. 65%; p<0.001); which persisted after adjustment for various factors as described above (Odds ratio 1.19; 95% confidence interval 1.12-1.26). Median time to death was 2 days (interquartile range [IQR] 1-6 days) and 3 days (IQR 1-8 days) for weekend and weekday admissions, respectively. Hospital length of stay in survivors was similar. Conclusions: In patients with cardiac arrest, all-cause risk-adjusted in-hospital mortality is significantly higher for weekend admissions compared to weekdays. Further studies are warranted to investigate the underlying causes responsible for this difference.