Abstract
BackgroundIncreased in-hospital mortality associated with weekend admission has been reported for many acute conditions, but no study has investigated “weekend effect” for acute kidney injury requiring dialysis (AKI-D).MethodsIn this large, propensity score matched cohort of AKI-D, we examined the impact of weekend admission and in-centre nephrology services in 53,170 AKI-D admissions between 1st April 2003 and 31st March 2015 using a hospital episode statistic dataset. Propensity score matching (PSM) was performed to match 4284 weekend admissions with AKI-D with 14,788 admissions on weekdays.ResultsOf the 53,170 admissions with AKI-D in the whole dataset, 12,357 (23%) were at weekends. The unadjusted mortality for weekend admissions was significantly higher compared to admissions on weekdays (40·6% versus 39·6%, p 0·046). However, in multivariable analysis of the PSM cohort, the odds of death for weekend admissions with AKI-D was 1·01 (95%CI 0·93,1·09). Mortality was higher for weekend admissions in West Midlands (odds ratio (OR) 1·32, 95% confidence interval (CI) 1·05, 1·66) and lower in East of England (OR 0·77, 95%CI 0·59, 1·00) but was not different to weekday admissions in all other regions. In 2003–04, weekend admissions had lower odds of death (OR 0·45, 95%CI 0·21, 0·96) and in 2010–11 higher odds of death (OR 1·28, 95%CI 1·00, 1·63) but in the other ten years observed, there was no significant difference in mortality between weekday and weekend admissions. Provision of in-centre nephrology services was associated with lower odds of death at 0·57 (95%CI 0·54, 0·62).ConclusionsWeekend admissions in patients with AKI-D had no effect on mortality. Further research is warranted to elucidate the reasons for the lower mortality in hospitals with in-centre nephrology services.
Highlights
Several studies have reported an unwanted adverse effect of weekend admission on mortality in certain acute medical conditions [1]
Mortality was higher for weekend admissions in West Midlands (odds ratio (OR) 1Á32, 95% confidence interval (CI) 1Á05, 1Á66) and lower in East of England but was not different to weekday admissions in all other regions
In 2003–04, weekend admissions had lower odds of death and in 2010–11 higher odds of death but in the other ten years observed, there was no significant difference in mortality between weekday and weekend admissions
Summary
Several studies have reported an unwanted adverse effect of weekend admission on mortality in certain acute medical conditions [1]. Some studies have reported that starting dialysis on Sunday or a diagnosis of severe AKI over weekends, does not affect mortality, while others have reported increased mortality for AKI in all sizes of hospital over weekends [5, 6]. One explanation for this observation is that necessary dialysis therapy may not be initiated on a weekend because of limited physician, nurse staff or device availability. Increased in-hospital mortality associated with weekend admission has been reported for many acute conditions, but no study has investigated “weekend effect” for acute kidney injury requiring dialysis (AKI-D)
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