Impact of weekend effect on neutropenic fever admissions associated with malignancy.

Abstract

e18658 Background: The impact of the “weekend effect” (increased mortality rate during Saturday and/or Sunday admissions) on hospitalizations for various medical emergencies has been studied with results often showing adverse patient outcomes. Febrile neutropenia in cancer patients is an acute oncological emergency with significant mortality and morbidity. Here, we attempt to explore if the day of admission impacts outcomes and healthcare utilization in cancer patients admitted for neutropenic fever. Methods: We performed a retrospective analysis using the National Inpatient Sample (NIS) database from 2019, and identified all adult admissions with cancer (hematological and solid cancers) and a concomitant primary or secondary diagnosis of Febrile Neutropenia using ICD 10 codes. These patients were divided based on the day of admission (group 1: weekday vs. group 2: weekend). The groups were compared for demographic differences, inpatient mortality, length of stay (LOS), and hospital charges (TCHG). Secondary outcomes studied were complications like sepsis, septic shock (SS), and mechanical ventilation (MV). Statistics were performed using the t-test, chi-square test, multivariate logistic analysis. Results: A total of 136,895 cancer patients were admitted with febrile neutropenia, and of those, 28,559 patients were admitted during the weekend. Both groups had similar demographics (p = > 0.05) with a mean age of 61 years, more males (52% vs. 51%), admitted in large-sized and urban teaching hospitals, and a majority had Medicare insurance (48% vs. 50%). 4.6% of weekday and 4.7 % of the weekend admissions died during hospitalization. Weekend admissions were likely to have a slightly lower mortality, although not statistically significant(aOR = 0.96,95% CI = 0.81-1.1, p = 0.72). The mean LOS was 9 days for group 1 and 8 days for group 2 (p < 0.001*). TCHG was lower for the weekend by $ 15,770 per admission (p < 0.001*). The rates and odds of having sepsis, SS, MV were similar between both groups (p > 0.05). In addition, increasing age, Hispanic race, and comorbid chronic kidney disease, diabetes, congestive heart failure, acute kidney injury, acute respiratory failure resulted in higher mortality, LOS, and all complications (p = < 0.001*) regardless of the day of the admission. Conclusions: The mortality rate and other outcomes in neutropenic fever did not statistically change between weekday and weekend admissions. Interestingly, the healthcare resource utilization (LOS and TCHG) was higher on weekdays. It is encouraging to note that the “weekend effect” has not impacted the in-hospital outcomes. However, patients admitted with febrile neutropenia have a high mortality rate and increased risk of serious complications. Therefore, utmost vigilance and close follow-up are necessary when treating these patients. *p = < 0.05 was considered significant; aOR = Adjusted Odds Ratio.