The Impact of Weekend Hospital Admission on the Timing of Intervention and Outcomes After Surgery for Spinal Metastases

Abstract

Many studies have found that patients admitted on the weekend have inferior outcomes compared with those admitted on a weekday, which may be due partially to decreased availability of procedures. To evaluate the impact of weekend admission on the timing of intervention and outcomes after surgery for metastatic spine disease. Data from the Nationwide Inpatient Sample (2005-2008) were retrospectively extracted. Patients were included if they had metastatic disease and underwent spine surgery; elective hospital admissions were excluded. Multivariate logistic regression analyses were conducted to calculate the odds of undergoing early surgery, in-hospital death, and the development of a complication for patients admitted on the weekend compared with those admitted on a weekday. All analyses were adjusted for differences in age, sex, comorbid disease, primary tumor histology, myelopathy, visceral metastases, and expected primary payer, as well as hospital volume, bed size, and teaching status. We evaluated 2714 admissions. Weekend admission was associated with a significantly lower adjusted odds of receiving surgery within 1 day (odds ratio, 0.66, 95% confidence interval, 0.54-0.81; P < .001) and within 2 days (odds ratio, 0.68; 95% confidence interval, 0.56-0.83; P < .001) of admission. The adjusted odds of in-hospital death and developing a postoperative complication were not significantly different for those admitted on the weekend. In this nationwide study examining patients with spinal metastases, those admitted on the weekend were significantly less likely to receive early intervention. Future studies are needed to delineate the reasons for differences in the timing of surgery.