Abstract
BackgroundTo establish which major disorders are susceptible to increased mortality following acute admissions on weekends, compared with week days, and how this may be explained.MethodsCohorts based on national administrative inpatient and mortality data for 14,168,443 hospitalised patients in England and 913,068 in Wales who were admitted for 66 disorders that were associated with at least 200 deaths within 30 days of acute admission. The main outcome measure was the weekend mortality effect (defined as the conventional mortality odds ratio for admissions on weekends compared with week days).ResultsThere were large, statistically significant weekend mortality effects (> 20%) in England for 22 of the 66 conditions and in both countries for 14. These 14 were 4 of 13 cancers (oesophageal, colorectal, lung and lymphomas); 4 of 13 circulatory disorders (angina, abdominal aortic aneurysm, peripheral vascular disease and arterial embolism & thrombosis); one of 8 respiratory disorders (pleural effusion); 2 of 12 gastrointestinal disorders (alcoholic and other liver disease); 2 of 3 ageing-related disorders (Alzheimer’s disease and dementia); none of 7 trauma conditions; and one of 10 other disorders (acute renal failure). Across the disorders, 64% of the variation in weekend mortality effects in England and Wales was explained by reductions in admission rates at weekends and the medical disease category.ConclusionsThe effect of weekend admission on 30 day mortality is seen mainly for cancers, some circulatory disorders, liver disease and a few other conditions which are mainly ageing- or cancer-related. Most of the increased mortality is associated with reduced admission rates at weekends and the medical disease category.
Highlights
To establish which major disorders are susceptible to increased mortality following acute admissions on weekends, compared with week days, and how this may be explained
A so-called ‘weekend mortality effect’ of increased mortality for hospital admissions on weekends - compared with normal week days - has been the subject of increased interest and controversy in recent years. [1,2,3] explanations for the variable evidence reported from numerous studies, often based on differing settings, methodologies and medical conditions, is still lacking
Comparison of patients admitted on week days and weekends For each of the 66 study disorders, Table 1 shows the numbers of admissions, population admission rates, median lengths of stay, mean ages and numbers of comorbidities for patients admitted on weekends, compared with week days, in England and in Wales
Summary
To establish which major disorders are susceptible to increased mortality following acute admissions on weekends, compared with week days, and how this may be explained. Further objectives were to test if weekend mortality effects could be explained by factors including reductions in admission rates at weekends, the type of medical condition, mortality risk soon after admission, changes in the source of admission and patient socio-demographics. The rationale behind these explanatory factors includes, firstly, greatly reduced admissions and increases in the proportion of admissions through emergency departments at weekends may reflect higher condition severity thresholds for admission at weekends. The main a priori hypothesis was that weekend effects would be largest for specific types of medical condition that have greatly reduced admission rates at weekends or high mortality during acute phases
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