Effect Of Weekend Admission Research Articles

Effect of weekend admission on mortality risk in patients with sepsis and septic shock: A systematic review and meta-analysis.

There is an ongoing debate if weekend admissions of critically ill patients are associated with higher mortality rates. The current review aimed to specifically assess this effect in sepsis and septic shock patients by comparing mortality rates with weekend versus weekday admissions. PubMed, CENTRAL, Scopus, Web of Science, and Embase were searched up to 20th February 2023 with an additional search of Google Scholar for gray literature. Nine studies were eligible. Meta-analysis of all nine studies with data from 1,134,417 patients demonstrated that sepsis or septic shock patients admitted on weekends don't have higher mortality as compared to those admitted on weekdays (OR: 1.04; 95% CI: 1.00, 1.09; p = 0.05; I2 = 93%). On subgroup analysis based on sample size (>2000 or <2000 patients) and timing of mortality, we noted no difference in the significance of the results. However, there was a small significant increased risk of mortality with weekend admission noted in studies on the Asian population and including septic shock patients. Weekend admission does not have an adverse impact on mortality rates of sepsis and septic shock patients. Results must be interpreted with caution owing to high interstudy heterogeneity and variation in confounders adjusted by individual studies.

Associations of weekend versus weekday admission on transesophageal echocardiogram utilization and outcomes in infective endocarditis hospitalizations

Abstract Background Infective endocarditis (IE) occurs worldwide and is associated with high mortality. Diagnosis and management of IE requires timely transesophageal echocardiography (TEE), which may not be consistently available in many institutions, especially on weekends. Hence, we wanted to evaluate the effect of weekend admission on IE in-hospital outcomes. Purpose To evaluate the differences in mortality and TEE utilization between weekend and weekday admissions in IE hospitalizations. Methods In this retrospective cohort study, we queried the 2017 and 2018 National Inpatient Sample (NIS) database to identify primary diagnosis of IE using appropriate ICD-10 CM codes. The variable for weekend admission which is available in the dataset was used to categorize hospitalizations into weekend and weekday admission groups. TEE procedures were identified using appropriate ICD-10 PCS codes. We used the Chi-square test to evaluate the difference between binary variables, and Student's t- test for differences between continuous variables. Multivariate logistic regression analysis was used to adjust for potential hospital and patient level confounders (age, sex, race, diabetes, hypertension, obesity, acute renal failure, diabetes, and Elixhauser comorbidity index score). Stata SE 16.1 was used to perform all statistical analyses. Results Among the identified 27,735 weighted adult IE hospitalizations, 6,145 (22.1%) were admitted on weekends. Weekend IE admissions were similar to weekday in all measured aspects except for elective admissions (Table 1). There were more elective admissions on the weekday compared to the weekend (11.3% for weekday vs. 4.9% for weekend; p&amp;lt;0.01). The mean age was 51 years for both hospitalizations. There were more TEEs in the first 24 hrs in weekday compared to weekend hospitalizations (7.8% vs. 3.4%; p&amp;lt;0.01). After adjusting for potential patient and hospital level confounders, there was no difference in mortality [Adjusted Odds ratio (aOR): 0.91 (0.62–1.33); p=0.63)], valve replacement procedures [aOR: 0.91 (0.62–1.33); p=0.63)] or incidence of atrioventricular (AV) blocks [aOR: 0.91 (0.62–1.33); p=0.63)] comparing weekend versus weekday IE hospitalizations. Additionally, we did not observe any mean difference in length of stay and total hospitalization charges between weekend and weekday hospitalizations. Conclusion In patients with IE, weekend admissions did not have a clinically significant difference in mortality, length of stay, incidence of AV blocks or valve replacements compared to weekday admissions. TEEs were performed equally in IE hospitalizations regardless of day of admission; however, early TEEs (within 24 hours of admission) were more commonly associated with weekday admission. Despite this, there was no clinically significant difference in the mortality between early TEEs and TEEs done after 24 hours of admission. Funding Acknowledgement Type of funding sources: None.

Hip fracture patients admitted to hospital on weekends are not at increased risk of 30-day mortality as compared with weekdays

BackgroundHip fractures remain a major health concern owing to the increasing elderly population and their association with significant morbidity and mortality. The effects of weekend admission on mortality have been studied since the late 1970s. Despite most studies showing that mortality rates are higher for patients admitted on a weekend, the characteristics of the admitted patients have remained unclear. We aim to investigate this ‘weekend effect’ at our hospital in patients presenting with a hip fracture.MethodsPatients undergoing acute hip fracture surgery were identified from the local National Hip Fracture Database. Patient demographics, fracture type, co-morbidities and admission blood parameters were examined. The outcome analysed was 30-day mortality. The data were analysed with regard to day of admission, i.e. weekday (Monday to Friday) or weekend (Saturday and Sunday).ResultsA total of 894 patients were included. Results demonstrated that 30-day mortality was similar on the weekend compared with the weekday (6.96% versus 10.39%, OR 0.65, 95% CI 0.36–1.14, p = 0.128) for patients who sustained an acute hip fracture. The total number of deaths within 30 days was 85 (69 weekday versus 16 weekend). This remained non-significant after adjusting for several variables: age and sex only (OR = 0.65, 95% CI 0.37–1.16, p = 0.146), age, sex, and care variables (OR = 0.59, 95% CI 0.33–1.06, p = 0.080), age, sex, and blood test results (OR = 0.62, 95% CI 0.35–1.12, p = 0.111), and all covariates (OR = 0.69, 95% CI 0.29–1.62, p = 0.392). In the fully adjusted model, the following variables were independent predictors of mortality: sex (male) (OR = 1.93, 95% CI 1.11–3.35, p = 0.019) and ASA > 2 (OR = 2.6, 95% CI 1.11–6.11, p = 0.028) and age (1.08, 95% CI 1.04–1.13, p < 0.001).ConclusionThe evidence for a ‘weekend effect’ in patients with a hip fracture is absent in this study. However, we have shown other factors that are associated with increased mortality such as increased age, male sex and higher ASA grade.Level of evidenceLevel 3.

Effect of weekend admission on geriatric hip fractures.

BACKGROUNDThe care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented. With respect to hip fractures, however, there is no consensus about the presence of a so-called “weekend effect”. This study sought to determine the effects, if any, of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital. It was hypothesized that geriatric hip fracture patients admitted on a weekend would have longer times to medical optimization and surgery and increased complication and mortality rates relative to those admitted on a weekday.AIMTo determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay.METHODSA retrospective chart review of operative geriatric hip fractures treated from 2015-2017 at a large tertiary care hospital was conducted. Two cohorts were compared: patients who arrived at the emergency department on a weekend, and those that arrived at the emergency department on a weekday. Primary outcome measures included mortality rate, complication rate, transfusion rate, and length of stay. Secondary outcome measures included time from emergency department arrival to surgery, time from emergency department arrival to medical optimization, and time from medical optimization to surgery.RESULTSThere were no statistically significant differences in length of stay (P = 0.2734), transfusion rate (P = 0.9325), or mortality rate (P = 0.3460) between the weekend and weekday cohorts. Complication rate was higher in patients who presented on a weekend compared to patients who presented on a weekday (13.3% vs 8.3%; P = 0.044). Time from emergency department arrival to medical optimization (22.7 h vs 20.0 h; P = 0.0015), time from medical optimization to surgery (13.9 h vs 10.8 h; P = 0.0172), and time from emergency department arrival to surgery (42.7 h vs 32.5 h; P < 0.0001) were all significantly longer in patients who presented to the hospital on a weekend compared to patients who presented to the hospital on a weekday.CONCLUSIONThis study provided insight into the “weekend effect” for geriatric hip fractures and found that day of presentation has a clinically significant impact on delivered care.

Weekend admissions and mortality for major acute disorders across England and Wales: record linkage cohort studies

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.

Sa1443 - Effect of Weekend Admission for Acute Liver Failure: Analysis of the National Inpatient Sample

Sa1443 - Effect of Weekend Admission for Acute Liver Failure: Analysis of the National Inpatient Sample

"Weekend Effect" in Patients With Upper Gastrointestinal Hemorrhage: A Systematic Review and Meta-analysis.

"Weekend effect" refers to worse outcomes among patients presenting to the hospital on weekends or holidays. We performed a systematic review and meta-analysis of observational studies assessing the impact of the "weekend effect" in patients with upper gastrointestinal hemorrhage (UGIH). We searched key bibliographic databases using keywords and MeSH terms related to gastrointestinal hemorrhage and "weekend effect". Our primary analysis evaluated mortality in patients with UGIH who were hospitalized on the weekend or after-hours compared with a weekday. Secondary outcomes included need for definitive therapy and length of hospital stay. Relevant data were extracted and meta-analyses were performed using random effects model. Subgroup sensitivity analyses were also performed to assess the effects of key variables. A total of 21 of 224 identified studies met inclusion criteria. Overall, there was no association between weekend admission and mortality among patients with UGIH (Odds Ratio (OR): 1.06; 95% confidence interval (CI): 0.99-1.14). However, meta-analysis using only the nine studies that did not report having a weekend rounder showed a significant increase in mortality (OR: 1.12; 95% CI: 1.07-1.17). There was no effect of weekend admission on any of our secondary outcomes. Current evidence suggests that weekend admission is associated with significant increase in mortality in patients with non-variceal UGIH but no difference in mortality was noted in patients with variceal UGIH. Our findings are relevant to policymakers, practitioners and providers who should ensure the creation of consistent quality and access to care throughout the week.

Effect of weekend admission on mortality associated with severe acute kidney injury in England: A propensity score matched, population-based study.

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.

“Weekend Effect” in Patients With Upper Gastrointestinal Hemorrhage: A Systematic Review and Meta-Analysis

Introduction: The acute management of upper gastrointestinal hemorrhage (UGIH) involves several steps and coordinated care ranging from resuscitation and stabilization to definitive diagnosis and therapy. ‘Weekend effect' refers to worse outcomes among patients presenting to the hospital on weekends or holidays. This is due to many reasons including decreased staffing on weekends, delay in performance of procedures and because patients are often in a critical condition when they present on the weekend. This has the potential to cause poorer outcomes among patients with UGIH who are hospitalized on the weekend compared with weekdays. Several observational studies have been conducted in multiple countries and yield conflicting results. We performed a systematic review and meta-analysis of observational studies assessing the impact of the ‘weekend effect' in patients with upper gastrointestinal hemorrhage (UGIH). Methods: We searched key bibliographic databases using keywords and MeSH terms related to gastrointestinal hemorrhage and ‘weekend effect'. Our primary analysis evaluated mortality in patients with UGIH who were hospitalized on the weekend or after-hours compared to a weekday. Secondary outcomes included need for definitive therapy and length of hospital stay. Relevant data were extracted and metaanalyses were performed using Revman. Results: Twenty of 223 identified studies met inclusion criteria. Overall, there was no association between weekend admission and mortality among patients with UGIH (OR: 1.05; 95% CI: 0.98-1.14). However, meta-analysis using only the 8 studies that did not report having a weekend rounder showed a significant increase in mortality (OR: 1.12; 95% CI: 1.06-1.18). Weekend admission was associated with a significant increase in mortality in patients with non-variceal UGIH (OR: 1.12; 95% CI: 1.07-1.16; N=8 studies) but no effect was seen in patients with variceal UGIH. There was no effect of weekend admission on any of our secondary outcomes including endoscopic therapy (OR 0.96; 95% CI: 0.86-1.07; N=12 studies), Need for surgery or angiography(OR 1.07; 95% CI: 0.93-1.23; N=12 studies)(OR 0.96; 95% CI: 0.86-1.07) or length of hospital stay. Lastly, the weekend effect on mortality was demonstrated in meta-analysis of studies conducted in the United States (US) (OR 1.10; 95% CI: 1.06-1.15; N=4 studies) but not European or Asian studies. No publication bias was noted on inspection of funnel plots. Conclusion: Current evidence suggests that lack of endoscopy services on the weekend is associated with significant increase in mortality in patients with non variceal UGIH and could be related to delay in the endoscopy services on the weekend. Our findings are relevant to policymakers and other stakeholders who should ensure the creation of consistent quality and access to care throughout the weekFigure: Association of weekend effect with mortality (stratified by availability of weekend rounder).Figure: Association of weekend effect with mortality (stratified by availability of variceal vs. non-variceal UGIH).Figure: Association of weekend effect with mortality (stratified by availability of geographical area).

Effect of weekend admission on process of care and clinical outcomes for the management of acute coronary syndromes: a retrospective analysis of three UK centres

ObjectivesThe effect of weekend versus weekday admission following acute coronary syndrome (ACS) on process of care and mortality remains controversial. This study aimed to investigate the ‘weekend-effect’ on outcomes using...

Traumatic subdural hematoma: Is there a weekend effect?

ObjectiveTraumatic subdural hematoma (TSDH) is a surgical emergency. The effect of weekend admission on surgery and in-hospital outcomes in TSDH is not known. MethodsWe queried the Nationwide Inpatient Sample from 2002 to 2011 and used ICD-9-CM codes to identify all non-elective admissions with a primary diagnosis of TSDH. We did a subgroup analysis of patients who underwent surgical evacuation. Predictor variables included several patient and hospital characteristics. Outcome variables included length of stay, total hospitalization cost, in-hospital complications, adverse discharge disposition, and in-hospital mortality. We used multivariable analysis to determine if weekend admission was independently associated with increased likelihood of poor outcomes. ResultsOut of a total of 404,212 TSDH admissions, 24.8% received surgical intervention. Patients admitted on weekends were less likely to undergo surgical intervention (odds ratio [OR]: 0.85). In the surgical cohort, weekend admissions consisted of more patients with prolonged loss of consciousness (24+h) without return to baseline (7.0% vs. 4.8%). In all TSDH patients and in sub-group of surgical cohort, weekend admission was associated with an increased likelihood of in-hospital complication (OR: 1.06 and 1.12), prolonged length of stay (OR: 1.08 and 1.17), increased total hospital costs (OR: 1.04 and 1.11), adverse discharge (OR: 1.08 and 1.18), and in-hospital mortality (OR: 1.04 and 1.11). All p-values were less than 0.01. ConclusionOur study demonstrates that patients admitted on weekends had similar mortality despite higher severity with no clinically significant weekend effect for tSDH.

Effect of weekend admission on in-hospital mortality and functional outcomes for patients with acute subarachnoid haemorrhage (SAH)

BackgroundAneurysmal subarachnoid haemorrhage (aSAH) is an acute cerebrovascular event with high socioeconomic impact as it tends to affect younger patients. The recent NCEPOD study looking into management of aSAH has recommended that neurovascular units in the United Kingdom should aim to secure cerebral aneurysms within 48 h and that delays because of weekend admissions can increase the mortality and morbidity attributed to aSAH.MethodWe used data from a prospective audit of aSAH patients admitted between January 2009 and December 2011. The baseline demographic and clinical features of the weekend and weekday groups were compared using the chi-squared test and T-test. Cox proportional hazards models (Proc Phreg in SAS) were used to calculate the adjusted overall hazard of in-hospital death associated with admission on weekend, adjusting for age, sex, baseline WFNS grade, type of treatment received and time from scan to treatment. Sliding dichotomy analysis was used to estimate the difference in outcomes after SAH at 3 months in weekend and weekday admissions.ResultsThose admitted on weekends had a significantly higher scan to treatment time (83.05 ± 83.4 h vs 40.4 ± 53.4 h, P < 0.0001) and admission to treatment (71.59 ± 79.8 h vs 27.5 ± 44.3 h, P < 0.0001) time. After adjustments for adjusted for relevant covariates weekend admission was statistically significantly associated with excess in-hospital mortality (HR = 2.1, CL [1.13–4.0], P = 0.01). After adjustments for all the baseline covariates, the sliding dichotomy analysis did not show effects of weekend admission on long-term outcomes on the good, intermediate and worst prognostic bands.ConclusionsThis study provides important data showing excess in-hospital mortality of patients with SAH on weekend admissions served by the United Kingdom’s National Health Service.; However, there were no effects of weekend admission on long-term outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00701-016-2746-z) contains supplementary material, which is available to authorized users.

Abstract TP321: Is Weekend Admission Associated With Increased 30-day Stroke Mortality? The Effect of Adjustment Using a Claims-Based Stroke Severity Index

Introduction: Whether weekend admission is associated with increased stroke mortality in Taiwan remains uncertain, partly because of an inadequate case-mix adjustment in other studies using an insurance claims databases. Hypothesis: Adding the 7-item claims-based stroke severity index (SSI) to a multivariate logistic regression model might alter the analysis of the effect of weekend admission on 30-day stroke mortality. Methods: We identified, in the Taiwan Longitudinal Health Insurance Database, which is linked with the National Death Registry, patients hospitalized for acute ischemic stroke between 2001 and 2013. The primary outcome was mortality 30 days post-admission. In base logistic regression models with and without the SSI, we tested the odds ratio (OR) of 30-day mortality in patient admitted on weekends using the covariates of age, sex, year of admission, Charlson’s comorbidity index, brain surgery, physician specialty and surgical volume, hospital ownership, accreditation, and patient volume. Results: We analyzed 46,007 consecutive hospitalized stroke patients (mean age: 68.8 ± 12.0 years; male: 59%), with an SSI of 7.5 ± 5.3 (range: 4.1-27.1), 23.0% were admitted on the weekend, and 4.2% died within 30 days. Patients who died within 30 days were more likely to have been admitted on a weekend (4.9% vs. 4.0%, p &lt; 0.001). Nevertheless, patients admitted on a weekend had a higher SSI than those admitted on a weekday (7.8 vs. 7.4, p &lt; 0.001). In multivariate logistic regression models, weekend admission was associated with 30-day mortality (OR: 1.22, 95% CI: 1.10-1.35) in the base model but not in the base model plus SSI (OR: 1.07, 95% CI: 0.95-1.20). Conclusions: We confirmed that, after stroke severity had been adjust by adding the SSI, weekend admission did not increase the 30-day mortality of stroke patients in Taiwan. A case-mix adjustment in comparative outcome studies of stroke patients is important when using an insurance claims database.

Effect of Weekend Admission on In-Hospital Mortality in Patients with Ischemic Stroke: An Analysis of Korean Nationwide Claims Data from 2002 to 2013

Studies conducted on patients with stroke in countries other than Korea demonstrated a phenomenon known as the weekend effect on 7-day, 30-day, and in-hospital mortalities. We studied patients with stroke using nationwide cohort data to determine if there was a weekend effect on mortality in a Korean population. Nationwide cohort data, collected from 2002 to 2013, were searched for all hospitalizations via the emergency department due to ischemic stroke. Cox's proportional hazards frailty model was employed, and we adjusted for all patient and hospital characteristics. There were 8957 patients with ischemic stroke admitted via the emergency department: 2632 weekend admissions and 6325 weekday admissions. Of these, 478 (5.3%) patients were dead. After adjusting for patient and hospital characteristics, the frailty model analysis revealed significantly higher in-hospital mortality in patients admitted on weekends than in those admitted on weekdays (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.01-1.47). We obtained consistent results for the 30-day mortality findings (HR, 1.27; 95% CI, 1.04-1.55). However, no significant differences were observed in the 7-day mortality (HR, 1.13; 95% CI, .88-1.45). Weekend admission for ischemic stroke was significantly associated with higher in-hospital and 30-day mortality after adjusting for individual characteristics and hospital factors.

Effect of Weekend Admission on Inhospital Outcomes Among Children with Ischemic and Hemorrhagic Strokes (P3.081)

Effect of Weekend Admission on Inhospital Outcomes Among Children with Ischemic and Hemorrhagic Strokes (P3.081)

Abstract 486: The Effects of Weekend Admission on the Outcomes and Management of Ruptured Aortic Aneurysms

The Effects of Weekend Admission on the Outcomes and Management of Ruptured Aortic Aneurysms Objective: Ruptured aortic aneurysm is a condition with a high rate of mortality that requires prompt surgical intervention. It has been noted that in some conditions requiting such prompt intervention, in-hospital mortality is increased in patients admitted on the weekends as compared to patients admitted on weekdays. We sought to determine if this was indeed the case for both ruptured thoracic and abdominal aortic aneurysm and elucidate the possible reasons. Methods: Using the Nationwide Inpatient Sample (NIS), a publicly available database of inpatient care, we analyzed the incidence of mortality among patients admitted on the weekends compared to weekdays for ruptured aortic aneurysm. Ultimately the care of over 7,000 patients was analyzed for the primary endpoints. We adjusted for demographics, comorbid conditions, hospital characteristics, rates of surgical intervention, timing of surgical intervention and use of additional therapeutic measures. Results: Patients admitted on the weekend for both ruptured thoracic and abdominal aortic aneurysm had a statistically significant increase in mortality as compared to those admitted on the weekdays (OR 2.55 for Thoracic and 1.32 for Abdominal). By our analysis this is likely due to a delay in surgical care on the weekends. Conclusions: Weekend admission for ruptured aortic aneurysm is associated with an increased mortality when compared to those admitted on the weekend and this is likely due to several factors with the most predominant being a delay in surgical intervention.

Effects of weekend admission on the outcomes and management of ruptured aortic aneurysms

Ruptured aortic aneurysm is a condition with a high rate of mortality that requires prompt surgical intervention. It has been noted that in some conditions requiring such prompt intervention, in-hospital mortality is increased in patients admitted on the weekends compared with patients admitted on weekdays. We sought to determine if this was indeed the case for both ruptured thoracic aortic aneurysms (TAA) and abdominal aortic aneurysms (AAA) and to elucidate the possible reasons. Using the Nationwide Inpatient Sample, a publicly available database of inpatient care, we analyzed the incidence of mortality among 7200 patients admitted on the weekends compared with weekdays for ruptured aortic aneurysm. Among these patients, 19% had a TAA and 81% had an AAA, and each group was analyzed for differences in mortality during the hospitalization. We adjusted for demographics, comorbid conditions, hospital characteristics, rates of surgical intervention, timing of surgical intervention, and use of additional therapeutic measures. Patients admitted on the weekend for both ruptured TAA and AAA had a statistically significant increase in mortality compared with those admitted on the weekdays (TAA: odds ratio, 2.55; 95% confidence interval, 1.77-3.68; P = .03; AAA: odds ratio, 1.32; 95% confidence interval, 1.13-1.55; P = .0004). Among those with TAA, a surgical intervention was performed on day of admission in 62.1% of weekday admissions vs 34.9% of weekend admissions (P < .0001). This difference was much smaller among those with an aortic aneurysm; 79.6% had a surgical intervention on day of admission on a weekday vs 77.2% on the weekend (P < .0001). Weekend admission for ruptured aortic aneurysm is associated with an increased mortality compared with admission on a weekday, and this is likely due to several factors including a delay in prompt surgical intervention.

Abstract W MP99: Seven-Day Mortality After Ischemic Stroke: International Comparison Among Industrialized Nations

Introduction: Stroke is the 2 nd leading cause of death worldwide, yet best practices for acute stroke care are lacking even among premier hospitals in industrialized countries. We compared 7-day mortality after ischemic stroke between academic medical centers in the Netherlands (NL), United Kingdom (UK), and United States (US). Methods: This was an observational study using in-hospital administrative data from select academic medical centers in the NL (n=8), UK (n=10), and US (n=11) from 2005-12. Chi-square was used to compare 7-day in-hospital mortality between countries and across years, and to explore the effect of weekend admission. Multiple logistic regression was conducted to further examine factors associated with mortality, including sex, age, weekend admission, year, and country. Results: From 2005-12, 51,409 patients were discharged with ischemic stroke from hospitals in the NL (n=6331), UK (n=25574), and US (n=19204). Mortality was significantly higher in the UK (8.1%) compared to the NL (6.4%) and US (4.8%) (p&lt;0.0001). Moreover, mortality was higher in patients admitted on week-ends compared to weekdays in the UK (9.2% vs. 7.7%, p=0.0001), but not in the NL (6.8% vs. 6.3%, p=0.44) or US (4.8% vs. 4.9%, p=0.73). This “week-end effect” was consistent throughout all hospitals in the UK (p=0.0002) but much more variable in hospitals in the other two countries. In the UK, 7-day mortality improved with time, declining from 10.7% in 2006 to 6.3% in 2012 (p&lt;0.0001). A decline in mortality was also seen in the NL (p=0.03), but remained unchanged in the US (p=0.72). The UK “weekend effect” also disappeared with time. Multiple logistic regression demonstrated that country and weekend admission remained a significant risk factor associated with mortality after controlling for age, gender, and year. Conclusions: A comparison of 7-day mortality among academic medical centers in industrialized counties reveals stark variability. Although 2006 stroke mortality in UK hospitals was almost double that of US hospitals, dramatic reductions were subsequently seen. Further analysis of national policy or practice changes that have driven these improvements promise to be revealing.

The effect of weekend admission on outcomes in patients with non-ST-segment elevation acute coronary syndrome

The effect of weekend admission on outcomes in patients with non-ST-segment elevation acute coronary syndrome

Glucagon-like peptide-1 and related agents: Novel anti-arrhythmic agents during myocardial ischemia and reperfusion

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