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.

Effect of weekend versus weekday admission on the mortality of acute ischemic stroke patients in China: an analysis of data from the Chinese acute ischemic stroke treatment outcome registry.

Due to disparities in medical resources in rural and urban areas as well as in different geographic regions in China, the effect of weekend versus weekday admission on the outcomes of acute ischemic stroke (AIS) patients is unknown. Our aim was to investigate whether the outcomes of AIS patients differ according to the day of admission in China. The data were extracted from the Chinese Acute Ischemic Stroke Treatment Outcome Registry (CASTOR), a multicenter prospective study database of patients diagnosed with AIS. The chi-square test (χ2) and logistic regression were used to assess mortality for weekday and weekend admissions among AIS patients stratified by rural or urban status and geographic region (including the eastern, northeastern, central, and western regions). In total, 9,256 patients were included in this study. Of these patients, 57.2% were classified as urban, and 42.8% were classified as rural. A total of 6,760 (73%) patients were admitted on weekdays, and 2,496 (27%) were admitted on weekends. There was no significant difference in the mortality rate among patients admitted on weekends compared with those admitted on weekdays in urban (7.5% versus 7.4%) or rural areas (8.8% versus 8.1%; p > 0.05). The mortality rate was the highest among patients admitted on weekends and weekdays (11.6% versus 10.3%) in the northeastern area, without statistical significance before and after adjusting for the patients' background characteristics (p > 0.05). In addition, regression analysis revealed that the mortality of patients admitted on weekdays was more likely to be influenced by regional subgroup, hospital level and intravenous thrombolysis than that of patients admitted on weekends. The weekend effect was not observed in the mortality of patients with AIS regardless of rural-urban status or geographic region in China.

Patterns and outcomes of weekend admission for acute ischemic stroke

Background and objectivesThe “weekend effect” describes worse care delivery during off-hours or weekends and has been demonstrated in multiple sub-specialties. Off-hours care for acute ischemic stroke (AIS) has been associated with poorer outcomes. However, there is less data about the “weekend effect” on endovascular thrombectomy (ET) outcomes. MethodsWe used Medicare 100% sample datasets and included all AIS admissions from 2018-2019, using validated International Classification of Diseases, 10th Revision, Clinical Modification codes to identify AIS and comorbidities. Medicare provides the date of admission for all hospitalizations, and the day of the week was determined and assigned to weekend (Saturday or Sunday) or weekday (Monday through Friday). We defined 3 major outcomes: inpatient mortality, discharge home (vs. other destination), and 30-day mortality. ResultsAmong 471427 AIS admissions,13.0% and 12.9% of all AIS admissions occurred on a Saturday and Sunday, respectively, less than the expected 14.3% occurring on any given day (p-value <0.0001). AIS admissions on a weekend were less likely to receive IV thrombolysis (13.6% on Saturday and 12.9% on Sunday) and ET (13.1% on Saturday and 13.2% on Sunday), p-value <0.0001. Among all AIS admissions, weekend admission was associated with worse outcomes, including higher odds of inpatient mortality (adjusted OR 1.04 [95% CI 1.01-1.08, p<0.0001]), lower odds of discharge home (0.94 [0.93-0.96, p<0.0001]), and higher odds of 30-day mortality (1.06 [1.04-1.08, p<0.0001]). However, among AIS patients treated with ET, there was no association of weekend admission with outcomes. ConclusionsIn this national and contemporary dataset, we observed that the proportion of thrombolysis and ET cases was less over the weekend, and outcomes (inpatient mortality, 30-day mortality and odds of discharge home) were worse overall. We did not observe this association among AIS patients undergoing ET on a weekend vs. weekday.

Admission on weekends does not increase mortality after hip fracture: a meta-analysis of 1.4 million patients.

The "weekend" effect resulting in increased complication rates in patients admitted on weekends has been noted in many diseases. This systematic review and meta-analysis aimed to collate adjusted data from published studies to assess if admission on weekends as compared to weekdays increases mortality rates in hip fracture patients. Databases of PubMed, CENTRAL, Scopus, Web of Science, and Embase were searched up to 31st December 2022 for studies comparing mortality between weekend versus weekday admission of hip fracture patients. Adjusted hazard ratios (HR) were pooled. Fourteen studies including 1,487,986 patients were analyzed. Most studies were from Europe and North America. Results showed no difference in mortality rates of hip fracture patients admitted on weekends versus weekdays (HR: 1.00 95% 0.96, 1.04 I2 = 75%). There was no publication bias and results did not change on the leave-one-out analysis. Subgroup analysis based on sample size and treatment did not change outcomes. This meta-analysis has shown no apparent weekend effect in cases of hip fractures. Patients admitted on weekends had similar mortality rates as compared to those admitted on weekdays. Current data has high heterogeneity and is mostly from developed countries.

Avoiding Hospital Admissions and Delayed Transfers of Care by Improved Access to Intermediate Care: A Simulation Study.

The current waiting times for intermediate care in the Netherlands prohibit timely access, leading to unwanted and costly hospital admissions. We propose alternative policies for improvement of intermediate care and estimate the effects on the waiting times, hospitalization, and the number of patient replacements. Simulation study. For our case study, data were used of older adults who received intermediate care in Amsterdam, the Netherlands, in 2019. For this target group, in- and outflows and patient characteristics were identified. A process map of the main pathways into and out of the intermediate care was obtained and a discrete event simulation (DES) was built. We demonstrate the use of our DES for intermediate care by evaluating possible policy changes for a real-life case study in Amsterdam. By means of a sensitivity analysis with the DES, we show that in Amsterdam the waiting times are not a result of a lack in bed capacity but are due to an inefficient triage and application process. Older adults have to wait a median of 1.8days for admission, leading to hospitalization. If the application process becomes more efficient and evening and weekend admissions are allowed, we find that unwanted hospitalization can be decreased substantially. In this study, a simulation model is developed for intermediate care that can serve as a basis for policy decisions. Our case study shows that the waiting times for health care facilities are not always solved by increasing bed capacity. This underlines the necessity for a data-driven approach to identify logistic bottlenecks and find the best ways to solve them.

Weekend effect on 30-day mortality for ischemic and hemorrhagic stroke analyzed using severity index and staffing level.

Previous studies on the weekend effect-a phenomenon where stroke outcomes differ depending on whether the stroke occurred on a weekend-mostly targeted ischemic stroke and showed inconsistent results. Thus, we investigated the weekend effect on 30-day mortality in patients with ischemic or hemorrhagic stroke considering the confounding effect of stroke severity and staffing level. We retrospectively analyzed data of patients hospitalized for ischemic or hemorrhagic stroke between January 1, 2015, and December 31, 2018, which were extracted from the claims database of the National Health Insurance System and the Medical Resource Report by the Health Insurance Review & Assessment Service. The primary outcome measure was 30-day all-cause mortality. In total, 278,632 patients were included, among whom 84,240 and 194,392 had a hemorrhagic and ischemic stroke, respectively, with 25.8% and 25.1% of patients, respectively, being hospitalized during the weekend. Patients admitted on weekends had significantly higher 30-day mortality rates (hemorrhagic stroke 16.84%>15.55%, p<0.0001; ischemic stroke 5.06%>4.92%, p<0.0001). However, in the multi-level logistic regression analysis adjusted for case-mix, pre-hospital, and hospital level factors, the weekend effect remained consistent in patients with hemorrhagic stroke (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.00-1.10), while the association was no longer evident in patients with ischemic stroke (OR 1.01, 95% CI 0.96-1.06). Weekend admission for hemorrhagic stroke was significantly associated with a higher mortality rate after adjusting for confounding factors. Further studies are required to understand factors contributing to mortality during weekend admission.

Weekend atrial fibrillation hospitalizations are associated with higher short-term mortality

Background Previous investigations have analysed the relationship between weekend (WE) admission and early death in patients with atrial fibrillation (AF) patients without reaching univocal results. We systematically reviewed the available literature and performed a meta-analysis of data from cohort studies to estimate the association between WE admission and short-term mortality in AF patients. Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. We searched relevant publications using MEDLINE and Scopus from inception until 15 November 2022. Studies reporting the mortality risk as an adjusted odds ratio (OR), with relative 95% confidence interval (CI) comparing early (in‐hospital or 30‐day) mortality between patients admitted during the WE (Friday to Sunday) versus weekdays (WD) and having confirmed AF were included into the analysis. Data were pooled using a random-effects models with OR and related 95% CI. Results Overall, 5.164.986 AF patients (mean age 69.7 years old, 47.6% males) enrolled in five retrospective investigations were considered for the analysis. A random-effect model evidenced that AF patients admitted during the WE had a higher risk of 30-day or in-hospital death (adjusted OR: 1.57; 95% CI, 1.05–1.27, p = .003, I2 = 64.7%). Sensitivity analysis confirmed yielded results. A meta-regression analysis showed a relationship between mortality and the mean age of the studies included (p = .001) while no associations were identified using sex as moderating variables (p = .15). Conclusions Patients admitted during WE for AF are characterised by an approximately 58% excess in the risk of early death.

#6584 WEEKEND EFFECT IN ACUTE KIDNEY INJURY ADMISSIONS AND 1-YEAR RENAL OUTCOME

Abstract Background and Aims The “weekend effect” is the finding of worse outcomes in hospital admissions occurring over weekends. The reasons for this are still unclear but shorter staffing has been suggested to contribute. Little is known about the impact of the “weekend effect” on renal outcomes. We aim to analyze the impact of the weekend effect on patients admitted with acute kidney injury (AKI). We evaluated one-year renal outcome and mortality in patients admitted for AKI over weekends and weekdays. Method We conducted a retrospective analysis of all adult patients admitted in a tertiary medical center in Portugal over a period of 6 months with a diagnosis of AKI. Variables were retrieved using clinical and laboratory data. AKI was defined and severity was accessed according to Kidney Disease Improving Global Outcomes classification. Patients were categorized according to weekdays or weekend admission. Outcomes were in-hospital mortality, hemodialysis (HD) requirement and one-year mortality. Statistical significance was defined as a P-value &amp;lt;0.05 Results We included 163 patients with mean age of 69.8±16.2 years and 52.7% were male. The majority of patients were admitted on weekdays (74.2%, n = 121). Also, the majority had AKI stage 3 (65.6%, n = 107). Forty eight patients (29.4%) required HD during hospitalization and in-hospital mortality was 24.5%. There were no significant differences in HD requirement (31.4% vs 23.8%, p = 0.434), mortality (25.6% vs 21.4%, p = 0.680) nor HD requirement at discharge (25.6% vs 26.2%, p = 0.681) between weekday or weekend admissions. Of the 123 patients discharged, during the one-year follow-up 30.1% (n = 37) died and 7.3% (n = 9) required HD. There were no differences between weekdays or weekend admissions concerning mortality (32.2% vs 24.2%, p = 0,507) and HD requirement (7.8% vs 6.1%, p = 0,746) Conclusion In this cohort of patients with AKI there was no “weekend effect”, which reflects the adequacy of care independently of the day of admission. The retrospective design with a limited number of patients may have influenced the results. Further studies focusing on renal outcomes are required to better understand the occurence of the weekend effect and its long-term impact.

Identifying temporal variations in burn admissions.

Variations in admission patterns have been previously identified in non-elective surgical services, but minimal data on the subject exists with respect to burn admissions. Improved understanding of the temporal pattern of burn admissions could inform resource utilization and clinical staffing. We hypothesize that burn admissions have a predictable temporal distribution with regard to the time of day, day of week, and season of year in which they present. A retrospective, cohort observational study of a single burn center from 7/1/2016 to 3/31/2021 was performed on all admissions to the burn surgery service. Demographics, burn characteristics, and temporal data of burn admissions were collected. Bivariate absolute and relative frequency data was captured and plotted for all patients who met inclusion criteria. Heat-maps were created to visually represent the relative admission frequency by time of day and day of week. Frequency analysis grouped by total body surface area against time of day and relative encounters against day of year was performed. 2213 burn patient encounters were analyzed, averaging 1.28 burns per day. The nadir of burn admissions was from 07:00 and 08:00, with progressive increase in the rate of admissions over the day. Admissions peaked in the 15:00 hour and then plateaued until midnight (p<0.001). There was no association between day of week in the burn admission distribution (p>0.05), though weekend admissions skewed slightly later (p = 0.025). No annual, cyclical trend in burn admissions was identified, suggesting that there is no predictable seasonality to burn admissions, though individual holidays were not assessed. Temporal variations in burn admissions exist, including a peak admission window late in the day. Furthermore, we did not find a predictable annual pattern to use in guiding staffing and resource allocation. This differs from findings in trauma, which identified admission peaks on the weekends and an annual cycle that peaks in spring and summer.

Use of daunorubicin and cytarabine in adults with acute myeloid leukemia and associated risk factors for inpatient mortality: National inpatient sample review.

e19029 Background: According to American Cancer Society’s 2023 estimates, Acute Myeloid Leukemia (AML) is the most common leukemia in adults, involving up to 34% of new cases in the United States. The conventional cytotoxic therapy in AML involves induction therapy with cytarabine and an anthracycline daunorubicin or idarubicin. The purpose of this study was to assess patient traits and disease variables augmenting mortality risk in AML patients treated with cytarabine and daunorubicin. Methods: We used the 2016-2020 National inpatient sample (NIS), via SPSS 29. 0, to find adult patients with a diagnosis of AML and use of Daunorubicin/Cytarabine. Several patient characteristics and comorbidities such as sex, race, obesity, diabetes, and hypertension were identified. The mortality rate among these patients were estimated and logistic regression models were used to report risk factors of mortality and their associated adjusted odds ratio and 95% confidence interval (95% CI). Results: Our analysis found 6695 cases of AML using Daunorubicin/Cytarabine. Among them 47.1% were above the age of 60, 45.7% were covered under private insurance, 71.8% were of White race, 54.4% were males and 31.8% were smokers. 10.3% of patients were admitted on the weekend. Various comorbidities were seen including diabetes (14.7%), obesity (13.0%), hypertension (32.9%), history of old myocardial infarction (2.5%), and cirrhosis (3.0%). While admitted, patients experienced a range of side effects and complications including fever (2.2%), nausea and vomiting (9.4%), weakness or malaise or fatigue (4.4%), septicemia (18.6%), Acute Kidney Injury (AKI) (18.5%), cardiac dysrhythmias (16.0%), cardiogenic shock (0.5%) and secondary or unspecified thrombocytopenia (21.0%). Unfortunately, 415 patients died (6.2%) during hospitalization. A higher risk of mortality was seen in weekend admissions (aOR 1.687, 95% CI 1.227-2.318, p &lt; 0.01), those who developed septicemia (aOR 7.859, 95% CI 6.076-10.164, p &lt; 0.01), and AKI (aOR 3.095, 95% CI 2.396-3.998, p &lt; 0.01). Mortality risk was also higher in those with cirrhosis (aOR 6.367, 95% CI 4.139-9.794, p &lt; 0.01) and age more than 60 (aOR 3.174, 95% CI 2.275-4.428, p &lt; 0.01). However, a lower mortality risk was seen in patients with hypertension (aOR 0.689, 95% CI 0.518-0.918, p = 0.011). Conclusions: Various factors such as weekend admissions, septicemia, AKI, cirrhosis, and age &gt; 60 were associated with poorer outcomes while hypertensive patients had a lower mortality rate. The drawbacks of this study were that complications and side effects couldn't be quantified in proportion to doses or number of cycles received post induction with or without consolidation therapy with cytarabine and daunorubicin. Further studies in clinical settings should investigate the various disparities observed in our study.

Comparison of 30-day Readmission Rates and Inpatient Cardiac Procedures for Weekday Versus Weekend Hospital Admissions for Heart Failure

BackgroundWhether the timing of hospital presentation impacts care delivery and clinical outcomes for patients hospitalized for heart failure (HF) remains a matter of debate. In this study, we examined all-cause and HF-specific 30-day readmission rates for patients who were admitted for HF on a weekend vs admitted for HF on a weekday. Methods and ResultsWe conducted a retrospective analysis using the 2010–2019 Nationwide Readmission Database to compare 30-day readmission rates among patients who were admitted for HF on a weekday (Monday to Friday) vs patients who were admitted for HF on a weekend (Saturday or Sunday). We also compared in-hospital cardiac procedures and temporal trends in 30-day readmission by day of index hospital admission. Among 8,270,717 index HF hospitalizations, 6,302,775 were admitted on a weekday and 1,967,942 admitted on a weekend. For weekday and weekend admissions, the 30-day all-cause readmission rates were 19.8% vs 20.3%, and HF-specific readmission rates were 8.1% vs 8.4%, respectively. Weekend admissions were independently associated with higher risk of all-cause (adjusted odds ratio [aOR] 1.04, 95% confidence interval [CI] 1.03–1.05, P < .001) and HF-specific readmission (aOR 1.04, 95% CI 1.03–1.05, P < .001). Weekend HF admissions were less likely to undergo echocardiography (aOR 0.95, 95% CI 0.94–0.96, P < .001), right heart catheterization (aOR 0.80, 95% CI 0.79–0.81, P < .001), electrical cardioversion (aOR 0.90, 95% CI 0.88–0.93, P < .001), or receive temporary mechanical support devices (aOR 0.84, 95% CI 0.79–0.89, P < .001). The mean length of stay was shorter for weekend HF admissions (5.1 days vs 5.4 days, P < .001). Between 2010 and 2019, 30-day all-cause (18.5% to 18.2%, trend P < .001) and HF-specific (8.4% to 8.3%, trend P < .001) readmission rates decreased among weekday HF admissions. Among weekend HF admissions, the HF-specific 30-day readmission rate decreased (8.8% to 8.7%, trend P < .001), but the all-cause 30-day readmission rate remained stable (trend P = .280). ConclusionsAmong patients hospitalized for HF, weekend admissions were independently associated with excess risk of 30-day all-cause and HF-specific readmission and a lower likelihood of undergoing in-hospital cardiovascular testing and procedures. The 30-day all-cause readmission rate has decreased modestly over time among patients admitted on weekdays, but has remained stable among patients admitted on weekends.

519 Weekend Admission for Patients with Hidradenitis Suppurativa Have Better Outcomes than Weekday Admission

Abstract Introduction Hidradenitis suppurativa (HS) is a condition that involves recurring inflammation and fibrosis of intertriginous areas. With increasing inpatient hospitalization rates in patients with HS, our study sought to examine differences in outcomes between weekend and weekday admission. The authors hypothesized that patients admitted on a weekend will have worse in-hospital mortality rates when compared to those admitted on a weekday. Methods We used a national database to perform a cross-sectional study focusing on 12,365 patients with a primary diagnosis of HS from 2017-2019. The variables measured were weekend or weekday admission, age, gender, race, and zip income quartiles, with the latter four identified as confounding factors controlled for in the logistic regression analysis. Descriptive analyses were performed to determine frequencies, means, and significance. Statistical significance was set at p&amp;lt; 0.05.The multivariate binomial logistic regression was used to calculate the odds ratio (OR) for the identified outcomes. The primary outcome was in-hospital mortality. The secondary outcomes were morbidity factors (infection and wound dehiscence rates, postoperative complications), time from admission to first procedure, and resource utilization (total hospitalization charges and costs, and length of hospitalization). Results Weekend admission is not associated with worse inpatient mortality in patients with HS (p=0.345). From 2017-2019, 5 patients died, all of whom were admitted on a weekday. Compared to weekday, weekend admission had significantly lower incidences of wound dehiscence (0.38% vs 0%; p=0.007) and postoperative complications (0.24% vs 0%; p=0.035). No significant difference was observed for incidence of infection in weekday (0.43%) vs weekend admission (0.27%) (p=0.311). Weekend admission was also not found to have significant difference in the odds of contracting an infection (OR=0.74 (0.29-1.90); p=0.536). Weekend admission had significantly lower length of stay (mean days=6.40 vs 4.94; p=0.001), total charge ($64598.94 vs $44616.44; p&amp;lt; 0.001), and total cost ($14441.22 vs $10082.79; p&amp;lt; 0.001). Conclusions In contrast to previous studies focused on other pathologies that have shown increased morbidity, treatment metrics, and resource utilization on weekend admission, our study demonstrates that specifically for patients with HS, weekend admission is associated with lower rates of morbidity, length of stay, and charge. Applicability of Research to Practice Given that patients with HS who have a weekday admission have worse outcomes than a weekend admission, it is imperative for the medical team providing care to this group of patients on a weekday to be aware of this and begin to identify any potential factors.

MP02-04 IS THERE A WEEKEND EFFECT IN THE MANAGEMENT OF TESTICULAR TORSION? ANALYSIS OF THE SPARCS DATABASE FOR PEDIATRIC AND ADULT PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP02-04 IS THERE A WEEKEND EFFECT IN THE MANAGEMENT OF TESTICULAR TORSION? ANALYSIS OF THE SPARCS DATABASE FOR PEDIATRIC AND ADULT PATIENTS Micah Levy, Chih Peng Chin, Evan B. Garden, Krishna T. Ravivarapu, Christopher Connors, Olamide O. Omidele, Hasan Bilal, Jeffrey A. Stock, and Michael A. Palese Micah LevyMicah Levy More articles by this author , Chih Peng ChinChih Peng Chin More articles by this author , Evan B. GardenEvan B. Garden More articles by this author , Krishna T. RavivarapuKrishna T. Ravivarapu More articles by this author , Christopher ConnorsChristopher Connors More articles by this author , Olamide O. OmideleOlamide O. Omidele More articles by this author , Hasan BilalHasan Bilal More articles by this author , Jeffrey A. StockJeffrey A. Stock More articles by this author , and Michael A. PaleseMichael A. Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The “weekend effect” refers to patients experiencing worse outcomes when presenting to the hospital on the weekend. This phenomenon has been evaluated for several surgical procedures but has yet to be studied in patients with testicular torsion, a condition requiring emergent surgical intervention to preserve testicular function. We evaluated for the presence of a weekend effect in the management of testicular torsion in both a pediatric and adult patients. METHODS: The Statewide Planning and Research Cooperative System, a New York State all payer data reporting system, was queried from 2010-2017. All patients presenting with testicular torsion requiring surgical management were stratified into pediatric (<16 years old) or adult (>17 years old) groups, and then sub-stratified by admission on weekday (WD) or weekend (WE). Patient age, rate of orchiectomy vs. orchiopexy, rate of bilateral orchiopexy, length of stay (LOS), operative time (OPT), total hospital cost (THC), and incidence of evaluation of torsion within 7 days prior to current admission were analyzed. RESULTS: Of 1,445 cases, 807 were pediatric (WD: 600 [74.3%], WE: 207 [25.7%]) and 638 were adult (WD: 464 [72.7%], WE: 174 [27.3%]) with no difference in rate of weekend admission between populations (p=0.487). WE pediatric patients had a greater rate of orchiectomy (WE: 11.6%, WD: 6.7%, p=0.024), and bilateral orchiopexy (WE: 71.0%, WD: 62.7%, p=0.040). They were also older (WE: 11.9, WD: 10.6, p=0.002), had a greater LOS (WE: 0.45, WD: 0.27, p=0.037) and THC (WE: $18,257, WD: $12,460, p=0.016) though these are likely clinically insignificant. There was no difference in OPT or prior torsion evaluations [Table 1A]. The adult cohorts had no significant differences for any analyses [Table 1B]. CONCLUSIONS: On weekends, pediatric patients had a greater rate of orchiectomy and of bilateral orchiopexy, suggesting a possible weekend effect in the pediatric population. This may be due to delays in presenting to the hospital by either the patient or parent. No evidence of a weekend effect was found in the adult population. Patients and parents should continue to be educated on the symptoms of testicular torsion and be encouraged to always seek immediate medical attention to improve the chances for testicular salvage. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e11 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Micah Levy More articles by this author Chih Peng Chin More articles by this author Evan B. Garden More articles by this author Krishna T. Ravivarapu More articles by this author Christopher Connors More articles by this author Olamide O. Omidele More articles by this author Hasan Bilal More articles by this author Jeffrey A. Stock More articles by this author Michael A. Palese More articles by this author Expand All Advertisement PDF downloadLoading ...

Weekend Admission Increases Risk of Readmissions Following Elective Cervical Spinal Fusion.

The "weekend effect" occurs when patients cared for during weekends versus weekdays experience worse outcomes. But reasons for this effect are unclear, especially amongst patients undergoing elective cervical spinal fusion (ECSF). Our aim was to analyze whether index weekend admission affects 30- and 90-day readmission rates post-ECSF. All ECSF patients > 18 years were retrospectively identified from the 2016-2018 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD), using unique patient linkage codes and International Classification of Diseases, Tenth Revision codes. Patient demographics, comorbidities, and outcomes were analyzed. Univariate logistic regression analyzed primary outcomes of 30- and 90-day readmission rates in weekday or weekend groups. Multivariate regression determined the impact of complications on readmission rates. Compared to the weekday group (n = 125,590), the weekend group (n = 1,026) held a higher percentage of Medicare/Medicaid insurance, incurred higher costs, had longer length of stay, and fewer routine home discharge (all p < 0.001). There was no difference in comorbidity burden between weekend versus weekday admissions, as measured by the Elixhauser Comorbidity Index (p = 0.527). Weekend admissions had higher 30-day (4.30% vs. 7.60%, p < 0.001) and 90-day (7.80% vs. 16.10%, p < 0.001) readmission rates, even after adjusting for sex, age, insurance status, and comorbidities. All-cause complication rates were higher for weekend admissions (8.62% vs. 12.7%, p < 0.001), specifically deep vein thrombosis, infection, neurological conditions, and pulmonary embolism. Index weekend admission increases 30- and 90-day readmission rates after ECSF. In patients undergoing ECSF on weekends, postoperative care for patients at risk for specific complications will allow for improved outcomes and health care utilization.

The weekend effect in aneurysmal subarachnoid haemorrhage: a single centre experience and review

Clinical outcomes for patients admitted to hospital during weekend hours have been reported to be poorer than for those admitted during the week. Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating form of haemorrhagic stroke, with a mortality rate greater than 30%. A number of studies have reported higher mortality for patients with aSAH who are admitted during weekend hours. This study evaluates the effect of weekend admission on patients in our unit with aSAH in terms of time to treatment, treatment type, rebleeding rates, functional outcome, and mortality. We analysed a retrospective database of all patients admitted to our tertiary referral centre with aneurysmal subarachnoid haemorrhage between February 2016 and February 2020. Chi-square tests and t-tests were used to compare weekday and weekend demographic and clinical variables. Univariate and multivariate logistic regression analyses were performed to assess for any association between admission during weekend hours and increased neurological morbidity (assessed via Glasgow Outcome Scale at 3 months) and mortality. Of the 571 patients included in this study, 191 were admitted during on-call weekend hours. There were no significant differences found in time to treatment, type of treatment, rebleeding rates, neurological morbidity, or mortality rates between patients admitted during the week and those admitted during weekend hours. Weekend admission was not associated with worsened functional outcome or increased mortality in this cohort. These results suggest that provision of 7-day cover by vascular neurosurgeons and interventional neuroradiologists in high-volume centres could mitigate the weekend effect sometimes reported in the aSAH cohort.

Urinary L-Type Fatty Acid-Binding Protein Predicts Oxygen Demand of COVID-19 in Initially Mild Cases.

To predict COVID-19 disease severity within 10 days, distinguishing cases that will progress to moderate or severe versus mild, patient urinary L-type fatty acid-binding protein (L-FABP) was assayed within 4 days of receiving a diagnosis. The study also examined whether L-FABP point of care (POC) test is helpful in risk screening. Symptomatic subjects who tested positive for SARS-CoV-2 and were hospitalized were prospectively enrolled at the National Center for Global Health and Medicine (NCGM), Yamanashi Prefectural Central Hospital (YPCH), and Sinai Hospital in Maryland. The outcome of each case was evaluated 7 days after admission and the diagnostic performance of L-FABP was assessed. Subjects were treated for COVID-19 at public healthcare centers in Japan from January 31, 2020, to January 31, 2021, to NCGM, YPCH, and at Sinai Hospital in Baltimore, MD, during the same period. The primary outcome was to determine whether urinary L-FABP within 48 hours of admission can predict the patient's severity of COVID-19 1 week later. We obtained demographic data, information on clinical symptoms, radiographic images, and laboratory data. Diagnostic performance was assessed using receiver operating characteristic analysis. Of the 224 participants in the study, 173 initially had a mild form of COVID-19. The area under the curve (AUC) for a severe outcome was 93.5%. L-FABP POC risk prediction of a severe outcome had an AUC of 88.9%. Urinary L-FABP can predict patient risk of COVID-19 illness severity. L-FABP POC is implementable for patient management. (ClinicalTrials.gov number, NCT04681040).

Mortality among acute myocardial infarction patients admitted to hospitals on weekends as compared with weekdays in Taiwan

Weekend effect has been considered to be associated with poorer quality of care and patient’s survival. For acute myocardial infarction (AMI) patients, the question of whether patients admitted during off-hours have worse outcomes as compared with patients admitted during on-hours is still inconclusive. We conducted this study to explore the weekend effect in AMI patients, using a nationwide insurance database in Taiwan. Using Taiwan National Health Insurance (NHI) claims database, we designed a retrospective cohort study, and extracted 184,769 incident cases of AMI through the NHI claims database between January 2006 and December 2014. We divided the patients into weekend admission group and weekday admission group. Patients were stratified as ST elevation/non-ST elevation AMI and receiving/not receiving percutaneous coronary intervention (PCI). We used a logistic regression model to examine the relative risk of in-hospital mortality and 1-year mortality which were obtained from the Taiwan National Death Registry between study groups. We found no difference between weekend group and weekday group for risk of in-hospital mortality (15.8% vs 16.2%, standardized difference 0.0118) and risk of 1-year mortality (30.2% vs 30.9%, standardized difference 0.0164). There was no statistically significant difference among all the comparisons through the multivariate logistic regression analysis adjusting for all the covariates and stratifying by the subtypes of AMI and whether or not executing PCI during hospitalization. As for AMI patients in Taiwan, admission on weekends or weekdays did not have a significant impact on either in-hospital mortality or 1-year cumulative mortality.

Factors associated with weekend emergency department visits in patients with GI cancer.

813 Background: Gastrointestinal (GI) cancers account for highest ED revisits among cancer patients. Weekend ED visits are also associated with higher mortality. We aimed to analyze factors associated with weekend ED visits among GI cancer patients. Methods: Nationwide Emergency Department Sample (NEDS) database was queried from 2009 to 2017 for ED visits with GI primary tumor. ED visits were characterized by demographic, socioeconomic factors, hospital characteristics and primary cancer. Univariate and multivariate logistic regression were performed. Data was analyzed using Stata. Results: From 2009 to 2017, 6,862,077 ED visits associated with GI cancer were analyzed and 1,811,111(26.4%) visits were on weekend. Weekend visits were associated with increased in-hospital mortality (odds ratio [OR] 1.06; 95% Confidence Interval [CI] 1.04-1.). Weekday mortality was 3.8%, while weekend was 3.9%. Weekend visits were negatively associated with presentation in 2013-2017 as compared to 2009-2012 (OR 0.96; 0.95-0.97), Northeast hospitals (OR 0.89; 0.88-0.91) compared to Midwest, teaching hospital status (OR 0.96; 0.95-0.97) compared to non-teaching and metastatic cancer (OR 0.96; 0.95-0.97) compared to non-metastatic cancers. Compared to colon, weekend admissions were also negatively associated with anorectal (OR 0.96; 0.95-0.98) and hepatobiliary cancers (OR 0.96; 0.95-0.98). Conclusions: Presentation between 2013 to 2017, teaching hospital status, Northeast hospitals and metastatic stage were associated with fewer weekend ED visits. These findings could be potentially explained by increased and primary care utilization. There was a statistically significant association between mortality and weekend admissions, however the absolute difference was only 0.1%. Possible explanations include potential differences in staffing, interventions and procedures over the weekends compared to weekdays. In comparison to colon, anorectal and hepatobiliary cancer patients are less likely to have weekend ED visits while pancreatic cancer patients are more likely to have weekend ED visits. Our findings may help GI oncologists identify patients at risk of weekend ED visits.[Table: see text]

Analysis of Care and Outcomes for Epistaxis Weekend Admissions

To study differences in care of patients admitted for epistaxis during the weekend compared to the weekday. Retrospective database review. 2003 to 2014 National Inpatient Sample. Patients admitted for a primary diagnosis of epistaxis were extracted from the National Inpatient Sample from 2003 to 2014. Univariate and multivariate analyses were applied to assess differences in patient demographics, clinical characteristics, treatment, and outcomes between weekend and weekday admissions. A total of 39,329 cases were included in our study cohort, with 28,458 weekday admissions and 10,892 weekend admissions. There was no significant difference in patient race, gender, insurance status, hospital ownership status, or location between weekend and weekday admissions (p > .05). Most weekend admissions were emergent (82.2%) and were treated with packing (51.8%). Upon performing logistic regression, the likelihood of emergent admission (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.32-1.51, p < .001) and prolonged length of stay (OR 1.11, 95% CI 1.05-1.17, p < .001) was higher for weekend admissions versus weekday admissions. Moreover, odds of packing for epistaxis were significantly higher (OR 1.14, 95% CI 1.09-1.19, p < .001) on the weekend, while odds of ligation (OR 0.88, 95% CI 0.80-0.97, p = .013) and endovascular arterial embolization (OR 0.74, 95% CI 0.65-0.84, p < .001) were lower. There were no significant differences in in-hospital mortality, patient discharge disposition, and total hospital charges (p > .05). Patients primarily admitted for epistaxis over the weekend were more likely to be emergent, experienced prolonged length of stay, and be treated nonoperatively with packing, than weekday admissions. No significant differences in patient insurance or hospital ownership were identified.

Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample.

A large body of research has been conducted on the "weekend effect," which is the reportedly increased risk of adverse outcomes for patients admitted to the hospital on weekends versus those admitted on weekdays. This effect has been researched in numerous patient populations, including sub-populations of end-stage renal disease (ESRD) patients, with varying conclusions. To assess whether differences in in-hospital mortality, access to renal replacement therapy (RRT), time to RRT, and other important outcomes exist in patients with ESRD or patients on RRT admitted on the weekend versus weekdays. A retrospective cohort study was conducted using the 2018 Nationwide Inpatient Sample.Patients were included if they were adults with a principal or secondary diagnosis of ESRD or if they were admitted with a diagnosis related to initiation, maintenance, or complications of RRT. Patients admitted between midnight Friday and midnight Sunday were classified as weekend admissions. Primary outcome measurements includedin-hospital mortality, in-hospital dialysis (peritoneal dialysis, hemodialysis, and continuous RRT), and renal transplantation (TP). Secondary outcomes included length of hospital stay (LOS) and total hospitalization charges. The study included 1,144,385 patients who satisfied the inclusion criteria. Compared with patients admitted on weekdays, patients with ESRD admitted on weekends had 8% higher adjusted odds of in-hospital mortality (OR: 1.08; 95% CI: 1.03-1.13; p = 0.002), 9% lower adjusted OR of any RRTover the weekend than on weekdays (OR: 0.91; 95% CI: 0.89-0.93; p = 0.000), lower RRT rates (within 24 hours) (adjusted OR: 0.71; 95% CI: 0.70-0.73; p = 0.000), higher odds of renal TP (adjusted OR: 1.32; 95% CI: 1.20-1.45; p = 0.000), and higher hospitalization charges (mean adjusted increase: $1451; p= 0.07). The limitations of the study include the use of retrospective data and an administrative database. Compared with weekday admissions, patients with ESRD admitted on weekends had higher odds of mortality, higher mean hospitalization charges, and higher odds of renal TP. They had lower overall RRT rates, and a longer time to first RRT. However, the average LOS was similar for both weekend and weekday admissions.