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Wang H, Yi Y, Xiao T, Li A, Liu Y, Huang X. The weekend effect in kidney transplantation outcomes: A meta-analysis. PLoS One 2023; 18:e0287447. [PMID: 37327225 PMCID: PMC10275449 DOI: 10.1371/journal.pone.0287447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVE To determine whether kidney transplants performed during weekends have worse outcomes than those performed during weekdays. METHODS For this systematic review, PubMed, EMBASE, and the Cochrane Library (January 2000 to January 2023) were searched. We examined the survival rates of patients and grafts for hospital inpatients admitted during weekends and those admitted during weekdays. To be included, the study had to be in English and had to provide discrete survival data around weekends versus weekdays, including patients who were admitted as inpatients over the weekend. RESULTS Five studies (n = 163,506 patients) were examined. The hazards ratio (HR) of the survival rate of patients with weekend transplantation was 1.01 (95% confidence interval [CI], 0.96 to 1.06) when compared with patients with weekday transplantation. Patients who had renal transplant on weekends had an overall allograft survival HR of 1.01 (95% CI, 0.99 to 1.03) and death-censored allograft survival HR of 1.01 (95% CI, 0.98 to 1.04). Comparison of length of hospital stay, rejection, surgical complications, and vascular complications between renal transplants on weekends and those on weekdays showed no statistical difference. CONCLUSION Hospital inpatients admitted for renal transplantation during weekends have a survival rate similar to that of inpatients admitted during weekdays. The weekend effect of renal transplantation was very weak; hence, transplantations done during weekends and weekdays are both appropriate.
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Affiliation(s)
- Haifeng Wang
- Department of Urology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Yi Yi
- Department of Urology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Tan Xiao
- Department of Urology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Aiqing Li
- Department of Urology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Yongfei Liu
- Department of Urology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Xiaoli Huang
- Department of Hematology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
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Weekend Effect and in-Hospital Mortality in Elderly Patients with Acute Kidney Injury: A Retrospective Analysis of a National Hospital Database in Italy. J Clin Med 2020; 9:jcm9061815. [PMID: 32545203 PMCID: PMC7357030 DOI: 10.3390/jcm9061815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 01/05/2023] Open
Abstract
Background: The aim of this study was to relate the weekend (WE) effect and acute kidney injury (AKI) in elderly patients by using the Italian National Hospital Database (NHD). Methods: Hospitalizations with AKI of subjects aged ≥ 65 years from 2000–2015 who were identified by the ICD-9-CM were included. Admissions from Friday to Sunday were considered as WE, while all the other days were weekdays (WD). In-hospital mortality (IHM) was our outcome, and the comorbidity burden was calculated by the modified Elixhauser Index (mEI), based on ICD-9-CM codes. Results: 760,664 hospitalizations were analyzed. Mean age was 80.5 ± 7.8 years and 52.2% were males. Of the studied patients, 9% underwent dialysis treatment, 24.3% were admitted during WE, and IHM was 27.7%. Deceased patients were more frequently comorbid males, with higher age, treated with dialysis more frequently, and had higher admission during WE. WE hospitalizations were more frequent in males, and in older patients with higher mEI. IHM was independently associated with dialysis-dependent AKI (OR 2.711; 95%CI 2.667–2.755, p < 0.001), WE admission (OR 1.113; 95%CI 1.100–1.126, p < 0.001), and mEI (OR 1.056; 95% CI 1.055–1.057, p < 0.001). Discussion: Italian elderly patients admitted during WE with AKI are exposed to a higher risk of IHM, especially if they need dialysis treatment and have high comorbidity burden.
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Ville S, Branchereau J, Cornuaud A, Dantal J, Legendre C, Buron F, Morelon E, Garrigue V, Lequentrec M, Albano L, Cassuto E, Girerd S, Ladrière M, Glotz D, Lefaucher C, Kerleau C, Foucher Y, Giral M. The weekend effect in kidney transplantation outcomes: a French cohort-based study. Transpl Int 2020; 33:1030-1039. [PMID: 32428980 DOI: 10.1111/tri.13653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/13/2020] [Accepted: 05/11/2020] [Indexed: 11/26/2022]
Abstract
Numerous studies have reported a weekend effect on outcomes for diseases treated at hospitals. No study has been conducted in France for kidney transplantation. We therefore performed a cohort-based study to evaluate whether outcomes of kidney transplant recipients display a weekend effect. Data were extracted from the French DIVAT cohort. Patients aged 18 years and older, transplanted with a single kidney from deceased donors between 2005 and 2017 were studied. Linear regression, logistic regression, and cause-specific Cox model were used. Among the 6652 studied patients, 4653 patients were transplanted during weekdays (69.9%) versus 1999 during weekends (30.1%). The only statistically significant difference was the percentage of patients with vascular surgical complication(s) at 30 days: 13.3% in the weekend group versus 16.2% in the weekday group 0.79 (95% CI: 0.68; 0.92). We did not observe other significant differences for the other outcomes: patient or graft survival, the risk of acute rejection episodes, the 30-day percentage of urological complications, and the 1-year estimated glomerular filtration rate. Our study highlights a small protective weekend effect with less post-surgery vascular complications compared to weekdays. This paradox might be explained by a different handling of weekend transplantations.
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Affiliation(s)
- Simon Ville
- CRTI UMR 1064, Université de Nantes, ITUN, RTRS Centaure, Inserm, Nantes, France.,INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Julien Branchereau
- CRTI UMR 1064, Université de Nantes, ITUN, RTRS Centaure, Inserm, Nantes, France.,INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | | | - Jacques Dantal
- CRTI UMR 1064, Université de Nantes, ITUN, RTRS Centaure, Inserm, Nantes, France.,INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Christophe Legendre
- Kidney Transplant Center, Necker University Hospital, APHP, RTRS Centaure, Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | - Fanny Buron
- Nephrology, Transplantation and Clinical Immunology Department, RTRS Centaure, Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Emmanuel Morelon
- Nephrology, Transplantation and Clinical Immunology Department, RTRS Centaure, Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Valérie Garrigue
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Moglie Lequentrec
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Laetitia Albano
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Elisabeth Cassuto
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Sophie Girerd
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Marc Ladrière
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Denis Glotz
- Department of Nephrology and Renal Transplantation, CHU Paris-GH St-Louis Lariboisière, Paris, France
| | - Carmen Lefaucher
- Department of Nephrology and Renal Transplantation, CHU Paris-GH St-Louis Lariboisière, Paris, France
| | - Clarisse Kerleau
- CRTI UMR 1064, Université de Nantes, ITUN, RTRS Centaure, Inserm, Nantes, France.,INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Yohann Foucher
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France.,Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Magali Giral
- CRTI UMR 1064, Université de Nantes, ITUN, RTRS Centaure, Inserm, Nantes, France.,Kidney Transplant Center, Necker University Hospital, APHP, RTRS Centaure, Paris Descartes and Sorbonne Paris Cité Universities, Paris, France.,Centre d'Investigation Clinique en Biothérapie, Nantes, France
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