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

Acute pancreatitis and the weekend effect: does weekend admission affect patient outcome?

Introduction

When a patient is admitted to a hospital for acute pancreatitis (AP), the day of the week on which the admission occurs may influence the outcome of care. The link between reduced weekend staffing practices and outcomes for patients hospitalised for AP, however, has been inadequately studied.

Aim

To evaluate the relationship between weekend admission and AP outcome.

Material and methods

One hundred and twenty-six patients were prospectively included, assessed according to the revised Atlanta criteria, and observed until discharge or death. Weekend and weekday admissions were compared in terms of severity, aetiology, length of hospital stay, and in-hospital mortality.

Results

Patients were divided into two groups according to the timing of admission (weekday, n = 99, 78.6%; or weekend, n = 27, 21.4%). AP was considered severe in 33 (26.2%) patients, moderately severe AP in 37 (29.4%) patients, and mild in 56 (44.4%) patients. No significant differences were found with regard to the distribution of AP severity between the two groups. The impact of weekend admission was not significant for aetiology or for the length of hospital stay (median of 9 vs. 10 days). In-hospital mortality rates were not significantly different for weekday and weekend admissions.

Conclusions

Patients admitted for hospitalisation during a weekend received the same level and quality of care at the facility under study as AP patients admitted during the week. Additionally, the rate of favourable outcomes for patients admitted during the weekend was found to be similar to the outcomes of patients admitted on a weekday.

Weekend Effect and in-Hospital Mortality in Elderly Patients with Acute Kidney Injury: A Retrospective Analysis of a National Hospital Database in Italy

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.

The weekend effect in liver transplantation

Background

The weekend effect describes a phenomenon whereby patients admitted to hospitals on weekends are at higher risk of complications compared to those admitted during weekdays. However, if a weekend effect exists in orthotopic liver transplantation (oLT).

Methods

We analyzed oLT between 2006 and 2016 and stratified patients into weekday (Monday to Friday) and weekend (Saturday, Sunday) groups. Primary outcome measures were one-year patient and graft survival.

Results

364 deceased donor livers were transplanted into 329 patients with 246 weekday (74.77%) and 83 weekend (25.23%) patients. Potential confounders (e.g. age, ischemia time, MELD score) were comparable. One-year patient and graft survival were similar. Frequencies of rejections, primary-non function or re-transplantation were not different. The day of transplantation was not associated with one-year patient and graft survival in multivariate analysis.

Conclusions

We provide the first data for the Eurotransplant region on oLT stratified for weekend and weekday procedures and our findings suggest there was no weekend effect on oLT. While we hypothesize that the absent weekend effect is due to standardized transplant procedures and specialized multidisciplinary transplant teams, our results are encouraging showing oLT is a safe and successful procedure, independent from the day of the week.

Adding a new dimension to the weekend effect: an analysis of a national data set of electronic AKI alerts

BACKGROUND

Increased mortality related to differences in delivery of weekend clinical care is the subject of much debate.

AIM

We compared mortality following detection of acute kidney injury (AKI) on week and weekend days across community and hospital settings.

DESIGN

A prospective national cohort study, with AKI identified using the Welsh National electronic AKI reporting system.

METHODS

Data were collected on outcome for all cases of adult AKI in Wales between 1 November 2013 and 31 January 2017.

RESULTS

There were a total of 107 298 episodes. Weekday detection of AKI was associated with 28.8% (26 439); 90-day mortality compared to 90-day mortality of 31.9% (4551) for AKI detected on weekdays (RR: 1.11, 95% CI: 1.08-1.14, P < 0.001, HR: 1.16 95% CI: 1.12-1.20, P < 0.001). There was no 'weekend effect' for mortality associated with hospital-acquired AKI. Weekday detection of community-acquired AKI (CA-AKI) was associated with a 22.6% (10 356) mortality compared with weekend detection of CA-AKI, which was associated with a 28.6% (1619) mortality (RR: 1.26, 95% CI: 1.21-1.32, P < 0.001, HR: 1.34, 95%CI: 1.28-1.42, P < 0.001). The excess mortality in weekend CA-AKI was driven by CA-AKI detected at the weekend that was not admitted to hospital compared with CA-AKI detected on weekdays which was admitted to hospital (34.5% vs. 19.1%, RR: 1.8, 95% CI: 1.69-1.91, P < 0.001, HR: 2.03, 95% CI: 1.88-2.19, P < 0.001).

CONCLUSION

'Weekend effect' in AKI relates to access to in-patient care for patients presenting predominantly to hospital emergency departments with AKI at the weekend.