Weekend hospitalization and inhospital mortality: a gender effect?

Giorgi, Alfredo De; Fabbian, Fabio; Tiseo, Ruana; Misurati, Elisa; Boari, Benedetta; Zucchi, Beatrice; Signani, Fulvia; Salmi, Raffaella; Gallerani, Massimo; Manfredini, Roberto

doi:10.1016/j.ajem.2015.07.068

Cited by 6 publications

(2 citation statements)

References 26 publications

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“…Sample sizes of individual studies ranged from 824 admissions from a single hospital28 to 3 51 170 803 admissions from a nationwide database 2920 27 29–37), all medical admissions (1 study38), all surgical admissions (3 studies39–41), emergency admissions (22 mixed,16–18 42–60 6 medical,19 28 61–66 6 surgical67–72), elective surgery (573–77) and maternity admissions (1378–90). Two studies focused on paediatric patients 31 69.…”

Section: Resultsmentioning

confidence: 99%

Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis

et al. 2019

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ObjectiveTo examine the magnitude of the weekend effect, defined as differences in patient outcomes between weekend and weekday hospital admissions, and factors influencing it.DesignA systematic review incorporating Bayesian meta-analyses and meta-regression.Data sourcesWe searched seven databases including MEDLINE and EMBASE from January 2000 to April 2015, and updated the MEDLINE search up to November 2017. Eligibility criteria: primary research studies published in peer-reviewed journals of unselected admissions (not focusing on specific conditions) investigating the weekend effect on mortality, adverse events, length of hospital stay (LoS) or patient satisfaction.ResultsFor the systematic review, we included 68 studies (70 articles) covering over 640 million admissions. Of these, two-thirds were conducted in the UK (n=24) or USA (n=22). The pooled odds ratio (OR) for weekend mortality effect across admission types was 1.16 (95% credible interval 1.10 to 1.23). The weekend effect appeared greater for elective (1.70, 1.08 to 2.52) than emergency (1.11, 1.06 to 1.16) or maternity (1.06, 0.89 to 1.29) admissions. Further examination of the literature shows that these estimates are influenced by methodological, clinical and service factors: at weekends, fewer patients are admitted to hospital, those who are admitted are more severely ill and there are differences in care pathways before and after admission. Evidence regarding the weekend effect on adverse events and LoS is weak and inconsistent, and that on patient satisfaction is sparse. The overall quality of evidence for inferring weekend/weekday difference in hospital care quality from the observed weekend effect was rated as ‘very low’ based on the Grading of Recommendations, Assessment, Development and Evaluations framework.ConclusionsThe weekend effect is unlikely to have a single cause, or to be a reliable indicator of care quality at weekends. Further work should focus on underlying mechanisms and examine care processes in both hospital and community.Prospero registration numberCRD42016036487

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Section: Resultsmentioning

confidence: 99%

Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis

et al. 2019

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“…In a previous study conducted by our group, we showed that CCI was significantly higher in subjects admitted during WE, and significantly contributed to clinical outcome, along with gender and age. In logistic regression analysis, in fact, admission on WE, CCI, male sex, and age were significantly associated with IHM [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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

Fabbian

Giorgi

Simone

et al. 2020

JCM

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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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