RT Journal
A1 Ricciardi R, Roberts PL, Read TE, Baxter NN, Marcello PW, Schoetz DJ
T1 MOrtality rate after nonelective hospital admission
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD May 1
VO 146
IS 5
SP 545
OP 551
DO 10.1001/archsurg.2011.106
UL http://dx.doi.org/10.1001/archsurg.2011.106
AB Objective 
    We hypothesized that the mortality rate after nonelective hospital admission is higher during weekends than weekdays.Design 
    Retrospective cohort analysis.Setting 
    Patients admitted to hospitals in the Nationwide Inpatient Sample, a 20% sample of US community hospitals.Patients 
    We identified all patients with a nonelective hospital admission from January 1, 2003, through December 31, 2007, in the Nationwide Inpatient Sample. Next, we abstracted vital status at discharge and calculated the Charlson comorbidity index score for all patients. We then compared odds of inpatient mortality after nonelective hospital admission during the weekend compared with weekdays, after adjusting for diagnosis, age, sex, race, income level, payer, comorbidity, and hospital characteristics.Main Outcome Measure 
    Mortality rate.Results 
    Discharge data were available for 29 991 621 patients with nonelective hospital admissions during the 5-year study period: 6 842 030 during weekends and 23 149 591 during weekdays. Inpatient mortality was reported in 185 856 patients (2.7%) admitted for nonelective indications during weekends and 540 639 (2.3%) during weekdays (P < .001). The regression revealed significantly higher mortality during weekends for 15 of 26 (57.7%) major diagnostic categories. The weekend effect remained, and mortality was noted to be 10.5% higher during weekends (odds ratio, 1.10; 95% confidence interval, 1.10-1.11) compared with weekdays after adjusting for all other variables with the imputed data set.Conclusions 
    These data demonstrate significantly worse outcomes after nonelective admission during the weekend compared with weekdays. Although the underlying mechanism of this finding is unknown, it is likely that factors such as differences in hospital staffing and services offered during the weekend compared with weekdays are causal and mutable.