Mode of presentation rather than the 'weekend effect' is a major determinant of in-hospital mortality

Williams, Anwen ORCID: https://orcid.org/0000-0001-6118-020X, Powell, Arfon G.M.T ORCID: https://orcid.org/0000-0002-3740-8275, Spernaes, Izabela, Basu, Pallavi, Edwards, Stephen and Edwards, Paul 2019. Mode of presentation rather than the 'weekend effect' is a major determinant of in-hospital mortality. Surgeon 17 (1) , pp. 15-18. 10.1016/j.surge.2018.04.007

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Abstract

Background The influence of patient demographics and mode of admission on the ‘weekend effect’ remains unclear. This study examins the relationship between day of admission, patient demographics, mode of presentation and survival. Methods Hospital admissions over a three-year period were studied. Patients with an inpatient stay less than 24 h and those who were discharged from the emergency department were excluded. In-hospital mortality was correlated with day of admission, age, gender and mode of presentation in a binary logistical regression analysis. Results There were 448,827 admissions, of which 350,648 (85.7%) occurred during a weekday. 256,777 (62.7%) were emergency presentations, which was closely related to a weekend admission (92.3% vs 57.8%, p < 0.001). There were 8099 deaths of which 6336 (78.2%) related to a weekday admission and 1736 (21.4%) related a weekend admission. Mortality for elective admissions was 78 (0.05%) compared to 8021 (3.12%), p < 0.001 in emergency admissions. Univariable regression analysis revealed a weekend admission (Odds Ratio (OR) 1.68 (95% confidence interval (CI) 1.60–1.78, p < 0.001) and emergency presentation (OR 63.02 (95%CI 50.42–78.77), p < 0.011) were associated with weekend mortality. On multivariable analysis the OR for weekend admission reduced to 1.07 (95%CI 1.01–1.13), p = 0.013 and the OR for emergency presentation increased to 76.68 (95%CI 61.40–96.00), p < 0.001. Conclusion This study highlights that higher weekend mortality rates are a consequence of a lower proportion of elective admissions. Extending the working week to seven days might reduce weekend mortality without reducing the total number of deaths.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Elsevier
ISSN:	1479-666X
Date of First Compliant Deposit:	1 August 2018
Date of Acceptance:	30 April 2018
Last Modified:	21 Nov 2024 01:00
URI:	https://orca.cardiff.ac.uk/id/eprint/113830

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