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

Abstract

BackgroundIncreased in-hospital mortality associated with weekend admission has been reported for many acute conditions, but no study has investigated “weekend effect” for acute kidney injury requiring dialysis (AKI-D).MethodsIn this large, propensity score matched cohort of AKI-D, we examined the impact of weekend admission and in-centre nephrology services in 53,170 AKI-D admissions between 1st April 2003 and 31st March 2015 using a hospital episode statistic dataset. Propensity score matching (PSM) was performed to match 4284 weekend admissions with AKI-D with 14,788 admissions on weekdays.ResultsOf the 53,170 admissions with AKI-D in the whole dataset, 12,357 (23%) were at weekends. The unadjusted mortality for weekend admissions was significantly higher compared to admissions on weekdays (40·6% versus 39·6%, p 0·046). However, in multivariable analysis of the PSM cohort, the odds of death for weekend admissions with AKI-D was 1·01 (95%CI 0·93,1·09). Mortality was higher for weekend admissions in West Midlands (odds ratio (OR) 1·32, 95% confidence interval (CI) 1·05, 1·66) and lower in East of England (OR 0·77, 95%CI 0·59, 1·00) but was not different to weekday admissions in all other regions. In 2003–04, weekend admissions had lower odds of death (OR 0·45, 95%CI 0·21, 0·96) and in 2010–11 higher odds of death (OR 1·28, 95%CI 1·00, 1·63) but in the other ten years observed, there was no significant difference in mortality between weekday and weekend admissions. Provision of in-centre nephrology services was associated with lower odds of death at 0·57 (95%CI 0·54, 0·62).ConclusionsWeekend admissions in patients with AKI-D had no effect on mortality. Further research is warranted to elucidate the reasons for the lower mortality in hospitals with in-centre nephrology services.

The weekend effect in liver transplantation

“…Previous studies suggested a reduction in medical staffing and resources as well as a possible restriction in diagnostic and therapeutic tools on weekends to be responsible for the observed differences in mortality and morbidity [ 2 , 3 ]. While studies have shown a weekend effect for different medical conditions (including acute kidney injury [ 4 ], pneumonia [ 5 ] or dysrhythmia [ 6 ]) major commonalities among conditions affected by a weekend effect are the need for time sensitive interventions and care at an intensive care unit. In line with this, there are numerous reports about a weekend effect for stroke [ 7 – 9 ] myocardial infarction [ 10 , 11 ] or pulmonary embolism [ 12 , 13 ].…”

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

“…Kolhe et al conducted a study on more than 53,000 dialysis-dependent AKI patients. The prevalence of WE admission was 23%, and WE admissions were significantly associated with higher mortality in the unadjusted model, but not in the multivariable analysis [ 26 ]. Finally, Holmes et al did not find any WE effect for mortality associated with hospital-acquired AKI [ 27 ].…”

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

“…Previous studies suggest a number of factors that might account for increased mortality and morbidity rates during weekends, including a reduction in medical staff, limited resources, and restricted access to diagnostic and therapeutic tools [ 6 , 7 ]. Some studies have demonstrated unfavourable outcomes of the weekend effect on certain medical conditions such as pneumonia [ 8 ], acute kidney injury [ 9 ], and dysrhythmia [ 10 ]; favourable outcomes for these medical conditions rely on time-sensitive interventions and admission to intensive-care units. The findings of these studies have generated a significant degree of discussion on the validity of the weekend effect and its relationship to reduction in-hospital staffing practices for weekend shifts, a bias toward disease severity, and comorbidities associated with patients seeking hospital care during the weekend [ 11 , 12 ].…”