Pulmonary Embolism

Abstract

Pulmonary embolism (PE) is a common, often fatal, acute medical condition for which timely therapy can be life saving. The average annual incidence of acute PE in the United States is about 110 in 100,000 adults. The case fatality rate in the years prior to the introduction of anticoagulant therapy exceeded 30%; current estimates of case fatality are , 10%. 1,2 The accurate diagnosis of PE relies on clinical acumen and timely use of appropriate diagnostic studies. Indi viduals with PE who present with shock or severe respiratory failure or who have limited cardiopul monary reserve benefi t from prompt use of complex therapies, such as mechanical ventilation, vasopressor infusion, inferior vena cava (IVC) fi lter placement, and thrombolysis.Previous studies of patients admitted with similarly time-sensitive conditions suggested that weekend admission increases the risk of poor outcomes. 3-10 However, the evidence for a weekend effect is not well established for people admitted with PE. Therefore, we carried out the present study to determine whether people admitted with PE on the weekend have worse outcomes than those admitted during the week. To better understand such a phenomenon, we sought to Background: Pulmonary embolism is a common, often fatal condition that requires timely recognition and rapid institution of therapy. Previous studies have documented worse outcomes for weekend admissions for a variety of time-sensitive medical conditions. This phenomenon has not been clearly demonstrated for pulmonary embolism. Methods: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the years 2000 to 2008 to identify people with a principal discharge diagnosis of pulmonary embolism. We classifi ed admissions as weekend if they occurred between midnight Friday and midnight Sunday. We compared all-cause in-hospital mortality between weekend and weekday admissions and investigated the timing of inferior vena cava (IVC) fi lter placement and thrombolytic infusion as potential explanations for differences in mortality. Results: Unadjusted mortality was higher for weekend admissions than weekday admissions (OR, 1.19; 95% CI, 1.13-1.24). This increase in mortality remained statistically signifi cant after controlling for potential confounding variables (OR, 1.17; 95% CI, 1.11-1.22). Among patients who received an IVC fi lter, a larger proportion of those admitted on a weekday than on the weekend received it on their fi rst hospital day (38% vs 29%, P , .001). The timing of thrombolytic therapy did not differ between weekday and weekend admissions. Conclusions: Weekend admissions for pulmonary embolism were associated with higher mortality than weekday admissions. Our fi nding that IVC fi lter placement occurred later in the hospital course for patients admitted on weekends with pulmonary embolism suggests differences in the timeliness of diagnosis and treatment between weekday and weekend admissions. Regardless of cause, physicians should be aware that weekend admissions for pulmonary embolis...

Changes in mortality on weekend versus weekday admissions for Acute Coronary Syndrome in the United States over the past decade

“…[9, 21] All other admissions were considered to be weekday admissions. This is the definition used by NIS and cannot be modified.…”

Day of Discharge Does Not Impact Hospital Readmission After Major Cardiac Surgery

“…Other studies have reported increased mortality with weekend or after-hour hospitalizations in stroke and myocardial infarction [22][23][24][25]. However, few have examined weekend discharge and its effect on postsurgical patient readmissions.…”

“…Applying principles of the "weekend effect" to the discharge process after cardiac surgery may provide an alternative approach to readmission reduction [20,21]. The weekend effect phenomenon, which has been used to describe higher mortality in myocardial infarction, stroke, and cardiac arrest admissions that occur on the weekend or at night, has been attributed to lower staffing levels and higher physician turnover on off-hours [22][23][24][25]. Given the strong correlation between weekend admissions and outcomes after common conditions, we aimed to investigate whether such differences in staffing from the usual weekday routine would affect the discharge process for cardiac surgical patients.…”

Weekend versus weekday transplant surgery and outcomes after kidney transplantation in the USA: a retrospective national database analysis

“… 14–16 Although the weekend effect may be a function of confounding by unmeasured differences in the severity of illness at the time of admission, others have hypothesised that differences in quality of care delivered between weekends and weekdays mediate this effect. 1 2 10 11 During the weekend, the hospital staffing may be reduced and/or less experienced medical staff may be working. In addition, restricted availability of diagnostic or therapeutic procedures leading to delays in care may influence patient outcomes.…”