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      Weekend versus weekday admission and short-term mortality : A meta-analysis of 88 cohort studies including 56,934,649 participants

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          Abstract

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          Abstract

          It is widely accepted that higher mortality related to weekend admissions basically exists; however, there has been no systematic exploration of whether weekend admissions are associated with higher risk of death in patients on the basis of certain diagnoses, geographic regions, and study subtypes.

          A meta-analysis was performed according to the reporting guidelines of the Meta-analysis of Observational Studies in Epidemiology (MOOSE Compliant). Literature search was conducted using electronic databases. Primary outcome was short-term (≤30-day) mortality. Patients were divided into 7 regions (North America, South America, Europe, Asia, Oceania, Africa, and Antarctica) for subgroup analyses and into 7 categories evaluating 24 major diagnoses. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated with DerSimonian and Laird random-effects models.

          Eighty-eight studies including 56,934,649 participants met our inclusion criteria. Overall pooled adjusted and crude OR of weekend to weekday admission for short-term mortality was 1.12 (95% CI, 1.07–1.18; I 2 = 97%) and 1.16 (95% CI, 1.14–1.19; I 2 = 97%), respectively. In subgroup analyses, higher risk of death on the weekend was significantly identified in patients living in all five continents (North America, South America, Europe, Asia, and Oceania). However, significant weekend effect was identified only in 15 of 24 diagnostic groups. Patients admitted on the weekend were more likely to die in an emergency situation (crude OR = 1.17, 95% CI, 1.12–1.22).

          Although weekend admissions were associated with higher risk of death compared with weekday admissions on all five continents, the effect was limited to certain diagnostic groups and admission subtypes. Weekend effect remains highly heterogeneous and limited, suggesting that further well-conducted cohort studies might be informative.

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          Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis

          Atsushi Sorita, Adil Ahmed, Stephanie Starr … (2014)
          Objective To assess the association between off-hour (weekends and nights) presentation, door to balloon times, and mortality in patients with acute myocardial infarction. Data sources Medline in-process and other non-indexed citations, Medline, Embase, Cochrane Database of Systematic Reviews, and Scopus through April 2013. Study selection Any study that evaluated the association between time of presentation to a healthcare facility and mortality or door to balloon times among patients with acute myocardial infarction was included. Data extraction Studies’ characteristics and outcomes data were extracted. Quality of studies was assessed with the Newcastle-Ottawa scale. A random effect meta-analysis model was applied. Heterogeneity was assessed using the Q statistic and I2. Results 48 studies with fair quality, enrolling 1 896 859 patients, were included in the meta-analysis. 36 studies reported mortality outcomes for 1 892 424 patients with acute myocardial infarction, and 30 studies reported door to balloon times for 70 534 patients with ST elevation myocardial infarction (STEMI). Off-hour presentation for patients with acute myocardial infarction was associated with higher short term mortality (odds ratio 1.06, 95% confidence interval 1.04 to 1.09). Patients with STEMI presenting during off-hours were less likely to receive percutaneous coronary intervention within 90 minutes (odds ratio 0.40, 0.35 to 0.45) and had longer door to balloon time by 14.8 (95% confidence interval 10.7 to 19.0) minutes. A diagnosis of STEMI and countries outside North America were associated with larger increase in mortality during off-hours. Differences in mortality between off-hours and regular hours have increased in recent years. Analyses were associated with statistical heterogeneity. Conclusion This systematic review suggests that patients with acute myocardial infarction presenting during off-hours have higher mortality, and patients with STEMI have longer door to balloon times. Clinical performance measures may need to account for differences arising from time of presentation to a healthcare facility.
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            Association between time of admission to the ICU and mortality: a systematic review and metaanalysis.

            Rodrigo Cavallazzi, Paul E Marik, Amyn Hirani … (2010)
            The organizational and staffing structure of an ICU influences the outcome of critically ill and injured patients. A change in the ICU staffing structure frequently occurs at nighttime and on weekends (off-hours). We postulated that patients who are admitted to an ICU during off hours may be at an increased risk of death. We performed a systematic review of the literature to assess whether admission to an ICU during off-hours is associated with an increased mortality. We selected studies that evaluated the association between time of admission to the ICU and mortality, with adjustment for severity of disease. We excluded studies that included pediatric and non-ICU patients. Study characteristics extracted included date of publication, study design, country where study was done, study population, time factor (weekend or night shift), severity adjustment tool, and outcome. Ten cohort studies met our inclusion criteria; eight of these studies evaluated nighttime admissions, whereas six studies evaluated weekend admissions. The pooled analysis demonstrated that nighttime admission was not associated with an increased mortality (odds ratio [OR], 1.0 [95% CI, 0.87-1.17]; P = .956); however, patients admitted over the weekend had a significant increase in the adjusted risk of death (OR, 1.08 [95% CI, 1.04-1.13]; P < .001). Significant heterogeneity was found in the studies that evaluated nighttime admissions. Whereas patients admitted to an ICU over the weekend appear to be at an increased risk of death, nighttime admissions were not associated with an increased mortality. The lower level of staffing and intensity of care provided by many hospitals over the weekend may account for this finding. The heterogeneity noted between studies evaluating nighttime admissions likely reflects the diverse organizational structure of the hospitals and ICUs where these studies were carried out.
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              Off-hour presentation and outcomes in patients with acute ischemic stroke: a systematic review and meta-analysis.

              Atsushi Sorita, Adil Ahmed, Stephanie Starr … (2014)
              Studies have suggested that patients with acute ischemic stroke who present to the hospital during off-hours (weekends and nights) may or may not have worse clinical outcomes compared to patients who present during regular hours.
              Article 0 comments Cited 29 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: April 2017
                Publication date (Electronic): 28 April 2017
                Volume: 96
                Issue: 17
                Electronic Location Identifier: e6685
                Affiliations
                [a ]Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan
                [b ]Department of Anesthesiology, Kanagawa Children's Medical Center, Kanagawa, Japan, Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Kanagawa
                [c ]Department of Anesthesia, Saitama Children's Medical Center, Saitama
                [d ]Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi
                [e ]Department of Anesthesiology, International University of Health and Welfare Shioya Hospital, and Department of Anesthesiology, International University of Health and Welfare Hospital, Tochigi (Current Institution: Department of Anesthesiology, Tokyo Medical University, Hachioji Medical Center, Tokyo)
                [f ]Department of Anesthesiology, Chemotherapy Research Institute, Kaken Hospital, International University of Health and Welfare, Chiba, Japan.
                Author notes
                [∗ ]Correspondence: Toshiya Shiga, Department of Anesthesiology, Chemotherapy Research Institute, Kaken Hospital, International University of Health and Welfare, Japan (e-mail: qzx02115@ 123456nifty.com ).
                Article
                Publisher ID: MD-D-16-06690 Accession ID: 06685
                DOI: 10.1097/MD.0000000000006685
                PMC ID: 5413234
                PubMed ID: 28445269
                SO-VID: a20debeb-5303-4ce4-a495-f8d45f7d4ae8
                Copyright © Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                Date received : 6 November 2016
                Date revision received : 25 March 2017
                Date accepted : 28 March 2017
                Categories
                Subject: 3700
                Subject: Research Article
                Subject: Meta-Analysis of Observational Studies in Epidemiology
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: healthcare quality,meta-analysis,mortality,weekday admission,weekend admission
                Data availability:
                Keywords: healthcare quality, meta-analysis, mortality, weekday admission, weekend admission

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