Evaluation of Effect of Weekend Admission on the Prevalence of Hospital-Acquired Conditions in Patients Receiving Cervical Fusions

Abstract

Background: Hospital-acquired conditions (HACs) are defined by the Centers for Medicaid and Medicare Services (CMS) as preventable adverse events that do not qualify for reimbursement of resulting hospital costs. HACs have been employed as a metric for quality of patient care. Patients undergoing cervical spine fusions are at risk for occurrence of HACs because of limited mobility and potential extended hospital length of stay (LOS). Previous studies have not evaluated the contribution of weekend admission on the rate of HACs in this patient population. We abstracted data from the Nationwide Inpatient Sample to evaluate rate of HACs as a function of weekend admission among patients admitted for cervical fusions.

Methods: Patients undergoing anterior and posterior cervical fusions were identified from the 2002-2010 Nationwide Inpatient Sample database. HACs as defined by the CMS were collected via International Classification of Diseases, Ninth Revision, Clinical Modification codes. Multivariate analysis, including adjustment for demographics, disease severity, admission acuity, and admission source, was used to evaluate the effect of weekend admission on HAC occurrence, prolonged LOS, and higher inpatient costs.

Results: During the period 2002-2010, 1,404,181 admissions for cervical fusion were identified. HACs occurred at a frequency of 4.6%. After multivariate adjustment for demographics, disease severity, and urgency of admission, weekend admissions were associated with a 56% increased risk of HAC occurrence compared with weekday admissions (relative risk = 1.56, 95% confidence interval = 1.51, 1.62, P < 0.01). HAC occurrence was independently associated with prolonged LOS and higher inpatient costs (P < 0.05).

Conclusions: Patients undergoing cervical fusions who are admitted on weekends have an increased rate of HACs. HACs were associated with increases in LOS and hospital costs. Further study is warranted to evaluate disparities and potential improvement among weekend admissions.

Keywords: Cervical spine fusions; Costs; Hospital-acquired complications; Nationwide Inpatient Sample; Never events; Weekend effect.