The Weekend Effect in Hospitalized Patients: A Meta-Analysis

Abstract

Background: The presence of a "weekend effect" (increased mortality rate during Saturday and/or Sunday admissions) for hospitalized inpatients is uncertain.

Purpose: We performed a systematic review to examine the presence of a weekend effect on hospital inpatient mortality.

Data sources: PubMed, EMBASE, SCOPUS, and Cochrane databases (January 1966-April 2013) were utilized for our search.

Study selection: We examined the mortality rate for hospital inpatients admitted during the weekend compared with those admitted during the workweek. To be included, the study had to provide discrete mortality data around the weekends (including holidays) versus weekdays, include patients who were admitted as inpatients over the weekend, and be published in English.

Data extraction: The primary outcome was all-cause weekend versus weekday mortality with subgroup analysis by personnel staffing levels, rates and times to procedures rates and delays, or illness severity.

Data synthesis: A total of 97 studies (N = 51,114,109 patients) were examined. Patients admitted on the weekends had a significantly higher overall mortality (relative risk, 1.19; 95% confidence interval, 1.14-1.23). With regard to the subgroup analyses, patients admitted on the weekends consistently had higher mortality than those admitted during the week, regardless of the levels of weekend/weekday differences in staffing, procedure rates and delays, and illness severity.

Conclusions: Hospital inpatients admitted during weekends may have a higher mortality rate compared with inpatients admitted during the weekdays.