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, 19 (1), 619

Weekend Admissions and Mortality for Major Acute Disorders Across England and Wales: Record Linkage Cohort Studies

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Weekend Admissions and Mortality for Major Acute Disorders Across England and Wales: Record Linkage Cohort Studies

Stephen E Roberts et al. BMC Health Serv Res.

Abstract

Background: To establish which major disorders are susceptible to increased mortality following acute admissions on weekends, compared with week days, and how this may be explained.

Methods: Cohorts based on national administrative inpatient and mortality data for 14,168,443 hospitalised patients in England and 913,068 in Wales who were admitted for 66 disorders that were associated with at least 200 deaths within 30 days of acute admission. The main outcome measure was the weekend mortality effect (defined as the conventional mortality odds ratio for admissions on weekends compared with week days).

Results: There were large, statistically significant weekend mortality effects (> 20%) in England for 22 of the 66 conditions and in both countries for 14. These 14 were 4 of 13 cancers (oesophageal, colorectal, lung and lymphomas); 4 of 13 circulatory disorders (angina, abdominal aortic aneurysm, peripheral vascular disease and arterial embolism & thrombosis); one of 8 respiratory disorders (pleural effusion); 2 of 12 gastrointestinal disorders (alcoholic and other liver disease); 2 of 3 ageing-related disorders (Alzheimer's disease and dementia); none of 7 trauma conditions; and one of 10 other disorders (acute renal failure). Across the disorders, 64% of the variation in weekend mortality effects in England and Wales was explained by reductions in admission rates at weekends and the medical disease category.

Conclusions: The effect of weekend admission on 30 day mortality is seen mainly for cancers, some circulatory disorders, liver disease and a few other conditions which are mainly ageing- or cancer-related. Most of the increased mortality is associated with reduced admission rates at weekends and the medical disease category.

Keywords: Acute disorders; Mortality; Weekend admissions.

Conflict of interest statement

Keir Lewis reports personal fees from Chiesi, Pfizer and Astra Zeneca for speaker fees and advisory during the conduct of the study. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Standardised mortality rates (at 30 days) for all 66 study conditions combined according to the week day of admission in England and Wales. Notes Mortality rates are standardised for age group and sex. Vertical bars represent 95% confidence intervals. Overall admission rates for the 66 conditions (per 1000 population) for each day of the week in England and Wales respectively were: Monday 42.9; 48.5, Tuesday 41.0; 45.9, Wednesday 40.0; 44.8, Thursday 40.3; 45.1, Friday 41.6; 47.0, Saturday 33.1; 34.2, Sunday 32.7; 33.2
Fig. 2
Fig. 2
a Weekend mortality effects for acute circulatory, respiratory and gastrointestinal disorders across England and Wales. Notes. The thick bold vertical line at 0 denotes no weekend mortality effect. Horizontal bars represent 95% confidence intervals. The increased mortality for admissions at weekends (%) are based on odds ratios, obtained through multiple logistic regression modelling. b Weekend mortality effects for trauma, cancers, ageing-related and other acute disorders across England and Wales. Notes. The thick bold vertical line at 0 denotes no weekend mortality effect. Horizontal bars represent 95% confidence intervals. The increased mortality for admissions at weekends (%) are based on odds ratios, obtained through multiple logistic regression modelling
Fig. 2
Fig. 2
a Weekend mortality effects for acute circulatory, respiratory and gastrointestinal disorders across England and Wales. Notes. The thick bold vertical line at 0 denotes no weekend mortality effect. Horizontal bars represent 95% confidence intervals. The increased mortality for admissions at weekends (%) are based on odds ratios, obtained through multiple logistic regression modelling. b Weekend mortality effects for trauma, cancers, ageing-related and other acute disorders across England and Wales. Notes. The thick bold vertical line at 0 denotes no weekend mortality effect. Horizontal bars represent 95% confidence intervals. The increased mortality for admissions at weekends (%) are based on odds ratios, obtained through multiple logistic regression modelling
Fig. 3
Fig. 3
Weekend mortality effects in relation to percentage reductions in admission rates for each of the 66 study disorders in: a). England, b).Wales

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