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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Weekends affect mortality risk and chance of discharge in critically ill patients: a retrospective study in the Austrian registry for intensive care

Authors: Paul Zajic, Peter Bauer, Andrew Rhodes, Rui Moreno, Tobias Fellinger, Barbara Metnitz, Faidra Stavropoulou, Martin Posch, Philipp G. H. Metnitz

Published in: Critical Care | Issue 1/2017

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Abstract

Background

In this study, we primarily investigated whether ICU admission or ICU stay at weekends (Saturday and Sunday) is associated with a different risk of ICU mortality or chance of ICU discharge than ICU admission or ICU stay on weekdays (Monday to Friday). Secondarily, we analysed whether weekend ICU admission or ICU stay influences risk of hospital mortality or chance of hospital discharge.

Methods

A retrospective study was performed for all adult patients admitted to 119 ICUs participating in the benchmarking project of the Austrian Centre for Documentation and Quality Assurance in Intensive Care (ASDI) between 2012 and 2015. Readmissions to the ICU during the same hospital stay were excluded.

Results

In a multivariable competing risk analysis, a strong weekend effect was observed. Patients admitted to ICUs on Saturday or Sunday had a higher mortality risk after adjustment for severity of illness by Simplified Acute Physiology Score (SAPS) 3, year, month of the year, type of admission, ICU, and weekday of death or discharge. Hazard ratios (95% confidence interval) for death in the ICU following admission on a Saturday or Sunday compared with Wednesday were 1.15 (1.08–1.23) and 1.11 (1.03–1.18), respectively. Lower hazard ratios were observed for dying on a Saturday (0.93 (0.87–1.00)) or Sunday (0.85 (0.80–0.91)) compared with Wednesday. This is probably related to the reduced chance of being discharged from the ICU at the weekend (0.63 (0.62–064) for Saturday and 0.56 (0.55–0.57) for Sunday). Similar results were found for hospital mortality and hospital discharge following ICU admission.

Conclusions

Patients admitted to ICUs at weekends are at increased risk of death in both the ICU and the hospital even after rigorous adjustment for severity of illness. Conversely, death in the ICU and discharge from the ICU are significantly less likely at weekends.
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Literature
1.
Freemantle N, Ray D, McNulty D, Rosser D, Bennett S, Keogh BE, et al. Increased mortality associated with weekend hospital admission: a case for expanded seven day services? Br Med J. 2015;351:h4596.CrossRef
2.
Freemantle N, Richardson M, Wood J, Ray D, Khosla S, Shahian D, et al. Weekend hospitalization and additional risk of death: an analysis of inpatient data. J R Soc Med. 2012;105:74–84.CrossRefPubMedPubMedCentral
3.
Aldridge C, Bion J, Boyal A, Chen Y-F, Clancy M, Evans T, et al. Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study. Lancet. 2016;388:178–86.
4.
Lilford RJ, Chen Y-F. The ubiquitous weekend effect: moving past proving it exists to clarifying what causes it. BMJ Qual Saf. 2015;24:480–2.CrossRefPubMed
5.
Arulkumaran N, Harrison DA, Brett SJ. Association between day and time of admission to critical care and acute hospital outcome for unplanned admissions to adult general critical care units: cohort study exploring the “weekend effect.” Br J Anaesth. 2016;118:112-22.
6.
Barnett MJ, Kaboli PJ, Sirio CA, Rosenthal GE. Day of the week of intensive care admission and patient outcomes: a multisite regional evaluation. Med Care. 2002;40:530–9.CrossRefPubMed
7.
Uusaro A, Kari A, Ruokonen E. The effects of ICU admission and discharge times on mortality in Finland. Intensive Care Med. 2003;29:2144–8.CrossRefPubMed
8.
Bhonagiri D, Pilcher DV, Bailey MJ. Increased mortality associated with after-hours and weekend admission to the intensive care unit: a retrospective analysis. Med J Aust. 2011;194:287–92.PubMed
9.
Ensminger SA, Morales IJ, Peters SG, Keegan MT, Finkielman JD, Lymp JF, et al. The hospital mortality of patients admitted to the ICU on weekends. Chest. 2004;126:1292–8.CrossRefPubMed
10.
Arabi Y, Alshimemeri A, Taher S. Weekend and weeknight admissions have the same outcome of weekday admissions to an intensive care unit with onsite intensivist coverage. Crit Care Med. 2006;34:605–11.CrossRefPubMed
11.
Laupland KB, Shahpori R, Kirkpatrick AW, Stelfox HT. Hospital mortality among adults admitted to and discharged from intensive care on weekends and evenings. J Crit Care. 2008;23:317–24.CrossRefPubMed
12.
Lee KK, Ng I, Ang BT. Outcome of severe head injured patients admitted to intensive care during weekday shifts compared to nights and weekends. Ann Acad Med Singapore. 2008;37:390–6.PubMed
13.
Ju M-J, Tu G-W, Han Y, He H-Y, He Y-Z, Mao H-L, et al. Effect of admission time on mortality in an intensive care unit in Mainland China: a propensity score matching analysis. Crit Care. 2013;17:1–9.CrossRef
14.
Cavallazzi R, Marik PE, Hirani A, Pachinburavan M, Vasu TS, Leiby BE. Association between time of admission to the ICU and mortality: a systematic review and metaanalysis. Chest. 2010;138:68–75.CrossRefPubMed
15.
16.
Metnitz PG, Vesely H, Valentin A, Popow C, Hiesmayr M, Lenz K, et al. Evaluation of an interdisciplinary data set for national intensive care unit assessment. Crit Care Med. 1999;27:1486–91.CrossRefPubMed
17.
Metnitz PG, Steltzer H, Popow C, Valentin A, Neumark J, Sagmüller G, et al. Definition and evaluation of a documentation standard for intensive care medicine: the ASDI (Working Group for Standardization of a documentation system for Intensive care medicine) pilot project. Wien Klin Wochenschr. 1997;109:132–8.PubMed
18.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–63.
19.
Metnitz PGH, Moreno RP, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3—from evaluation of the patient to evaluation of the intensive care unit. Part 1: objectives, methods and cohort description. Intensive Care Med. 2005;31:1336–44.CrossRefPubMedPubMedCentral
20.
Moreno RP, Metnitz PGH, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3—from evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 2005;31:1345–55.CrossRefPubMedPubMedCentral
21.
Miranda DR, de Rijk A, Schaufeli W. Simplified therapeutic intervention scoring system: the TISS-28 items—results from a multicenter study. Crit Care Med. 1996;24:64–73.CrossRefPubMed
22.
Fine J, Gray R. A proportional hazards model for the sub-distribution of a competing risk. Am Stat Assoc. 1999;94:496–509.CrossRef
23.
Beyersmann J, Allignol A, Schumacher M. Competing Risks and Multistate Models with R. New York: Springer; 2012.CrossRef
24.
25.
Metnitz B, Schaden E, Moreno R, Le Gall J-R, Bauer P, Metnitz PGH, et al. Austrian validation and customization of the SAPS 3 Admission Score. Intensive Care Med. 2009;35:616–22.CrossRefPubMed
26.
Sjoding MW, Luo K, Miller MA, Iwashyna TJ. When do confounding by indication and inadequate risk adjustment bias critical care studies? A simulation study. Crit Care. 2015;19:195.CrossRefPubMedPubMedCentral
27.
Wolbers M, Koller MT, Witteman JCM, Steyerberg EW. Prognostic models with competing risks. Epidemiology. 2009;20:555–61.CrossRefPubMed
28.
Austin PC, Steyerberg EW. Interpreting the concordance statistic of a logistic regression model: relation to the variance and odds ratio of a continuous explanatory variable. BMC Med Res Methodol. 2012;12:82.CrossRefPubMedPubMedCentral
29.
van Zaane B, van Klei WA, Buhre WF, Bauer P, Boerma EC, Hoeft A, et al. Nonelective surgery at night and in-hospital mortality. Eur J Anaesthesiol. 2015;32:477–85.CrossRefPubMed
30.
Metcalfe D, Perry DC, Bouamra O, Salim A, Lecky FE, Woodford M, et al. Is there a “weekend effect” in major trauma? Emerg Med J. 2016;33:836-42.
31.
Giannoudis V, Panteli M, Giannoudis PV. Management of polytrauma patients in the UK: is there a “weekend effect”? Injury. 2016;47:2385–90.CrossRefPubMed
32.
Metnitz B, Metnitz PGH, Bauer P, Valentin A, ASDI Study Group. Patient volume affects outcome in critically ill patients. Wien Klin Wochenschr. 2009;121:34–40.CrossRefPubMed
33.
Metnitz PGH, Reiter A, Jordan B, Lang T. More interventions do not necessarily improve outcome in critically ill patients. Intensive Care Med. 2004;30:1586–93.CrossRefPubMed
34.
Isogai T, Yasunaga H, Matsui H, Tanaka H, Ueda T, Horiguchi H, et al. Effect of weekend admission for acute myocardial infarction on in-hospital mortality: a retrospective cohort study. Int J Cardiol. 2015;179:315–20.CrossRefPubMed
35.
Cho KH, Park E-C, Nam CM, Choi Y, Shin J, Lee SG. Effect of weekend admission on in-hospital mortality in patients with ischemic stroke: an analysis of Korean nationwide claims data from 2002 to 2013. J Stroke Cerebrovasc Dis. 2016;25:419–27.CrossRefPubMed
36.
Richardson LC, Lehnbom EC, Baysari MT, Walter SR, Day RO, Westbrook JI. A time and motion study of junior doctor work patterns on the weekend: a potential contributor to the weekend effect? Intern Med J. 2016;46:819–25.CrossRefPubMed
37.
Li L, Rothwell PM. Biases in detection of apparent “weekend effect” on outcome with administrative coding data: population based study of stroke. BMJ. 2016;353:i2648.CrossRefPubMedPubMedCentral
Metadata
Title
Weekends affect mortality risk and chance of discharge in critically ill patients: a retrospective study in the Austrian registry for intensive care
Authors
Paul Zajic
Peter Bauer
Andrew Rhodes
Rui Moreno
Tobias Fellinger
Barbara Metnitz
Faidra Stavropoulou
Martin Posch
Philipp G. H. Metnitz
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1812-0

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