DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.
Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."
Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.
Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.
After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.
"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."
Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.
He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.
Dr. Sakhuja reported having no relevant financial disclosures.