Weekend versus weekday admission and mortality after acute pulmonary embolism

Abstract

Background: Optimal management of acute pulmonary embolism (PE) requires medical expertise, diagnostic testing, and therapies that may not be available consistently throughout the entire week. We sought to assess whether associations exist between weekday or weekend admission and mortality and length of hospital stay for patients hospitalized with PE.

Methods and results: We evaluated patients discharged with a primary diagnosis of PE from 186 acute care hospitals in Pennsylvania (January 2000 to November 2002). We used random-effect logistic models to study the association between weekend admission and 30-day mortality and used discrete survival models to study the association between weekend admission and time to hospital discharge, adjusting for hospital (region, size, and teaching status) and patient factors (race, insurance, severity of illness, and use of thrombolytic therapy). Among 15 531 patient discharges with PE, 3286 patients (21.2%) had been admitted on a weekend. Patients admitted on weekends had a higher unadjusted 30-day mortality rate (11.1% versus 8.8%) than patients admitted on weekdays, with no difference in length of stay. Patients admitted on weekends had significantly greater adjusted odds of dying (odds ratio 1.17, 95% confidence interval 1.03 to 1.34) than patients admitted on weekdays. The higher mortality among patients hospitalized on weekends was driven by the increased mortality rate among the most severely ill patients.

Conclusions: Patients with PE who are admitted on weekends have a significantly higher short-term mortality than patients admitted on weekdays. Quality-improvement efforts should aim to ensure a consistent approach to the management of PE 7 days a week.

Figure. Survival among patients admitted on weekdays and weekends

Cumulative survival curve for patients with pulmonary embolism who were admitted on weekdays (full line) and on weekends (dashed line). The gray zones represent the 95% confidence intervals. The cumulative 30-day mortality was significantly higher among patients admitted on weekends than in patients admitted on weekdays (11.1% versus 8.8%; P < 0.001 by the log-rank test). Survival curves began to diverge at day 1 after admission and continued to separate throughout the 30-day follow-up period.