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Meta-Analysis
. 2016 Mar 18;5(3):e003102.
doi: 10.1161/JAHA.115.003102.

Off-Hour Admission and Mortality Risk for 28 Specific Diseases: A Systematic Review and Meta-Analysis of 251 Cohorts

Yanfeng Zhou  1 , Wenzhen Li  1 , Chulani Herath  1 , Jiahong Xia  2 , Bo Hu  3 , Fujian Song  4 , Shiyi Cao  5 , Zuxun Lu  5
Affiliations
Meta-Analysis

Off-Hour Admission and Mortality Risk for 28 Specific Diseases: A Systematic Review and Meta-Analysis of 251 Cohorts

Yanfeng Zhou et al. J Am Heart Assoc. .

Abstract

Background: A considerable amount of studies have examined the relationship between off-hours (weekends and nights) admission and mortality risk for various diseases, but the results remain equivocal.

Methods and results: Through a search of EMBASE, PUBMED, Web of Science, and Cochrane Database of Systematic Reviews, we identified cohort studies that evaluated the association between off-hour admission and mortality risk for disease. In a random effects meta-analysis of 140 identified articles (251 cohorts), off-hour admission was strongly associated with increased mortality for aortic aneurysm (odds ratio, 1.52; 95% CI, 1.30-1.77), breast cancer (1.50, 1.21-1.86), leukemia (1.45, 1.17-1.79), respiratory neoplasm (1.32, 1.20-1.26), pancreatic cancer (1.32, 1.12-1.56), malignant neoplasm of genitourinary organs (1.27, 1.08-1.49), colorectal cancer (1.26, 1.07-1.49), pulmonary embolism (1.20, 1.13-1.28), arrhythmia and cardiac arrest (1.19, 1.09-1.29), and lymphoma (1.19, 1.06-1.34). Weaker (odds ratio <1.19) but statistically significant association was noted for renal failure, traumatic brain injury, heart failure, intracerebral hemorrhage, subarachnoid hemorrhage, stroke, gastrointestinal bleeding, myocardial infarction, chronic obstructive pulmonary disease, and bloodstream infections. No association was found for hip fracture, pneumonia, intestinal obstruction, aspiration pneumonia, peptic ulcer, trauma, diverticulitis, and neonatal mortality. Overall, off-hour admission was associated with increased mortality for 28 diseases combined (odds ratio, 1.11; 95% CI, 1.10-1.13).

Conclusions: Off-hour admission is associated with increased mortality risk, and the associations varied substantially for different diseases. Specialists, nurses, as well as hospital administrators and health policymakers can take these findings into consideration to improve the quality and continuity of medical services.

Keywords: disease; meta‐analysis; mortality; off‐hour.

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Figures

Figure 1
Figure 1
Flow chart for selection of eligible studies. COPD indicates chronic obstructive pulmonary disease.
Figure 2
Figure 2
Data sets by year and population group. Size of circle is proportional to sample size.
Figure 3
Figure 3
Study quality rating for 140 studies. NOS indicates Newcastle–Ottawa Scale.
Figure 4
Figure 4
Summary risk estimates of off‐hour admission and mortality risk for 28 specific diseases. Box sizes are in proportion to study weights. “Total” means summary risk estimates for 28 diseases combined. COPD indicates chronic obstructive pulmonary disease; OR, odds ratio.
Figure 5
Figure 5
Meta‐regression for short‐term mortality. Inor indicates In(odds ratio).
See this image and copyright information in PMC

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