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Meta-Analysis
. 2018 Nov 20;18(1):870.
doi: 10.1186/s12913-018-3688-3.

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

Kate Honeyford  1 , Elizabeth Cecil  2 , Michelle Lo  3 , Alex Bottle  2 , Paul Aylin  2
Affiliations
Meta-Analysis

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

Kate Honeyford et al. BMC Health Serv Res. .

Abstract

Background: The concept of a weekend effect, poorer outcomes for patients admitted to hospitals at the weekend is not new, but is the focus of debate in England. Many studies have been published which consider outcomes for patients on admitted at the weekend. This systematic review and meta-analysis aims to estimate the effect of weekend admission on mortality in UK hospitals.

Methods: This is a systematic review and meta-analysis of published studies on the weekend effect in UK hospitals. We used EMBASE, MEDLINE, HMIC, Cochrane, Web of Science and Scopus to search for relevant papers. We included systematic reviews, randomised controlled trials and observational studies) on patients admitted to hospital in the UK and published after 2001. Our outcome was death; studies reporting mortality were included. Reviewers identified studies, extracted data and assessed the quality of the evidence, independently and in duplicate. Discrepancy in assessment was considered by a third reviewer. All meta-analyses were performed using a random-effects meta-regression to incorporate the heterogeneity into the weighting.

Results: Forty five articles were included in the qualitative synthesis. 53% of the articles concluded that outcomes for patients either undergoing surgery or admitted at the weekend were worse. We included 39 in the meta-analysis which contributed 50 separate analyses. We found an overall effect of 1.07 [odds ratio (OR)] (95%CI:1.03-1.12), suggesting that patients admitted at the weekend had higher odds of mortality than those admitted during the week. Sub-group analyses suggest that the weekend effect remained when measures of case mix severity were included in the models (OR:1.06 95%CI:1.02-1.10), but that the weekend effect was not significant when clinical registry data was used (OR:1.03 95%CI: 0.98-1.09). Heterogeneity was high, which may affect generalisability.

Conclusions: Despite high levels of heterogeneity, we found evidence of a weekend effect in the UK, even after accounting for severity of disease. Further work is required to examine other potential explanations for the "weekend effect" such as staffing levels and other organisational factors.

Trial registration: PROSPERO International Prospective Register of Systematic Reviews -registration number: CRD42016041225 .

Keywords: Hospital; Mortality; Quality of care; Weekend effect.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: PA reports grants from Dr. Foster Intelligence, during the conduct of the study; no financial relationships with any organisation that might have interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Flow diagram of studies selected for meta-analysis
Fig. 2
Fig. 2
Pooled estimate for mortality between weekend and weekday patients. Patients who were admitted at the weekends had a significantly higher mortality (OR: 1.07; 95% CI 1.03 to 1.12)
See this image and copyright information in PMC

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