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. 2025 Jun 12;13(12):1412.
doi: 10.3390/healthcare13121412.

The Weekend Effect on In-Hospital Mortality-First 13-Year Retrospective Observational Study in Slovakia

Orsolya Hrubá  1 , Lucia Žigová  1 , Michala Hrončová  1 , Simona Valášková  2   3 , Juraj Smaha  3 , Peter Jackuliak  3 , Martin Kužma  3 , Alexander Mayer  4 , Andrej Dukat  3 , Juraj Payer  3 , Jan Kyselovic  3   5 , Andrea Gažová  1
Affiliations

The Weekend Effect on In-Hospital Mortality-First 13-Year Retrospective Observational Study in Slovakia

Orsolya Hrubá et al. Healthcare (Basel). .

Abstract

Objectives: The "weekend effect" refers to the higher risk of death for patients admitted to hospitals on weekends compared to weekdays. While this pattern is well documented in many countries, there is limited data from Central Europe, including Slovakia.

Study design: We conducted a 13-year retrospective study at a large internal medicine department in Bratislava, Slovakia, to determine (1) whether there is a weekend effect, (2) which patient groups are most affected, and (3) what clinical and demographic factors might play a role.

Methods: Using statistical tests, we analysed 45,955 hospitalisations between 2010 and 2022, comparing mortality rates between weekday (Monday-Friday) and weekend (Saturday-Sunday) admissions. We also used logistic regression to adjust for age, gender, length of stay, and re-hospitalisation. Causes of death were classified using ICD-10 codes.

Results: Patients admitted on weekends had a significantly higher in-hospital mortality rate (15.58%, 1203 deaths among 7719 admissions) than patients admitted on weekdays (10.47%, 4002 deaths among 38,236 admissions, p < 0.0001). Even after adjusting for other factors, weekend admission remained a strong predictor of death (adjusted odds ratio = 1.31, 95% CI: 1.22-1.41). Cardiovascular disease was the most common cause of death on weekends. The weekend effect persisted across all years and was particularly pronounced in the COVID-19 pandemic (2020-2021).

Conclusions: Our findings confirm the weekend effect in Slovakia, with patients admitted on weekends facing a higher risk of in-hospital death. Identifying the reasons behind this trend is critical to improving hospital care and ensuring consistent quality of care throughout the week.

Keywords: mortality rate; retrospective cohort; weekend admissions; weekend effect.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of exclusion criteria and final cohort.
Figure 2
Figure 2
Total hospital admissions, in-hospital deaths, and mortality rates by day of admission (2010–2022) with 95% CI.
Figure 3
Figure 3
Trends in weekday vs. weekend mortality rates 2010–2022.
See this image and copyright information in PMC

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