Mortality after discharge from the intensive care unit during the early weekend period: a population-based cohort study in Denmark.
BACKGROUND
As a result of a shortage of intensive care capacity, patients may be discharged prematurely early during weekends which may lead to an increased mortality and risk of readmission to intensive care units (ICU). We examined whether discharge from the ICU during the first part of the weekend was associated with an increased mortality and readmission to the ICU.


METHODS
The study was conducted at a university clinic of internal medicine and included all patients admitted for the first time to the ICU, and discharged alive in the period 1 January 2001 to 31 December 2005. Patients were divided in those discharged between 00.00 h Friday and 24.00 h Saturday (weekend group) and those discharged Sunday to Thursday (non-weekend group). The main outcome was time from discharge from the ICU to the combined endpoint death or re-admission to ICU which ever came first. We used Kaplan-Meier analysis and Cox's proportional-hazards regression to compute survival curves and risk ratio estimates.


RESULTS
There were 228 patients in the weekend group and 555 patients in the non-weekend group. Crude and adjusted 28-day risk ratio of the combined endpoint was 1.50 [95% confidence interval (CI): 1.15-1.97] and 1.43 (1.09-1.87) in the weekend group. Although an increased risk of death was observed in the weekend group immediately after discharge from the ICU, the difference in mortality between the two groups had disappeared after 2 years.


CONCLUSIONS
Medical patients discharged from the ICU early in the weekends seem to have an increased mortality and risk of readmission to the ICU.
Obel
N
N
Department of Internal Medicine C, Odense University Hospital and University of Southern Denmark, Odense, Denmark. niels.obel@ouh.fyns-amt.dk
Schierbeck
J
J
Pedersen
L
L
Storgaard
M
M
Pedersen
C
C
Sørensen
H T
HT
Hansen
B
B
D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D015996:Survival Rate; D013997:Time Factors