Weekend hospital admission, acute kidney injury, and mortality.
Admission to the hospital on weekends is associated with increased mortality for several acute illnesses. We investigated whether patients admitted on a weekend with acute kidney injury (AKI) were more likely to die than those admitted on a weekday. Using the Nationwide Inpatient Sample, a large database of admissions to acute care, nonfederal hospitals in the United States, we identified 963,730 admissions with a diagnosis of AKI between 2003 and 2006. Of these, 214,962 admissions (22%) designated AKI as the primary reason for admission (45,203 on a weekend and 169,759 on a weekday). We used logistic regression models to examine the adjusted odds of in-hospital mortality associated with weekend versus weekday admission. Compared with admission on a weekday, patients admitted with a primary diagnosis of AKI on a weekend had a higher odds of death [adjusted odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02 to 1.12]. The risk for death with admission on a weekend for AKI was more pronounced in smaller hospitals (adjusted OR 1.17, 95% CI 1.03 to 1.33) compared with larger hospitals (adjusted OR 1.07, 95% CI 1.01 to 1.13). Increased mortality was also associated with weekend admission among patients with AKI as a secondary diagnosis across a spectrum of co-existing medical diagnoses. In conclusion, among patients hospitalized with AKI, weekend admission is associated with a higher risk for death compared with admission on a weekday.
James
Matthew T
MT
Department of Medicine, University of Calgary, Alberta, Canada.
Wald
Ron
R
Bell
Chaim M
CM
Tonelli
Marcello
M
Hemmelgarn
Brenda R
BR
Waikar
Sushrut S
SS
Chertow
Glenn M
GM
D058186:Acute Kidney Injury / Q000401:mortality*; D015897:Comorbidity; D017052:Hospital Mortality; D006801:Humans; D010343:Patient Admission / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013997:Time Factors; D014481:United States / Q000453:epidemiology
N Engl J Med. 2001 Nov 8;345(19):1368-77
11794169
JAMA. 2008 Feb 20;299(7):793-805
18285591
Intensive Care Med. 2004 May;30(5):895-901
15007545
J Am Soc Nephrol. 2006 Apr;17(4):1135-42
16495381
Am J Med. 2004 Aug 1;117(3):151-7
15276592
N Engl J Med. 2008 Jul 3;359(1):7-20
18492867
Am J Med. 2004 Aug 1;117(3):175-81
15276596
Cerebrovasc Dis. 2005;20(5):325-31
16131801
Crit Care Med. 2007 Jan;35(1):3-11
17080000
J Emerg Nurs. 2007 Feb;33(1):6-13; quiz 90
17258046
N Engl J Med. 2007 Mar 15;356(11):1099-109
17360988
Am J Kidney Dis. 2008 Aug;52(2):272-84
18562058
Crit Care Med. 2002 Oct;30(10):2205-11
12394945
Lancet. 1994 Feb 5;343(8893):311-22
7905143
J Am Soc Nephrol. 2006 Apr;17(4):1143-50
16495376
Clin J Am Soc Nephrol. 2006 Sep;1(5):915-9
17699307
J Clin Epidemiol. 1992 Jun;45(6):613-9
1607900
JAMA. 2005 Aug 17;294(7):803-12
16106005
J Am Soc Nephrol. 2006 Jun;17(6):1688-94
16641149
Clin J Am Soc Nephrol. 2007 Jul;2(4):623-30
17699474
N Engl J Med. 2001 Aug 30;345(9):692-4
11547726
J Chronic Dis. 1987;40(5):373-83
3558716
J Crit Care. 2008 Sep;23(3):317-24
18725035
Stroke. 2007 Apr;38(4):1211-5
17347472
N Engl J Med. 2001 Aug 30;345(9):663-8
11547721
Br J Anaesth. 2006 Apr;96(4):450-4
16443639
Eur J Intern Med. 2006 Aug;17(5):322-4
16864005