Weekend hospitalization and additional risk of death: an analysis of inpatient data.
OBJECTIVE
To assess whether weekend admissions to hospital and/or already being an inpatient on weekend days were associated with any additional mortality risk.


METHODS
Retrospective observational survivorship study. We analysed all admissions to the English National Health Service (NHS) during the financial year 2009/10, following up all patients for 30 days after admission and accounting for risk of death associated with diagnosis, co-morbidities, admission history, age, sex, ethnicity, deprivation, seasonality, day of admission and hospital trust, including day of death as a time dependent covariate. The principal analysis was based on time to in-hospital death.


METHODS
National Health Service Hospitals in England.


METHODS
30 day mortality (in or out of hospital).


RESULTS
There were 14,217,640 admissions included in the principal analysis, with 187,337 in-hospital deaths reported within 30 days of admission. Admission on weekend days was associated with a considerable increase in risk of subsequent death compared with admission on weekdays, hazard ratio for Sunday versus Wednesday 1.16 (95% CI 1.14 to 1.18; P < .0001), and for Saturday versus Wednesday 1.11 (95% CI 1.09 to 1.13; P < .0001). Hospital stays on weekend days were associated with a lower risk of death than midweek days, hazard ratio for being in hospital on Sunday versus Wednesday 0.92 (95% CI 0.91 to 0.94; P < .0001), and for Saturday versus Wednesday 0.95 (95% CI 0.93 to 0.96; P < .0001). Similar findings were observed on a smaller US data set.


CONCLUSIONS
Admission at the weekend is associated with increased risk of subsequent death within 30 days of admission. The likelihood of death actually occurring is less on a weekend day than on a mid-week day.
Department of Primary Care & Population Health, University College London NW3 2PF,  UK.
N
N
Freemantle
M
M
Richardson
J
J
Wood
D
D
Ray
S
S
Khosla
D
D
Shahian
W R
WR
Roche
I
I
Stephens
B
B
Keogh
D
D
Pagano
D004739:England; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013222:State Medicine; D015996:Survival Rate; D013997:Time Factors