title: Off-Hour Admission and Mortality Risk for 28 Specific Diseases: A Systematic Review and Meta-Analysis of 251 Cohorts.
abstract: BACKGROUND
  A considerable amount of studies have examined the relationship between off-hours (weekends and nights) admission and mortality risk for various diseases, but the results remain equivocal.
  
  
  RESULTS
  Through a search of EMBASE, PUBMED, Web of Science, and Cochrane Database of Systematic Reviews, we identified cohort studies that evaluated the association between off-hour admission and mortality risk for disease. In a random effects meta-analysis of 140 identified articles (251 cohorts), off-hour admission was strongly associated with increased mortality for aortic aneurysm (odds ratio, 1.52; 95% CI, 1.30-1.77), breast cancer (1.50, 1.21-1.86), leukemia (1.45, 1.17-1.79), respiratory neoplasm (1.32, 1.20-1.26), pancreatic cancer (1.32, 1.12-1.56), malignant neoplasm of genitourinary organs (1.27, 1.08-1.49), colorectal cancer (1.26, 1.07-1.49), pulmonary embolism (1.20, 1.13-1.28), arrhythmia and cardiac arrest (1.19, 1.09-1.29), and lymphoma (1.19, 1.06-1.34). Weaker (odds ratio <1.19) but statistically significant association was noted for renal failure, traumatic brain injury, heart failure, intracerebral hemorrhage, subarachnoid hemorrhage, stroke, gastrointestinal bleeding, myocardial infarction, chronic obstructive pulmonary disease, and bloodstream infections. No association was found for hip fracture, pneumonia, intestinal obstruction, aspiration pneumonia, peptic ulcer, trauma, diverticulitis, and neonatal mortality. Overall, off-hour admission was associated with increased mortality for 28 diseases combined (odds ratio, 1.11; 95% CI, 1.10-1.13).
  
  
  CONCLUSIONS
  Off-hour admission is associated with increased mortality risk, and the associations varied substantially for different diseases. Specialists, nurses, as well as hospital administrators and health policymakers can take these findings into consideration to improve the quality and continuity of medical services.
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Yanfeng
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Wenzhen
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Chulani
authors.initials: C
authors.lastname: Herath
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Jiahong
authors.initials: J
authors.lastname: Xia
authors.affiliation: Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.affiliation: Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK.
authors.forename: Fujian
authors.initials: F
authors.lastname: Song
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China zuxunlu@yahoo.com hai_tao_cao@163.com.
authors.forename: Shiyi
authors.initials: S
authors.lastname: Cao
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China zuxunlu@yahoo.com hai_tao_cao@163.com.
authors.forename: Zuxun
authors.initials: Z
authors.lastname: Lu
mesh_terms: D039602:After-Hours Care; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D002423:Cause of Death; D016009:Chi-Square Distribution; D003141:Communicable Diseases / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016017:Odds Ratio; D010343:Patient Admission; D011379:Prognosis; D012044:Regression Analysis; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: disease; meta‐analysis; mortality; off‐hour