Background: Weekend admissions have reportedly been associated with adverse outcomes and increased inpatient mortality[1]. This weekend phenomenon has been a subject of intense scrutiny and research. It has been attributed to fluctuations in healthcare personnel’s staffing and reduced or delayed access to diagnostic and therapeutic procedures. Patients admitted over the weekend are generally sicker than the weekday-admits, which may also explain the difference in outcomes[2]. The existence of the weekend effect has been debated and is not seen among all specialties. Patients admitted with certain conditions that require immediate intervention reportedly have increased mortality due to the inability to receive management promptly over the weekends[3, 4]. We conducted a National Inpatient Sample (NIS) database analysis to examine the weekend effect among primary systemic lupus erythematosus (SLE) hospitalizations.
Methods: We conducted a retrospective analysis of adult discharges from the NIS between 2004 and 2014. International Disease Classification codes were used to identify primary SLE hospitalizations. Prevalence estimates were weighted using NIS-provided discharge-level weights to reflect national estimates. Weighted multivariable logistic regression was used to assess the impact of weekend admission on in-hospital mortality, length of stay (LOS), and inflation-adjusted cost. These models were adjusted for patient age, gender, Charlson Comorbidity Index and hospital bed-size, location, teaching status, and region.
Results: A total of 138821 weighted primary SLE hospitalizations were identified from 2004-2014. Out of these, 110531 and 28290 weighted admissions occurred during weekdays and weekends, respectively. There was no significant difference in adjusted all-cause mortality (OR= 0.88, CI 0.67-1.15; p 0.354). Admissions on the weekends had a statistically significant higher adjusted log of LOS (days) (β 0.03, P=0.007) and inflation-adjusted hospital cost (β 0.05 P=<0.001) when compared to admissions on the weekdays.
Conclusions: Our study did not show any difference in mortality among SLE admissions on the weekends vs. weekdays. One plausible explanation for this could be that primary hospitalizations with SLE, unlike other conditions, may not have required interventions that were extremely time-sensitive. However, LOS and cost were significantly higher for the admissions that occurred during the weekends.