The Weekend Effect: An Assessment of Mortality During Emergent Hepatocellular Carcinoma Hospitalizations

Patients with hepatocellular carcinoma (HCC) are frequently hospitalized emergently. Studies that describe the factors associated with HCC-related mortality during hospitalizations are limited. We sought to use a nationally representative database to investigate whether a weekend versus non-weekend admission was associated with increased odds of mortality in hospitalized patients with HCC.

We studied patients aged 21 years and above in the Nationwide Inpatient Sample database,(NIS), who were hospitalized from 2001-2010 with a diagnosis of HCC (identified using ICD9 code 1550). We excluded patients without urgent or emergent admission types, as well as with missing data on key variables of interest. Multivariable logistic regression was performed to investigate the adjusted odds of mortality comparing weekend and non weekend admissions. Discharge level weights were applied to the analyses. Our model adjusted for patient level factors, hospital factors, and discharge year.

A total of 30,087 patients’ records met the inclusion criteria, comprising 6,641       (22.0%) with a weekend admission. Overall, patients were predominantly male (72.9%), insured (90.7%), treated at a teaching hospital (61.2%), and at an urban location (91.8%). Proportion of black patients and female patients admitted did not differ by weekend or weekday status (13.0% vs 12.6%, P=0.40 and 27.5% vs 27.0%, P=0.43, respectively). There was also no difference in the mean age of patients admitted over the weekend versus weekday (66.3 vs 66.5, P=0.29)

Patients admitted during a weekend had equal odds of undergoing a procedure compared to weekday admissions (adjusted odds ratio [OR], 0.99; 95%confidence interval [CI], 0.90-1.09). However, weekend admissions were associated with an increased odds of mortality compared to weekday admissions (OR 1.17; 95%CI, 1.08-0.28). Female gender (OR 0.89; 95% CI, 0.82–0.97), teaching hospital (OR 0.86; 95% CI, 0.76–0.96), and urban location  (OR 0.73; 95% CI, 0.60–0.87) were associated with reduced odds of mortality. Compared to white race, Blacks and Asian/Pacific Islanders had increased overall mortality [(OR 1.14; 95% CI, 1.00–1.29) and (OR 1.23; 95% CI, 1.04–1.47) respectively].

Among emergently hospitalized patients with HCC, weekend admission is associated with an increased odds of mortality. Studies are needed to define the factors that increase the risk for death in HCC patients hospitalized during the weekend.