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Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample

Background: A large body of research has been conducted on the "weekend effect," which is the reportedly increased risk of adverse outcomes for patients admitted to the hospital on weekends versus those admitted on weekdays. This effect has been researched in numerous patient populations,...

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Autores principales: Uwumiro, Fidelis E, Okpujie, Victory O, Oyesomi, Aminnah, Madu, Festa C, Ilelaboye, Ayodeji, Shielu, Muhammed L, Otu, Ruth C, Ogunkoya, Grace D, Ezennaya, Loveth S, Bojerenu, Michael M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9948686/
https://www.ncbi.nlm.nih.gov/pubmed/36843711
http://dx.doi.org/10.7759/cureus.34139
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author Uwumiro, Fidelis E
Okpujie, Victory O
Oyesomi, Aminnah
Madu, Festa C
Ilelaboye, Ayodeji
Shielu, Muhammed L
Otu, Ruth C
Ogunkoya, Grace D
Ezennaya, Loveth S
Bojerenu, Michael M
author_facet Uwumiro, Fidelis E
Okpujie, Victory O
Oyesomi, Aminnah
Madu, Festa C
Ilelaboye, Ayodeji
Shielu, Muhammed L
Otu, Ruth C
Ogunkoya, Grace D
Ezennaya, Loveth S
Bojerenu, Michael M
author_sort Uwumiro, Fidelis E
collection PubMed
description Background: A large body of research has been conducted on the "weekend effect," which is the reportedly increased risk of adverse outcomes for patients admitted to the hospital on weekends versus those admitted on weekdays. This effect has been researched in numerous patient populations, including sub-populations of end-stage renal disease (ESRD) patients, with varying conclusions. Objectives: To assess whether differences in in-hospital mortality, access to renal replacement therapy (RRT), time to RRT, and other important outcomes exist in patients with ESRD or patients on RRT admitted on the weekend versus weekdays. Design and setting: A retrospective cohort study was conducted using the 2018 Nationwide Inpatient Sample. Patients were included if they were adults with a principal or secondary diagnosis of ESRD or if they were admitted with a diagnosis related to initiation, maintenance, or complications of RRT. Patients admitted between midnight Friday and midnight Sunday were classified as weekend admissions. Primary outcome measurements included in-hospital mortality, in-hospital dialysis (peritoneal dialysis, hemodialysis, and continuous RRT), and renal transplantation (TP). Secondary outcomes included length of hospital stay (LOS) and total hospitalization charges. Results: The study included 1,144,385 patients who satisfied the inclusion criteria. Compared with patients admitted on weekdays, patients with ESRD admitted on weekends had 8% higher adjusted odds of in-hospital mortality (OR: 1.08; 95% CI: 1.03-1.13; p = 0.002), 9% lower adjusted OR of any RRT over the weekend than on weekdays (OR: 0.91; 95% CI: 0.89-0.93; p = 0.000), lower RRT rates (within 24 hours) (adjusted OR: 0.71; 95% CI: 0.70-0.73; p = 0.000), higher odds of renal TP (adjusted OR: 1.32; 95% CI: 1.20-1.45; p = 0.000), and higher hospitalization charges (mean adjusted increase: $1451; p = 0.07). Limitations: The limitations of the study include the use of retrospective data and an administrative database. Conclusion: Compared with weekday admissions, patients with ESRD admitted on weekends had higher odds of mortality, higher mean hospitalization charges, and higher odds of renal TP. They had lower overall RRT rates, and a longer time to first RRT. However, the average LOS was similar for both weekend and weekday admissions.
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spelling pubmed-99486862023-02-24 Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample Uwumiro, Fidelis E Okpujie, Victory O Oyesomi, Aminnah Madu, Festa C Ilelaboye, Ayodeji Shielu, Muhammed L Otu, Ruth C Ogunkoya, Grace D Ezennaya, Loveth S Bojerenu, Michael M Cureus Internal Medicine Background: A large body of research has been conducted on the "weekend effect," which is the reportedly increased risk of adverse outcomes for patients admitted to the hospital on weekends versus those admitted on weekdays. This effect has been researched in numerous patient populations, including sub-populations of end-stage renal disease (ESRD) patients, with varying conclusions. Objectives: To assess whether differences in in-hospital mortality, access to renal replacement therapy (RRT), time to RRT, and other important outcomes exist in patients with ESRD or patients on RRT admitted on the weekend versus weekdays. Design and setting: A retrospective cohort study was conducted using the 2018 Nationwide Inpatient Sample. Patients were included if they were adults with a principal or secondary diagnosis of ESRD or if they were admitted with a diagnosis related to initiation, maintenance, or complications of RRT. Patients admitted between midnight Friday and midnight Sunday were classified as weekend admissions. Primary outcome measurements included in-hospital mortality, in-hospital dialysis (peritoneal dialysis, hemodialysis, and continuous RRT), and renal transplantation (TP). Secondary outcomes included length of hospital stay (LOS) and total hospitalization charges. Results: The study included 1,144,385 patients who satisfied the inclusion criteria. Compared with patients admitted on weekdays, patients with ESRD admitted on weekends had 8% higher adjusted odds of in-hospital mortality (OR: 1.08; 95% CI: 1.03-1.13; p = 0.002), 9% lower adjusted OR of any RRT over the weekend than on weekdays (OR: 0.91; 95% CI: 0.89-0.93; p = 0.000), lower RRT rates (within 24 hours) (adjusted OR: 0.71; 95% CI: 0.70-0.73; p = 0.000), higher odds of renal TP (adjusted OR: 1.32; 95% CI: 1.20-1.45; p = 0.000), and higher hospitalization charges (mean adjusted increase: $1451; p = 0.07). Limitations: The limitations of the study include the use of retrospective data and an administrative database. Conclusion: Compared with weekday admissions, patients with ESRD admitted on weekends had higher odds of mortality, higher mean hospitalization charges, and higher odds of renal TP. They had lower overall RRT rates, and a longer time to first RRT. However, the average LOS was similar for both weekend and weekday admissions. Cureus 2023-01-24 /pmc/articles/PMC9948686/ /pubmed/36843711 http://dx.doi.org/10.7759/cureus.34139 Text en Copyright © 2023, Uwumiro et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Uwumiro, Fidelis E
Okpujie, Victory O
Oyesomi, Aminnah
Madu, Festa C
Ilelaboye, Ayodeji
Shielu, Muhammed L
Otu, Ruth C
Ogunkoya, Grace D
Ezennaya, Loveth S
Bojerenu, Michael M
Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample
title Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample
title_full Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample
title_fullStr Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample
title_full_unstemmed Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample
title_short Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample
title_sort weekend effect on mortality, access to renal replacement therapy, and other outcomes among patients with end-stage renal disease: a retrospective analysis of the nationwide inpatient sample
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9948686/
https://www.ncbi.nlm.nih.gov/pubmed/36843711
http://dx.doi.org/10.7759/cureus.34139
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