Dialysis Patients Hospitalized on Weekends Have Worse Outcomes

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HD patients admitted on weekends are 18% more likely to die in the first three days.
HD patients admitted on weekends are 18% more likely to die in the first three days.

Maintenance dialysis patients hospitalized over weekends have increased mortality rates and longer lengths of stay compared with those admitted during weekdays, according to researchers.

Ankit Sakhuja, MD, of Cleveland Clinic, and colleagues analyzed 3,278,572 nonelective hospital admissions of maintenance dialysis patients, of which 704,491 occurred over weekends and 2,574,081 occurred during weekdays. After adjusting for potential confounders, patients hospitalized over weekends had a 6% higher in-hospital mortality risk than those admitted on weekdays and an 18% higher mortality risk during the first three days of admission, Dr. Sakhuja's group reported in the American Journal of Kidney Diseases (2013;62:763-770). 

Compared with patients admitted on weekdays, those admitted over a weekend were less likely to be discharged to home and more likely to be discharged to long-term skilled nursing facilities, the researchers reported. In addition, the adjusted time to death was 9% shorter and the adjusted length of hospital stay of survivors was 3% longer in patients admitted over a weekend versus those admitted on a weekday.

The phenomenon of more unfavorable outcomes associated with weekend hospital admissions has been demonstrated in other patient populations, including those with acute kidney injury, myocardial infarction, and stroke, the investigators pointed out. Potential explanations include differential staffing models with limited availability of clinician expertise, unmeasured differences in severity of illness, and decreased accessibility to diagnostic and therapeutic procedures, the authors wrote.

The researchers classified weekend admissions as those occurring from midnight Friday to midnight Sunday, and noted that this does not take into account that healthcare services on Friday evenings, early mornings on Mondays , and holidays likely are similar to those provided over weekends. “We therefore may have underestimated the worse outcomes over weekends,” they stated.

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