Patients with metastatic prostate cancer (PCa) are more likely to die in the hospital if they are admitted on a weekend instead of a weekday, according to a new study.
Researchers led by Marianne Schmid, MD, of Harvard Medical School in Boston, used the National Inpatient Sample to identify 534,011 hospitalized patients with metastatic PCa. Of these, 81.7% were admitted on a weekday and 18.3% on a weekend. The in-hospital mortality rate was 8.6% for patients admitted on a weekend and 10.9% for those admitted on a weekend. In multivariate analysis, a weekend admission was associated with a significant 20% increased odds of death and 15% increased odds of complications compared with a weekday admission, Dr. Schmid’s team reported online ahead of print in BJU International.
Patients admitted over the weekend were significantly more likely than those admitted on weekdays to be treated at rural hospitals (17.8% vs. 15.7%), non-teaching hospitals (57.6% vs. 53.7%), and low-volume hospitals (53.4% vs. 49.4%). Weekend patients also were significantly less likely than weekday patients to undergo interventional procedures (10.6% vs. 11.4%), including cystoscopy with clot evacuation (4.0% vs. 34.4%) and ureteral stent/percutaneous nephrostomy tube placement (3.7% vs. 4.2%). They also were significantly less likely to undergo diagnostic imaging (5.7% vs. 6.5%).
The investigators discussed some hypotheses proposed to explain the cause of the “weekend effect.” Prior studies have suggested that decreased staffing on weekends may decrease the intensity of medical care provided in that setting. “This was congruent with data from our study which suggest that patients admitted over the weekend were less likely to undergo diagnostic imaging and procedures such as cystocopy with clot evacuation and ureteral stent/percutaneous nephrostomy tube.” Other studies suggest that physicians covering weekends often provide coverage for more patients and may be less familiar with them, they noted. “Taken together, patients presenting over the weekend may be subjected to delayed or inappropriate diagnosis and therapy,” the authors wrote.