Increased Mortality Among Patients With Acute Leukemia Admitted on Weekends Compared to Weekdays

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Abstract

Micro-Abstract

The mortality of patients admitted on the weekends was compared with that on weekdays. There was significantly increased mortality among acute leukemia patients admitted on a weekend. We also conclude that patients admitted to teaching hospitals have a better outcome. This study emphasizes the importance of availability of resources and early presentation to tertiary care centers for acute leukemia patients.

Background:

The association between weekend admission and patient outcomes has been reported in several acute illnesses but is unknown in acute leukemia.

Patients and Methods:

We used the 2002 to 2014 Nationwide Inpatient Sample to identify patients admitted with a primary diagnosis of acute leukemia. Admissions were classified as weekend or weekday admissions for comparison. Hierarchical logistic regression models were used to analyze predictors of hospital mortality.

Results:

There was a 22.3% decline in acute leukemia admissions in 2014 compared to 2002 and a 4% decline in in-hospital mortality (19.0%-14.9%; P < .001). A total of 82,833 admissions were included in the study, and 14,241 (17.19%) occurred over the weekend. Hospital mortality was higher for weekend than weekday admissions (18.8% vs. 16.1%; P < .001). Weekend admissions were less likely to undergo early bone marrow biopsy than their weekday counterparts (27.5% vs. 46.3%; P < .01). Bone marrow biopsy (adjusted odds ratio 0.36; 95% confidence interval [CI], 0.33-0.39; P < .001) and admission to a teaching hospital (adjusted odds ratio, 0.65; 95% CI, 0.56-0.75; P < .001) independently predicted lower hospital mortality. Weekend admission was associated with higher hospital mortality (adjusted odds ratio, 1.12; 95 CI, 1.02-1.23; P = .01) and more complications (50.6% vs. 47.8%; P < .001) than weekday admissions.

Conclusion:

There was significantly increased mortality among weekend admissions for acute leukemia. Mortality was reduced among patients admitted to teaching hospitals.

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