Chest
Volume 142, Issue 3, September 2012, Pages 690-696
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Original Research
Pulmonary Vascular Disease
Pulmonary Embolism: The Weekend Effect

https://doi.org/10.1378/chest.11-2663Get rights and content

Background

Pulmonary embolism is a common, often fatal condition that requires timely recognition and rapid institution of therapy. Previous studies have documented worse outcomes for weekend admissions for a variety of time-sensitive medical conditions. This phenomenon has not been clearly demonstrated for pulmonary embolism.

Methods

We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the years 2000 to 2008 to identify people with a principal discharge diagnosis of pulmonary embolism. We classified admissions as weekend if they occurred between midnight Friday and midnight Sunday. We compared all-cause in-hospital mortality between weekend and weekday admissions and investigated the timing of inferior vena cava (IVC) filter placement and thrombolytic infusion as potential explanations for differences in mortality.

Results

Unadjusted mortality was higher for weekend admissions than weekday admissions (OR, 1.19; 95% CI, 1.13–1.24). This increase in mortality remained statistically significant after controlling for potential confounding variables (OR, 1.17; 95% CI, 1.11–1.22). Among patients who received an IVC filter, a larger proportion of those admitted on a weekday than on the weekend received it on their first hospital day (38% vs 29%, P < .001). The timing of thrombolytic therapy did not differ between weekday and weekend admissions.

Conclusions

Weekend admissions for pulmonary embolism were associated with higher mortality than weekday admissions. Our finding that IVC filter placement occurred later in the hospital course for patients admitted on weekends with pulmonary embolism suggests differences in the timeliness of diagnosis and treatment between weekday and weekend admissions. Regardless of cause, physicians should be aware that weekend admissions for pulmonary embolism have a 20% increased risk of death and warrant closer attention than provided during the week.

Section snippets

Data Source

We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS), a large, publicly available database of inpatient care in the United States. It is an administrative data set created by the Agency for Healthcare Research and Quality from data contributed by participating states. Each year, the NIS includes data on 5 to 8 million hospital stays from about 1,000 hospitals selected to approximate a 20% stratified sample of US hospitals. All hospital types are sampled,

Results

We estimated that there were 1,143,707 discharges with the principal diagnosis of PE among hospitals represented in the NIS during the years 2000 to 2008. Of these, 248,592 (21.7%) were weekend admissions.

Discussion

Using nationally representative data, we show that in-hospital mortality of patients given a principal diagnosis of PE between 2000 to 2008 was significantly higher if patients were admitted on a weekend compared to a weekday. This effect persisted independently from demographic characteristics, hospital characteristics, region, and number of comorbid conditions. Although hospital mortality rates for PE declined across the 9 years we studied, the magnitude of the weekend effect remained

Acknowledgments

Author contributions: Dr Nanchal had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Nanchal: contributed to the study design, statistical analysis, and writing of the manuscript.

Dr Kumar: contributed to the study design, statistical analysis, and writing of the manuscript.

Dr Taneja: contributed to the critical review and revision of the manuscript.

Dr Patel: contributed to the critical review and

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    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

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