Trinity College Dublin, The University of Dublin Trinity College, Dublin, Ireland.
St. James's Hospital, Dublin, Ireland.
Ir J Med Sci. 2024 Oct;193(5):2139-2145. doi: 10.1007/s11845-024-03729-y. Epub 2024 Jun 11.
Acute medical admission at the weekend has been reported to be associated with increased mortality. We aimed to assess 30-day in-hospital mortality and subsequent follow-up of all community deaths following discharge for acute medical admission to our institution over 21 years.
We employed a database of all acute medical admissions to our institution over 21 years (2002-2023). We compared 30-day in-hospital mortality by weekend (Saturday/Sunday) or weekday (Tuesday/Wednesday) admission. Outcome post-discharge was determined from the National Death Register to December 2021. Predictors of 30-day in-hospital and long-term mortality were analysed by logistic regression or Cox proportional hazards models.
The study population consisted of 109,232 admissions in 57,059 patients. A weekend admission was associated with a reduced 30-day in-hospital mortality, odds ratio (OR) 0.70 (95%CI 0.65, 0.76). Major predictors of 30-day in-hospital mortality were acute illness severity score (AISS) OR 6.9 (95%CI 5.5, 8.6) and comorbidity score OR 2.4 (95%CI 1.2, 4.6). At a median follow-up of 5.9 years post-discharge, 19.0% had died. The strongest long-term predictor of mortality was admission AISS OR 6.7 (95%CI 4.6, 9.9). The overall survival half-life after hospital discharge was 16.6 years. Survival was significantly worse for weekend admissions at 20.8 years compared to weekday admissions at 13.3 years.
Weekend admission of acute medical patients is associated with reduced 30-day in-hospital mortality but reduced long-term survival.
据报道，周末急性内科入院与死亡率增加有关。我们旨在评估 21 年来我院所有急性内科入院患者的 30 天院内死亡率和随后出院后的社区死亡情况。
我们使用了 21 年来我院所有急性内科入院患者的数据库（2002-2023 年）。我们比较了周末（周六/周日）和工作日（周二/周三）入院的 30 天院内死亡率。出院后的结果通过国家死亡登记处确定到 2021 年 12 月。通过逻辑回归或 Cox 比例风险模型分析 30 天院内和长期死亡率的预测因素。
研究人群包括 57059 例患者的 109232 例入院。周末入院与 30 天院内死亡率降低相关，比值比（OR）为 0.70（95%CI 0.65，0.76）。30 天院内死亡率的主要预测因素是急性疾病严重程度评分（AISS）OR 6.9（95%CI 5.5，8.6）和合并症评分 OR 2.4（95%CI 1.2，4.6）。出院后中位随访 5.9 年，19.0%的患者死亡。死亡率最强的长期预测因素是入院 AISS OR 6.7（95%CI 4.6，9.9）。出院后 16.6 年的总体生存半衰期。与工作日入院相比，周末入院的总生存率为 20.8 年，明显较差，为 13.3 年。
周末急性内科患者入院与 30 天院内死亡率降低但长期生存率降低有关。
