Abstract: TH-PO826

Weekend versus Weekday Admission in Dialysis Dependent Patients Requiring Hospitalization – A Nationwide Analysis

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Wen, Yumeng, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
  • Pan, Di, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
  • Mariuma, David, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
  • Gramuglia, Michael, Montefiore Medical Center, Scarsdale, New York, United States
  • Meisels, Ira S., Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
Background

End Stage Renal Disease (ESRD) is a major cause of worldwide mortality and morbidity. ESRD requiring chronic dialysis is associated with high mortality and morbidity, requiring frequent hospitalization for complications from dialysis and comorbidities. The aim of this study is to determine the differences in outcomes and resource utilization of dialysis dependent patients hospitalized on weekends compared to weekdays.

Methods

This is a retrospective cohort study using the 2014 National Inpatient Sample, the largest publically available inpatient database in the United States. The inclusion criteria were age above 18 and an ICD-9 CM code for diagnosis of ESRD on chronic dialysis. Patients hospitalized for elective procedures were excluded. The primary outcome was in-hospital mortality. The secondary outcomes were morbidities, as measured by the development of shock and acute respiratory failure, as well as resource utilization including length of hospital stay (LOS) and total hospitalization charges. Analysis is performed by using Stata, version 14.2. Odds ratio (OR) and means were adjusted for the following confounders using multivariate regression models: demographics, Charlson Comorbidity Index, early dialysis in hospital (defined as receiving dialysis within 1 day of admission), primary insurance, hospital bedsize, hospital region and household income.

Results

934,575 patients with ESRD on chronic dialysis were included in the study. Patients admitted on weekends were associated with significantly higher in-hospital mortality rates (5.45% versus 4.87%, p=0.02) and higher rate of acute respiratory failure (3.89% versus 3.32%, OR 1.11, p=0.001). The development of shock was not significantly different (OR 0.97, p=0.69). Weekend admission was associated with greater length of stay (6.90 versus 6.89, p<0.001), however the total hospital charges were not significantly different (p=0.07). Patients admitted on weekends had lower rate of receiving early dialysis (43.72% versus 52.72%, p<0.001).

Conclusion

Compared to weekday admission, weekend admission in patients with ESRD on chronic dialysis was associated with higher rates of mortality and acute respiratory failure, as well as greater length of stay even after controlling for early dialysis. Patients admitted on weekends were less likely to receive early dialysis.