An evaluation of the 'weekend effect' in patients admitted with metastatic prostate cancer - Abstract

OBJECTIVES: To investigate whether mortality is increased for patients with metastatic prostate cancer (mCaP) admitted over the weekend.

PATIENTS AND METHODS: Using the Nationwide Inpatient Sample (NIS) between 1998-2009, admitted patients with a diagnosis of prostate cancer and concomitant metastases were identified. Rates of in-hospital mortality, complications, utilization of imaging and procedures were assessed. Adjusted logistic regression models examined associations of mortality and complications.

RESULTS: A weighted sample of 534,011 patients with mCaP was identified, including 81.7% weekday and 18.3% weekend admissions. Of these, 8.6% died following a weekday vs. 10.9% after a weekend admission (p< 0.001). Patients admitted over the weekend were more likely treated at rural (17.8 vs. 15.7%), non-teaching (57.6 vs. 53.7%) and low volume hospitals (53.4 vs. 49.4%) (all p< 0.001) compared to weekday admissions. They presented higher rates of organ failure (25.2 vs. 21.3%), and were less likely to undergo an interventional procedure (10.6 vs. 11.4%) (all p< 0.001). More patients admitted over the weekend had pneumonia (12.2 vs. 8.8%), pyelonephritis (18.3 vs. 14.1%) and sepsis (4.5 vs. 3.5%) (all p< 0.001). In multivariate analysis, weekend admission was associated with an increased likelihood of complications (Odds ratio [OR]: 1.15, 95% Confidence Interval [CI]: 1.11-1.19) and mortality (OR: 1.20, 95% CI: 1.14- 1.27).

CONCLUSION: In patients with mCaP, weekend admissions are associated with a significant increase in mortality and morbidity. Our findings suggest that weekend patients may present with more acute medical issues; alternatively, the quality of care over the weekend may be inferior.

Written by:
Schmid M, Ghani KR, Choueiri TK, Sood A, Kapoor V, Abdollah F, Chun FK, Leow JJ, Olugbade K Jr, Sammon JD, Menon M, Kibel AS, Fisch M, Nguyen PL, Trinh QD.   Are you the author?
Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Reference: BJU Int. 2014 Aug 7. Epub ahead of print.
doi: 10.1111/bju.12891

PubMed Abstract
PMID: 25099032 Prostate Cancer Section