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(Circulation. 2009;119:962-968.)
© 2009 American Heart Association, Inc.

Health Services and Outcomes Research

Weekend Versus Weekday Admission and Mortality After Acute Pulmonary Embolism

Drahomir Aujesky, MD, MSc; David Jiménez, MD; Maria K. Mor, PhD; Ming Geng, MS; Michael J. Fine, MD, MSc; Said A. Ibrahim, MD, MPH

From the Division of General Internal Medicine, University of Lausanne (D.A.), Lausanne, Switzerland; Respiratory Department, Ramón y Cajal Hospital (D.J.), Madrid, Spain; VA Center for Health Equity Research and Promotion (M.K.M., M.G., M.J.F., S.A.I.), Pittsburgh, Pa; and Department of Biostatistics, Graduate School of Public Health (M.K.M., M.G.) and Division of General Internal Medicine, Department of Medicine (M.J.F., S.A.I.), University of Pittsburgh, Pittsburgh, Pa.

Correspondence to Drahomir Aujesky, MD, MSc, Service de Médecine Interne, BH 10-622, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland. E-mail drahomir.aujesky{at}chuv.ch

Received September 25, 2008; accepted December 9, 2008.

Background— Optimal management of acute pulmonary embolism (PE) requires medical expertise, diagnostic testing, and therapies that may not be available consistently throughout the entire week. We sought to assess whether associations exist between weekday or weekend admission and mortality and length of hospital stay for patients hospitalized with PE.

Methods and Results— We evaluated patients discharged with a primary diagnosis of PE from 186 acute care hospitals in Pennsylvania (January 2000 to November 2002). We used random-effect logistic models to study the association between weekend admission and 30-day mortality and used discrete survival models to study the association between weekend admission and time to hospital discharge, adjusting for hospital (region, size, and teaching status) and patient factors (race, insurance, severity of illness, and use of thrombolytic therapy). Among 15 531 patient discharges with PE, 3286 patients (21.2%) had been admitted on a weekend. Patients admitted on weekends had a higher unadjusted 30-day mortality rate (11.1% versus 8.8%) than patients admitted on weekdays, with no difference in length of stay. Patients admitted on weekends had significantly greater adjusted odds of dying (odds ratio 1.17, 95% confidence interval 1.03 to 1.34) than patients admitted on weekdays. The higher mortality among patients hospitalized on weekends was driven by the increased mortality rate among the most severely ill patients.

Conclusions— Patients with PE who are admitted on weekends have a significantly higher short-term mortality than patients admitted on weekdays. Quality-improvement efforts should aim to ensure a consistent approach to the management of PE 7 days a week.

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