Increased Mortality Among Patients With Acute Leukemia Admitted on Weekends Compared to Weekdays

Micro-Abstract The mortality of patients admitted on the weekends was compared with that on weekdays. There was significantly increased mortality among acute leukemia patients admitted on a weekend. We also conclude that patients admitted to teaching hospitals have a better outcome. This study emphasizes the importance of availability of resources and early presentation to tertiary care centers for acute leukemia patients. Background The association between weekend admission and patient outcomes has been reported in several acute illnesses but is unknown in acute leukemia. Patients and Methods We used the 2002 to 2014 Nationwide Inpatient Sample to identify patients admitted with a primary diagnosis of acute leukemia. Admissions were classified as weekend or weekday admissions for comparison. Hierarchical logistic regression models were used to analyze predictors of hospital mortality. Results There was a 22.3% decline in acute leukemia admissions in 2014 compared to 2002 and a 4% decline in in-hospital mortality (19.0%-14.9%; P <.001). A total of 82,833 admissions were included in the study, and 14,241 (17.19%) occurred over the weekend. Hospital mortality was higher for weekend than weekday admissions (18.8% vs. 16.1%; P <.001). Weekend admissions were less likely to undergo early bone marrow biopsy than their weekday counterparts (27.5% vs. 46.3%; P <.01). Bone marrow biopsy (adjusted odds ratio 0.36; 95% confidence interval [CI], 0.33-0.39; P <.001) and admission to a teaching hospital (adjusted odds ratio, 0.65; 95% CI, 0.56-0.75; P <.001) independently predicted lower hospital mortality. Weekend admission was associated with higher hospital mortality (adjusted odds ratio, 1.12; 95 CI, 1.02-1.23; P =.01) and more complications (50.6% vs. 47.8%; P <.001) than weekday admissions. Conclusion There was significantly increased mortality among weekend admissions for acute leukemia. Mortality was reduced among patients admitted to teaching hospitals.