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  • Is the weekend effect really ubiquitous? A retrospective clinical cohort analysis of 30-day mortality by day of week and time of day using linked population data from New South Wales, Australia

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Health services research
Research
Is the weekend effect really ubiquitous? A retrospective clinical cohort analysis of 30-day mortality by day of week and time of day using linked population data from New South Wales, Australia
  1. Heather J Baldwin1,2,
  2. Sadaf Marashi-Pour1,
  3. Huei-Yang Chen1,
  4. Jill Kaldor1,
  5. Kim Sutherland1,
  6. Jean-Frederic Levesque3
  1. 1 Bureau of Health Information, Chatswood, New South Wales, Australia
  2. 2 Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, New South Wales, Australia
  3. 3 Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Jean-Frederic Levesque; JeanFrederic.Levesque{at}health.nsw.gov.au

Abstract

Objective To examine the associations between day of week and time of admission and 30-day mortality for six clinical conditions: ischaemic and haemorrhagic stroke, acute myocardial infarction, pneumonia, chronic obstructive pulmonary disease and congestive heart failure.

Design Retrospective population-based cohort analyses. Hospitalisation records were linked to emergency department and deaths data. Random-effect logistic regression models were used, adjusting for casemix and taking into account clustering within hospitals.

Setting All hospitals in New South Wales, Australia, from July 2009 to June 2012.

Participants Patients admitted to hospital with a primary diagnosis for one of the six clinical conditions examined.

Outcome measures Adjusted ORs for all-cause mortality within 30 days of admission, by day of week and time of day.

Results A total of 148 722 patients were included in the study, with 17 721 deaths within 30 days of admission. Day of week of admission was not associated with significantly higher likelihood of death for five of the six conditions after adjusting for casemix. There was significant variation in mortality for chronic obstructive pulmonary disease by day of week; however, this was not consistent with a strict weekend effect (Thursday: OR 1.29, 95% CI 1.12 to 1.48; Friday: OR 1.25, 95% CI 1.08 to 1.44; Saturday: OR 1.18, 95% CI 1.02 to 1.37; Sunday OR 1.05, 95% CI 0.90 to 1.22; compared with Monday). There was evidence for a night effect for patients admitted for stroke (ischaemic: OR 1.30, 95% CI 1.17 to 1.45; haemorrhagic: OR 1.58, 95% CI 1.40 to 1.78).

Conclusions Mortality outcomes for these conditions, adjusted for casemix, do not vary in accordance with the weekend effect hypothesis. Our findings support a growing body of evidence that questions the ubiquity of the weekend effect.

  • public health
  • quality in health care
  • health policy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-016943

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    Footnotes

    • Contributors HJB, SM-P, H-YC, JK, KS and J-FL contributed to the study design. HJB and SM-P cleaned and analysed the data and HJB produced the figure and tables. All authors contributed to the interpretation of the results. HJB drafted the manuscript, and all authors contributed to revising the manuscript. All authors approved the final version of the manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval New South Wales Ministry of Health approves our use of these deidentified data for research purposes.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Privacy restrictions for the datasets used in this study prohibit free online availability. Access to these data may be sought from the data custodians, the New South Wales Ministry of Health.

    • Correction notice This article has been corrected since it first published. In the article title ‘A retrospective clinical analyses’ was corrected to ‘A retrospective clinical analysis’.

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