Effect of Weekend vs. Weekday Admission on Endocrine Emergencies Results from National Inpatient Sample Database 2016-2019
BACKGROUND: Limited studies exist to understand the effect of weekend vs. weekday admission on Endocrine emergencies. METHODS: We queried the National Inpatient Sample database from 2016-2019 for hospitalizations with a primary diagnosis of Endocrine emergencies (Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycemic State (HHS), Thyrotoxicosis, Myxedema coma and Addison's Crisis). We used NIS-predefined admission days to find whether the admission was on weekends or weekdays. We assessed the two groups' demographics, in-hospital mortality, length of stay, and cost of hospital admission. In-hospital mortality was adjusted for potential confounders using multivariable logistic regression analysis adjusting for baseline characteristics significantly different in univariate analysis (liberal threshold of p<0.20). RESULTS: From 2016 to 2019, we found 934,685 patients admitted for endocrine emergencies, of which 85.03% were for DKA, 9.63% were for HHS, 3.80% were for thyrotoxicosis, 1.12% were for Adrenal Crisis, and 0.41% were for Myxedema coma. Patients in the Weekday admission were older (43.76 vs. 43.25 years, p<0.001) with higher comorbidities like heart failure, obesity, valvular heart disease, and a higher Elixhauser comorbidity index (-3.09 vs. -3.19, p<0.001). In-hospital mortality was not statistically different in univariate analysis between weekend admission vs. weekday admission (0.55% vs. 0.49%, OR: 1.11, 95% CI: 0.97-1.28, p=0.136); however, when adjusted for the difference in comorbidities, we found slightly higher mortality in weekend admission compared to weekday admission (adjusted OR: 1.16, 95% CI: 1.01-1.34, p=0.039). We didn't find any cost difference between weekend and weekday admission ($8,043.50 vs. $8080.67 USD, p=0.437). We also didn't find any differences in length of stay between weekend and weekday admissions (3.38 days vs. 3.42 days, p=0.052). On Subgroup analysis of endocrine emergencies, we found a higher unadjusted (unadjusted OR: 1.82, 95% CI: 1.05-3.14, p=0.03) and adjusted (adjusted OR: 1.80, 95% CI: 1.02-3.16, p=0.042) in-hospital mortality in weekend admission vs. weekday admission for Myxedema Coma. We also found a higher adjusted in- hospital mortality (adjusted OR: 1.88, 95% CI: 1.02-3.50, p=0.044) in weekend admission vs. weekday admission in patients admitted for thyrotoxicosis. We didn't find any difference in adjusted or unadjusted in- hospital mortality in weekend vs. weekday admission in patients admitted for DKA, HHS, and adrenal Crisis. For hospital cost and length of stay, we didn't find any differences in subgroup analysis for the various endocrine emergencies. CONCLUSIONS: Weekend admission for endocrine emergencies was associated with a higher in-hospital mortality than weekday admission, primarily driven by myxedema coma and thyrotoxicosis. Further study is needed to understand the hospital, administrative and physician factors contributing to poorer outcomes in endocrine emergencies, especially in myxedema coma and thyrotoxicosis.
Journal of General Internal Medicine
Poudel, B., & Shrestha, B. (2023). Effect of Weekend vs. Weekday Admission on Endocrine Emergencies Results from National Inpatient Sample Database 2016-2019. Journal of General Internal Medicine, 38 (Supplement 2), S88-S88. https://doi.org/10.1007/s11606-023-08226-z