Oh, those weekends, don’t you just love them? They provide us with an opportunity to spend time with our families, drive to the country house or go to the theater. Now, we know they also provide us with an increased opportunity to die in a hospital. Research shows that men with metastatic prostate cancer who are admitted to a hospital on a weekend are more likely to die and suffer complications compared with those admitted on weekdays!
The research, which was led by Marianne Schmid, MD, of Harvard Medical School, used the National Inpatient Sample to identify 534,011 hospitalized men with metastatic prostate cancer. Of these, 81.7% were admitted on a weekday and 18.3% on a weekend. The in-hospital mortality rate was 8.6% for those men admitted on a weekend and 10.9% for those admitted on a weekend.
This means that in a multivariate analysis, a weekend admission was associated with a significant 20% increased odds of death and 15% increased odds of complications compared with a weekday admission.
Dr. Schmid’s team online and ahead of print in BJU International reported these results.
They also found that patients admitted over the weekend were significantly more likely than those admitted on weekdays to be treated at rural hospitals (17.8% vs. 15.7%), non-teaching hospitals (57.6% vs. 53.7%), and low-volume hospitals (53.4% vs. 49.4%). Weekend patients also were significantly less likely than weekday patients to undergo interventional procedures (10.6% vs. 11.4%), including cystoscopy with clot evacuation (4.0% vs. 34.4%) and ureteral stent/percutaneous nephrostomy tube placement (3.7% vs. 4.2%). They also were significantly less likely to undergo diagnostic imaging (5.7% vs. 6.5%).
The researchers did point out that prior studies have suggested that staffing decreases on weekends may impact the intensity of medical care provided on weekends. “This was congruent with data from our study which suggest that patients admitted over the weekend were less likely to undergo diagnostic imaging and procedures such as cystocopy with clot evacuation and ureteral stent/percutaneous nephrostomy tube.”
Other studies suggest that physicians covering weekends often provide coverage for more patients and may be less familiar with them. “Taken together, patients presenting over the weekend may be subjected to delayed or inappropriate diagnosis and therapy,” according to the researchers.
Since today is July 2 we also need to be aware that we are also at a higher risk resulting from a hospital admission because July 1 is the universal starting date for all residents and fellows at American hospitals. The month of July offers us the opportunity to be treated by doctors with no or little experience.
The bottom line, if you can avoid hospitals during the month of July and on all weekends, you might live longer and suffer less.