Higher risk of death associated with weekend hospitalisation
Published 13 August 2015
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1. Summary
A paper by Freemantle, Richardson, Woods, Ray, Khosla, Shahian, Roche, Stephens, Keogh and Pagano (2012) analysed all admissions to the NHS in England during the financial year 2009 to 2010, following up all patients for 30 days after admission and accounting for risk of death associated with:
- diagnosis
- co-morbidities
- admission history
- age
- sex
- ethnicity
- deprivation
- seasonality
- hospital trust
- day of admission
2. Derivation
The following table is derived from figure 3 of that paper. It shows the mortality risk ratio for admission on each day of the week compared with admission on Wednesday, having adjusted for other factors.
| - | Risk ratio | Lower 95% CI | Upper 95% CI |
|---|---|---|---|
| Sunday | 1.16 | 1.14 | 1.18 |
| Monday | 1.02 | 1.01 | 1.04 |
| Tuesday | 1.00 | 0.99 | 1.02 |
| Wednesday | |||
| Thursday | 1.00 | 0.98 | 1.01 |
| Friday | 1.00 | 0.98 | 1.02 |
| Saturday | 1.11 | 1.09 | 1.13 |
CI = confidence intervals
There were 199,993 in-hospital deaths within 30 days after admission to hospital in 2009 to 2010. The breakdown by day of week of admission is given in the table below:
| - | In-hospital deaths | Deaths if risk was the same as Wednesday | Difference |
|---|---|---|---|
| Sunday | 24,175 | 20,841 | 3,334 |
| Monday | 31,373 | ||
| Tuesday | 30,579 | ||
| Wednesday | 29,898 | ||
| Thursday | 29,657 | ||
| Friday | 29,988 | ||
| Saturday | 24,323 | 21,913 | 2,410 |
| Total | 199,993 |
The estimated excess in-hospital deaths associated with admission on Saturday or Sunday compared with Wednesday is 5,745. The 95% confidence interval for this is [4,977, 6,486].