John H. Stroger, Jr. Hospital of Cook County Chicago, IL
Daniel A. Guifarro, MD1, Alejandro Nieto Dominguez, MD1, Chun-Wei Pan, MD1, Bhanu Siva Mohan Pinnam, MD1, Mihir P. Shah, MD2, Angelo Caputi, MD1, Abhin Sapkota, MD1, Muhammad Ali Khaqan, MD1, Carlos Alvarez Florimon, MD1, Daksh Ahluwalia, MD1 1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 2John H. Stroger, Jr. Hospital of Cook County, Cook County, IL
Introduction: The weekend effect describes the difference in outcomes that patients may have related to the day of the week they were admitted to the hospital. For the past years, it has been theorized that patients admitted over the weekend and holidays can experience worse outcomes. Hepatic failure can be related to life-threatening emergencies that warrant immediate attention due to severe complications that can develop with delay of care. We aimed to study the weekend effect on patients admitted with hepatic failure in the United States.
Methods: Utilizing data from the National Inpatient Sample from 2016 to 2019, we studied patients admitted with hepatic failure and analyzed the difference in outcomes related to admission on weekdays compared to the weekend. We also performed a subgroup analysis to evaluate the difference in outcomes between unspecified hepatic failure (UHF) and acute hepatic failure (AHF). Statistical analysis included measures of central tendency, T-test, and logistic regression analysis; statistical significance was determined by p< 0.05, and risk was assessed with odds ratio (OR). We accounted for confounders such as age, gender, hospital characteristics, and insurance status, utilizing STATA 18.
Results: A total of 279,887 cases of UHF were identified in the study period, and 93,519 were cases of AHF. Of the patients with UHF, 75.3% were admitted on weekdays and 24.7% on the weekend, with 56.4% males and 43.6% females. Of the AHF patients, 74.4% were admitted on weekdays and 25.6% on weekends; 55.1% were males and 44.9% females. The most common comorbidities are shown in Figure 1. Admission with UHF and AHF over the weekend was associated with an increased risk of worse outcomes as shown in Table 1. Patients admitted with UHF on the weekend had worse outcomes when compared to weekdays, showing an increased risk of death, mechanical ventilation, coagulopathy, encephalopathy, and bleeding requiring transfusions. Patients with acute hepatic failure were more likely to develop acute kidney injury and respiratory failure when admitted over the weekend.
Discussion: Our study showed that patients admitted with hepatic failure experience worse outcomes when admitted over the weekend, reinforcing the possible weekend effect that patients may experience with various diseases and emergencies. Further studies are needed to explore the causality of these worse outcomes associated with the weekend effect such as possible hospital understaffing and delay of procedures among other factors.
Figure: Diabetes, hypertension, anemia and chronic kidney disease were the comorbidities mostly associated to death in patients admitted with unspecified hepatic failure on weekends (OR: 1.10, p<0.001, 1.06, p<0.01, 1.07, p<0.001, 1.10, p<0.001).
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Daniel Guifarro indicated no relevant financial relationships.
Alejandro Nieto Dominguez indicated no relevant financial relationships.
Chun-Wei Pan indicated no relevant financial relationships.
Bhanu Siva Mohan Pinnam indicated no relevant financial relationships.
Mihir Shah indicated no relevant financial relationships.
Angelo Caputi indicated no relevant financial relationships.
Abhin Sapkota indicated no relevant financial relationships.
Muhammad Ali Khaqan indicated no relevant financial relationships.
Carlos Alvarez Florimon indicated no relevant financial relationships.
Daksh Ahluwalia indicated no relevant financial relationships.
Daniel A. Guifarro, MD1, Alejandro Nieto Dominguez, MD1, Chun-Wei Pan, MD1, Bhanu Siva Mohan Pinnam, MD1, Mihir P. Shah, MD2, Angelo Caputi, MD1, Abhin Sapkota, MD1, Muhammad Ali Khaqan, MD1, Carlos Alvarez Florimon, MD1, Daksh Ahluwalia, MD1. P1216 - Impact of the Weekend Effect on the Outcomes of Patients With Hepatic Failure. A United States Nationwide Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
