The Weekend Effect in Hospitalizations for COPD Exacerbation: A Nationwide Analysis

SESSION TITLE: COPD 3 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) affects 30 million individuals in the United States. Hospital admissions relating to exacerbations of this condition incur significant costs to the healthcare system. The aim of our study was to determine in-hospital outcomes including measures of morbidity and resource utilization in patients with COPD exacerbation admitted over the weekend versus weekday. METHODS: This was a retrospective cohort study using the 2013 National Inpatient Sample (NIS), the largest publically available inpatient database in the United States. The inclusion criteria were age >18 years and an ICD-9 CM code for primary diagnosis of COPD. There were no exclusion criteria. The primary outcome was in-hospital mortality. There were two secondary outcomes: (1) morbidity, as measured by need for intensive care unit (ICU) admission, and presence of shock or acute respiratory failure, and (2) resource utilization, as measured by mean length of hospital stay (LOS), total hospitalization charges, and utilization of bronchoscopy and thoracentesis. Analyses were performed by using Stata, version 13.0. Odds ratios and means were adjusted for the following confounders using multivariate regression analysis models: age, gender, race, Charlson Comorbidity Index, primary insurance, and hospital teaching status. Group 1: COPD admission on the weekend, Group 2: COPD admission on a weekday. RESULTS: 631,664 patients with a primary diagnosis of COPD were included in the study. The mean age was 68 years and 56% of patients were female. The in-hospital mortality rate was not increased in COPD patients admitted over the weekend (OR 1.09; p=0.13) throughout the examined time period. Patients admitted on weekends (group 1) were more likely to have an ICU stay during their hospitalization (OR 1.15; p<0.01) and acute respiratory failure (OR 1.11; p<0.01). Looking at resource utilization, group 1 did not have increased total mean hospital charges ($28,776 vs. $28,615; p=0.503), utilization of bronchoscopy (OR 0.84; p=0.12) and thoracentesis (OR 1.08; p =0.463). In addition, group 1 was not more likely to have shock (OR 0.968; p=0.80). On the other hand, mean length of stay was shorter in group 1 (4.19 vs 4.30 days; p<0.01). CONCLUSIONS: There was no difference in mortality between patients admitted for COPD exacerbation during the weekend versus weekday however those admitted on a weekend had a higher likelihood of ICU admission and acute respiratory failure. Total hospitalization charges, and utilization of bronchoscopy and thoracentesis were not significantly different between the two groups. Weekend admissions had a lower LOS. CLINICAL IMPLICATIONS: There has been an increasing amount of medical literature showing worse outcomes in patients admitted for medical and surgical conditions on the weekend. This has been coined “the weekend effect.” The data presented shows no statistical difference in primary and secondary outcomes of patients admitted over the weekend. DISCLOSURE: The following authors have nothing to disclose: Navid Gholitabar, Caroline Dooley, Syed Ahsan, Farid Gholitabar, Joseph Mathew No Product/Research Disclosure Information