Weekend admission and early in-hospital mortality among patients with hematologic malignancies admitted for febrile neutropenia.

INTRODUCTION

Weekend admissions have been associated with worse health outcomes compared with weekday admissions. Our study assessed the association between weekend admission and early in-hospital mortality among patients with hematologic malignancies and febrile neutropenia. We further evaluated whether septic shock mediates this relationship, regardless of length of in-hospital stay.

METHODS

We conducted a retrospective analysis of the 2016-2020 NIS database identifying patients with febrile neutropenia and hematologic malignancies using ICD-10 codes. Weekend admission was the primary exposure, while 3- and 7-day in-hospital mortality were the study outcomes. Generalized linear models estimated the association between weekend admission and each outcome, adjusting for sociodemographic characteristics, comorbidities, cancer type, elective admission status and length of stay.

RESULTS

Among 45,540 patients in this study, 57% were male, 65% were white and the mean age was 51 years. Weekend admission was significantly associated with a higher risk of 3-day (RR=1.48; 95%CI: [1.21-1.83]) and 7-day mortality (RR=1.32; 95%CI: [1.12-1.56]). Mediation analysis demonstrated that septic shock significantly mediated the association between weekend admission and overall in-hospital mortality - indirect effect (RR=1.03; 95% CI [1.01-1.04]), whereas the direct effect and overall effect of weekend admission on mortality were not statistically significant.

CONCLUSION

Weekend admission was associated with a higher risk of early in-hospital mortality. Septic shock partially mediated this relationship when assessed across the entire in-hospital stay. The absence of a direct weekend effect suggests that health system-level factors contributing to septic shock may represent key intervention targets to improve mortality outcomes in this high-risk population.