The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

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Title: The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis
Authors: Honeyford, C
Cecil, E
Lo, M
Bottle, R
Aylin, P
Item Type: Journal Article
Abstract: Background The concept of a weekend effect, poorer outcomes for patients admitted to hospitals at the weekend is not new, but is the focus of debate in England. Many studies have been published which consider outcomes for patients on admitted at the weekend. This systematic review and meta-analysis aims to estimate the effect of weekend admission on mortality in UK hospitals. Methods This is a systematic review and meta-analysis of published studies on the weekend effect in UK hospitals. We used EMBASE, MEDLINE, HMIC, Cochrane, Web of Science and Scopus to search for relevant papers. We included systematic reviews, randomised controlled trials and observational studies) on patients admitted to hospital in the UK and published after 2001. Our outcome was death; studies reporting mortality were included. Reviewers identified studies, extracted data and assessed the quality of the evidence, independently and in duplicate. Discrepancy in assessment was considered by a third reviewer. All meta-analyses were performed using a random-effects meta-regression to incorporate the heterogeneity into the weighting. Results Forty five articles were included in the qualitative synthesis. 53% of the articles concluded that outcomes for patients either undergoing surgery or admitted at the weekend were worse. We included 39 in the meta-analysis which contributed 50 separate analyses. We found an overall effect of 1.07 [odds ratio (OR)] (95%CI:1.03–1.12), suggesting that patients admitted at the weekend had higher odds of mortality than those admitted during the week. Sub-group analyses suggest that the weekend effect remained when measures of case mix severity were included in the models (OR:1.06 95%CI:1.02–1.10), but that the weekend effect was not significant when clinical registry data was used (OR:1.03 95%CI: 0.98–1.09). Heterogeneity was high, which may affect generalisability. Conclusions Despite high levels of heterogeneity, we found evidence of a weekend effect in the UK, even after accounting for severity of disease. Further work is required to examine other potential explanations for the “weekend effect” such as staffing levels and other organisational factors.
Issue Date: 20-Nov-2018
Date of Acceptance: 5-Nov-2018
ISSN: 1472-6963
Publisher: BioMed Central
Journal / Book Title: BMC Health Services Research
Volume: 18
Copyright Statement: © The Author(s). 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated
Sponsor/Funder: National Institute for Health Research
Dr Foster Intelligence
Funder's Grant Number: n/a
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Quality of care
Weekend effect
Gastrointestinal Hemorrhage
Hospital Mortality
Prospective Studies
Pulmonary Disease, Chronic Obstructive
Time Factors
1117 Public Health And Health Services
0807 Library And Information Studies
Health Policy & Services
Publication Status: Published
Article Number: ARTN 870
Appears in Collections:Department of Medicine (up to 2019)
Faculty of Medicine
Epidemiology, Public Health and Primary Care

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