Weekend Hospital Admission for Stroke Raises Mortality Risk

TORONTO, March 8 -- Stroke patients admitted to a hospital on a weekend had a 13% increased risk of death compared with those admitted on a weekday, found researchers here.

Similar to research that determined poorer hospital care on the weekend in other medical conditions, the study demonstrated a significant effect on several ischemic stroke outcomes, including seven-day and discharge mortality, said Gustavo Saposnik, M.D., of the University of Toronto, and colleagues.

The occurrence of stroke increases during weekends, making up a quarter of the total, they reported in Stroke: Journal of the American Heart Association. However, hospitals face shortages of staffers and specialized services during the weekend.

The researchers also noted that high alcohol and drug use on weekends may have an impact on stroke mortality.

The investigators analyzed all hospital admissions for ischemic stroke from April 2003 to March 2004 recorded in the Hospital Morbidity Database. The national database contains sociodemographic, diagnostic, procedural, and administrative information for all Canadian acute care facilities.

Altogether, 26,676 patients were admitted to 606 hospitals for ischemic stroke. Weekend admissions comprised 6,629 (24.8%) of all admissions. Overall, seven-day stroke mortality was 7.6%, while mortality at discharge was 15.6%.

Patients admitted on weekends were older and more likely to be male. After adjusting for age, sex, comorbidities, and major medical complications, weekend admission increased the risk of dying by 13% (OR 1.13, 95% CI 1.02 to 1.26).

Weekend admissions were associated with a higher stroke mortality than weekday admissions, 8.5% versus 7.4% (odds ratio, 1.17; 95% CI, 1.06 to 1.29), with similar results for mortality at discharge, 16.4% versus 15.3% (OR 1.08, CI, 1.004 to 1.29), the researchers reported.

In addition, patients admitted on weekends were less likely to be discharged to the same place of residence (P

Although variations in care might explain the study's findings, they wrote that they had no information on fluctuations in staff levels, coverage, differences in expertise, or availability of stroke consultants.

Among the study's limitations they noted that the administrative data did not provide information on stroke severity or brain imaging, and errors in recording demographic data could not be excluded. Finally, comorbid conditions and medical complications may have been under-reported, thus limiting the statistical analysis of the weekend effect.

Even in a country with universal health insurance, disparities in resources, expertise, and the number of healthcare providers working during weekends may exist and may explain the observed differences in weekend mortality between facilities, Dr. Saposnik said.

Understanding the factors affecting the processes of care may provide new ways to implement initiatives to improve quality, the researchers concluded.