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

Abstract

11087 Background: Weekend admissions have been associated with worse health outcomes compared with weekday admissions, a phenomenon known as the ‘weekend effect’. While predictors of in-hospital outcomes among patients with febrile neutropenia (FN) and hematologic malignancies are well described, the impact of the ‘weekend effect’ in this population remains unclear. Our study assessed the association between weekend admission, 3- and 7-day mortality. We further evaluated whether septic shock mediates the relationship between weekend admission and inpatient mortality, regardless of length of inpatient stay. Methods: We conducted a retrospective analysis of the National Inpatient Sample (2016 to 2020). Using ICD-10 codes, we identified patients with hematologic malignancies admitted for FN (D70.X, R50.81 and R50.9). Weekend admission was the primary exposure, while 3- and 7-day in-hospital mortality were the outcomes assessed. Generalized linear models were used to assess the association between weekend admission and each outcome, adjusting for sociodemographic characteristics, Charlson Comorbidity Index, mechanical ventilation, acute renal failure, protein energy malnutrition, cancer type, and length of stay. We performed a mediation analysis to assess whether septic shock mediated the association between weekend admission and overall mortality, estimating natural direct, indirect, and marginal total effects. Results: Among 45,540 patients in this study, 57% were male, 65% were white (mean age was 51 years). Patients had lymphoma (27%), leukemia (54%), multiple myeloma (10%), and multiple/other hematologic malignancies (9%). Weekend admission was associated with a higher risk of 3-day (adjusted risk ratio [adj RR] 1.48; 95% CI: 1.21–1.83) and 7-day mortality (adj RR 1.32; 95% CI: 1.12–1.56). When outcomes were assessed across the entire inpatient stay, weekend admission was associated with higher risk of septic shock (adj RR 1.14; 95% CI, 1.05–1.25). Further mediation analysis demonstrated that septic shock significantly mediated the association between weekend admission and overall inpatient mortality – indirect effect (adj RR 1.03; 95% CI 1.01–1.04), whereas the direct effect (adj RR 1.06; 95% CI 0.94–1.20) and overall effect (adj RR 1.09; 95% CI: 0.96–1.23) of weekend admission on mortality were not statistically significant. Conclusions: Weekend admission was associated with a higher risk of 3- and 7-day mortality. Septic shock partially mediated the relationship between weekend admission and mortality when assessed across the entire inpatient stay. The absence of a direct weekend effect suggests that health system-level factors contributing to septic shock such as delays in recognition, escalation, or time to antibiotics, may represent key intervention targets to improve mortality outcomes in this high-risk population.