Weekend admission and inpatient outcomes in hospitalized patients with acute promyelocytic leukemia.

Abstract

e18546 Background: Acute promyelocytic leukemia [APL] has historically been associated with significant early mortality, but it is now one of the most curable leukemias, with long-term survival rates >90%. Early recognition and prompt treatment initiation are critical to prevent early death. Although early mortality remains a significant challenge, the impact of weekend admission on hospitalization outcomes of patients with APL is unclear. We evaluated the association between weekend versus weekday admission and inpatient outcomes among patients with APL. Methods: Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS) collected between 2017 and 2021. Using ICD-10 CM codes, adult (≥18 years) inpatient hospitalizations with a diagnosis of APL were identified. Multivariable logistic and linear regression models were used to examine the association between day of admission and inpatient outcomes among hospitalized patients with APL. Results: Among 4,959 hospitalizations with a diagnosis of APL, 19% of admissions occurred on a weekend. Patients admitted on weekends were more likely to be male (49% vs 43%, p=0.027), non-Hispanic Black (19% vs 11%, p<0.01) and insured by Medicare (72% vs 59%, p<0.001). There was no significant difference in weekend admissions by age. After multivariable adjustment, patients admitted over the weekend had higher odds of in-hospital mortality compared to those admitted during a weekday (Adjusted odds ratio [AOR] 1.80, 95% CI, 1.20 – 2.40). Weekend admission was associated with length of stay (LOS) >5 days (AOR 2.60, 95% CI, 1.80 – 4.50) relative to 5 days or less. Additionally, patients admitted over the weekend had $3,579 (95% CI, $43.6 – $78,964.5) higher total hospital charges compared to those admitted during a weekday. Conclusions: Our findings demonstrate a weekend effect on hospitalization outcomes among patients with APL, with weekend admissions associated with higher in-hospital mortality, longer hospital stays, and increased hospital costs. Further investigation is needed to identify the underlying causes of these differences and implement strategies to attenuate them. Impact of weekend admission on inpatient outcomes among hospitalized patients with acute promyelocytic leukemia. Weekend Admission Unadjusted Adjusted Mortality OR (95% CI) No Reference Reference Yes 1.23 (0.56–2.60) 1.80 (1.20–2.40) Length of stay OR (95% CI) 5 days or less Reference Reference More than 5 days 2.30 (1.20-3.60) 2.60 (1.80-4.50) Total Charges ß (95% CI) 49.05 (-654.35-178643.76) 3578.8 (43.64-78964.54) AOR=Adjusted odds ratio; CI=confidence intervals. Model adjusted for age, gender, race/ethnicity, median household income national quartiles, hospital region, hospital location, Charlson comorbidity index, insurance type, admission type and length of stay. Boldface indicates statistical significance.