Background: Sickle cell disease frequently necessitates hospital admissions due to its complications. This study examines the disparities in treatment outcomes for sickle cell disease between weekend and weekday admissions. Given the acute and unpredictable nature of the disease's exacerbations, as well as the potential for variability and limitations in healthcare staffing and resource availability on weekends, it is crucial to understand how these factors may affect patient care and outcomes.

Methods: The 2021 NIS database was analysed to identify 177,604 admissions with sickle cell disease and associated complications, such as acute chest syndrome, splenic sequestration, cerebral vascular involvement, and dactylitis, using appropriate ICD-10 codes. The study examined demographic characteristics, comorbidities, socioeconomic status, insurance types, hospital characteristics, and mortality outcomes. Chi-square tests and logistic regression models were used to determine statistical significance.

Results: Out of all the SCD admissions, 24.5% occurred on weekends. The overall in-hospital mortality rate was 0.91% (95% CI: 0.81% - 1.02%). Mortality was significantly higher for weekend admissions compared to weekdays (1.10% vs. 0.85%, p=0.0337), with an adjusted odds ratio (OR) of 1.37 (95% CI: 1.06 - 1.78, p=0.016). This indicates that SCD patients admitted on weekends have a higher odds of dying in the hospital compared to those admitted on weekdays, even after adjusting for various demographic and clinical factors.

The mean LOS was 5.48 days (95% CI: 5.36 - 5.59 days), with no significant difference between weekend (5.56 days) and weekday (5.45 days) admissions after adjustment (p=0.356). The mean TOTCHG was $57,061.37 (95% CI: $54,475.07 - $59,647.68), with no significant difference between weekend and weekday admissions after adjustment (p=0.786).

Demographic analysis revealed significant differences in sex and insurance status between weekend and weekday admissions. A higher proportion of male patients were admitted on weekends compared to weekdays (36.57% vs. 34.79%, p=0.0032). Additionally, a higher proportion of Medicaid patients were admitted on weekends (25.08%) compared to weekdays (23.41%, p=0.0001).

Conclusion: SCD patients admitted on weekends exhibit a significantly higher risk of in-hospital mortality compared to those admitted on weekdays, even after adjusting for confounders. However, weekend admissions did not significantly impact LOS or hospital charges. These findings highlight the need for further investigation into the factors contributing to the increased mortality risk for weekend admissions and the development of strategies to improve outcomes for SCD patients.

Disclosures

No relevant conflicts of interest to declare.

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2024
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