54.17 Can Increased Trauma Mortality At Weekends Be Explained by Failure to Rescue?

Posted on January 26, 2017

D. Metcalfe1, O. A. Olufajo6, A. J. Rios-Diaz5, C. K. Zogg4, R. Chowdhury2,3, A. Haider2,3, J. M. Havens2,3, A. Salim2,3  6Washington University School Of Medicine,Department Of Surgery,St Louis, MO, USA 1University Of Oxford,Kadoorie Centre for Critical Care Research,Oxford, OXFORDSHIRE, United Kingdom 2Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 3Harvard Medical School,Boston, MA, USA 4Yale University School Of Medicine,New Haven, CT, USA 5Thomas Jefferson University Hospital,Department Of Surgery,Philadelphia, PA, USA

Introduction:

Previous studies found that trauma patients admitted to US hospitals at weekends have higher odds of mortality. We hypothesized that providers respond less effectively to serious adverse events (SAEs) at weekends. The aim of this study was to determine whether the trauma “weekend effect” could be explained by differences in FTR, i.e. death subsequent to an SAE.

Methods:

An observational study was undertaken using the Nationwide Inpatient Sample (NIS) 2001-2011. All inpatients with a primary injury diagnosis (ICD-9-CM 800-957) were included. The outcome measures were SAE (myocardial infarction, venous thromboembolism, acute renal failure, respiratory failure, pneumonia, bleeding), in-hospital mortality, and FTR. Logistic multivariable regression models were used to adjust for patient- (age, sex, race, payer status, Charlson score, ISS) and hospital-level (trauma designation) characteristics. Counterfactual modeling was used to explore the hypothetical effect of eliminating FTR.

Results:

There were 1,727,124 individual patient records (8.5 million weighted admissions). The overall rate of SAE was 11.1% (11.3% weekend, 11.1% weekday, p<0.001), in-hospital mortality 2.3% (2.4% weekend, 2.2% weekday, p<0.001), and FTR 9.8% (10.0% weekend, 9.8% weekday, p=0.181). Weekend admission was independently associated with higher adjusted odds of SAE (aOR 1.09, 95% CI 1.08-1.11) and death (OR 1.12, 1.09-1.15) but not FTR (1.04, 1.00-1.09). Within a counterfactual model, increased weekend mortality was not reduced by eliminating FTR (aOR 1.11, 1.07-1.16).

Conclusion:

Trauma patients have higher odds of death when admitted at weekends. This finding is more likely to be explained by increased SAEs at weekends than by FTR.