| Study | Population | Analysis | Prognostic variable | Confounders | Outcomes | Comments |
|---|---|---|---|---|---|---|
|
Aldridge 20166 Retrospec tive cohort | All adult (≥16 years) emergency admissions for 141 trusts for financial year 20132014 from hospital episode statistics. | Logistic regression |
Weekend (Saturday or Sunday by date) Versus Weekday (Wednesday by date) |
Trust Sex Age Income deprivation component of the Index of Multiple Deprivation 2010 Diagnostic category as represented by the Clinical Classification Software code and a categorised index of comorbidity | In-hospital mortality | |
|
Anselmi 20168 Retrospective cohort | Patients admitted to hospital following attendance at A&E at 140 non-specialist acute hospitals in England 1 April 2013 to 28 March 2014 from Hospital Episode statistics | Logistic regression |
Saturday day (7am-6.59pm) Saturday night (7pm-6.59am) Sunday day (7am-6.59pm) Sunday night (7pm-6.59am) Versus. Wednesday day (7am-6.59pm) |
Interaction between gender and age Ethnicity Primary diagnosis Comorbidities (30 binary indicators recorded in the secondary diagnosis fields, measured using Elixhauser conditions) Source of admission Deprivation in area of residence Admitting hospital Month of admission | In-hospital mortality within 30 days of admission | High risk of detection bias – short follow up |
|
Aylin 201011 Retrospective cohort |
Emergency inpatient admissions extracted from finished consultant episodes of care for inpatients in all acute public hospitals in England from the NHS Wide Clearing Service with discharge dates between 1 April 2005 and 31 March 2006 n=4,317,866 Number of events = 215,054 | Logistic regression |
Weekend (admissions starting on a Saturday or Sunday by date) Versus Weekday |
Age Sex Deprivation quintile Charlson comorbidity score Case mix (clinical classification system diagnostic groups) | Hospital mortality | |
|
Bell 201323 Retrospective cohort |
Adult (≥16 years) acute medical admissions derived from hospital episode statistics for patients admitted to participating hospitals as an acute medical emergency 1 April 2009 to 31 March 2010 n=1.3 million Event rate = 4.3% | Step-wise multivariate regression analysis |
Weekend Versus Weekday |
Charlson comorbidity index Age Index of multiple deprivation | Hospital mortality | Weekend not defined |
|
Bray 201428 Retrospective cohort |
Adults (≥18 years) admitted with stroke from the Stroke Improveme nt National Audit Programme from 1 June 2011 to 1 December 2012 linked with English national register of deaths n=32,388 Event rate = 11.8% | Cox proportion al hazards model |
Weekend Versus Weekday |
Age Stroke type Pre-stroke independence Hypoxia in the first 24 hours of admission Lowest level of consciousness in the first 24 hours Arm weakness Leg weakness Hemianopia Dysphasia No. of SU beds Presence of 24/7 on-site thrombolysis service Ratio of HCAs/nurses to beds Presence of 7-day physician ward rounds Management solely in an optimal setting in first 24 hours Antiplatelet therapy if required Brain scan within 24 hours | 30 day mortality |
Weekend not defined HR for weekend versus weekday with 7 days per week stroke specialist physician rounds |
|
Bray 201629 Retrospective cohort | All adults (>16 years) admitted to hospital in England and Wales with acute stroke between April 1, 2013 and March 31, 2014 from the Sentinel Stroke National Audit Programme (SSNAP). | Logistic regression |
Weekend (Saturday to Sunday 08:00-19:59 h and Saturday to Sunday 20:00-07:59 h) Versus Weekday (Monday to Friday 08:00-19:59 h and Monday to Friday 20:00-07:59 h) |
Age Sex Place of stroke onset (in or out of hospital) Stroke type Vascular comorbidity (atrial fibrillation, heart failure, diabetes, previous stroke or transient ischemic attack, hypertension) Pre-stroke functional level(as measured by the modified Rankin Scale) Time from stroke onset to admission Stroke severity (National Institutes of Health Stroke Scale score or level of consciousness on admission) Hospital level random intercepts | 30-day survival (following admission) | |
|
Brims 201131 Retrospective cohort |
Acute exacerbatio ns of chronic obstructive pulmonary disease patients admitted to a large secondary care hospital in Portsmouth between January 1997 and December 2004 extracted from hospital databases n=9,915 Number of events = 1,516 | Multivariate logistic regression |
Weekend (midnight Friday to midnight Sunday) Versus Weekday (all other time) |
Age Sex Creatinine PaO2 | Hospital mortality (within 7 days) | High risk of detection bias – short follow up |
|
Campbell 201433 Retrospec tive cohort |
Stroke admissions to 130 hospitals in England (1 April 2010 - 31 January 2012) from the Stroke Improveme nt National Audit Programme n= 45,726 Number of events = 5,956 | Logistic regression |
Weekend Versus Weekday Out of hours (weekdays before 08:00 or after 18:00 or at any time on a weekend day or English public holiday) Versus In hours (weekdays 08:00 to 18:00) |
Age Sex Worst level of consciousness in the first 24 hours (surrogate for severity) Stroke type Pre-stroke independence | 30 day mortality | |
|
Deshmukh 201657 Retrospective cohort | Patients admitted between January 2009 and December 2011 with acute subarachnoid haemorrhage from 12 hospitals in Northwest England. | Cox proportional hazards |
Weekend (16:00 Friday to 16:00 Sunday) Versus Weekday |
Age Sex Severity of SAH (baseline World Federation of Neurosurgical Societies grade) Treatment modalities following admission Time from scan to admission and from admission to treatment | In-hospital mortality | |
|
Freemantle 201262 Retrospective cohort |
All admissions to National Health Service Hospitals in England April 2009 - March 2010 using inpatient hospital trusts within England. Linked data on mortality from the Office of National Statistics n=14,217,640 Number of events = 187,337 (inhospital) 284,852 (30 day) | Contingency tables for each day, utilising a complementary log-log link function and binomial error |
Saturday Sunday Versus Wednesday |
Age Sex Ethnicity Source of admission Diagnostic group No. of previous emergency admissions No. of previous complex admissions Charlson comorbidity index Social deprivation Hospital trust Day of the year (seasonality) |
Hospital mortality 30 day mortality | Saturday and Sunday analysed separately – both statistics included in weekend versus weekday meta-analysis |
|
Freemantle 201563 Retrospective cohort |
All admissions to National Health Service Hospitals in England in 2013-2014 n= 14 818 374 Number of events = 280 788 | Identical to previous analysis |
Saturday Sunday Versus Wednesday |
Case mix (clinical classifications software category) Age Time of year Trust Deprivation No. of previous emergency admissions No. of previous complex admissions Admission source Admission urgency Sex Ethnicity Charlson comorbidity index | 30 day mortality | Saturday and Sunday analysed separately – both statistics included in weekend versus weekday meta-analysis |
|
Iqbal 201588 Retrospective cohort |
Consecutive STEMI patients treated with PPCI between 2005 and 2011 at 8 tertiary centres in London from local British Cardiac Intervention Society databases linked with Office of National Statistics data n=11,466 Number of events = 607 | Logistic regression and Cox proportion al hazards regression models |
Out of hours (weekdays 17:00 to 09:00 and any time on a Saturday or Sunday) Versus In hours (09:00 to 17:00 Monday to Friday) |
Age Sex Diabetes GP2b-3a inhibitor use Previous MI Renal disease Radial access Cardiogenic shock IABP use Intubation status LMS intervention LAD intervention Multi-vessel intervention Completeness of revascularisati on |
30 day mortality Avoidable adverse events (inhospital bleeding complications) | Procedure time taken as admission time |
|
Jairath 201189 Retrospective cohort |
Adults (16 years and over) presenting with acute upper gastrointest inal bleeding from the 2007 UK National audit of AUGIB of all NHS hospitals accepting acute admissions in the UK (majority from England). 1 May - 30 June 2007 n=6,749 | Mixed effects logistic regression |
Weekend (3 sensitivity analyses performed: 5pm Friday - midnight Sunday, Midnight Friday - 5pm Sunday, 5pm Friday to 5pm Sunday) Versus Weekday |
Individual components of the Rockall score (age, presentation with shock, co-morbid illness) Presentation with hematemesis Presentation with melaena Haemoglobin and urea concentration on admission Use of aspirin Use of non-steroidal anti-inflammatory drugs Use of proton pump inhibitors Gender Variceal bleeding Peptic ulcer bleeding Availability of OOH rota enabling 24hr access to endoscopy Admission status (new patient versus inpatient) |
Hospital mortality up to 30 days post-index AUGIB Avoidable adverse events (re-bleeding, surgery/radi ology, red cell transfusion) |
Unclear which weekend definition was used in the analysis High risk of detection bias (for mortality outcome) – short follow up |
|
Kolic 201599 Prospective cohort |
All patients presenting to the acute medical unit at Queen Elizabeth Hospital in London 1 October 2013 - 15 October 2013 and 9 December 2013 - 22 December 2013 Exclusion: patients with <12hr inpatient stay n=370 Number of events = 96 | Multivariate logistic regression |
Weekend Versus Weekday |
Age Severity (NEW score) | Avoidable adverse events (inadequate clinical response to NEW score) |
Weekend not defined High risk of detection bias (short follow up) and performance bias (unclear whether staff were aware of the study) |
|
Meacock 2016118 Retrospective cohort | Emergency admissions to type 1 units (consultant-led, multispecial ty 24-hour services with full resuscitation facilities and designated accommodation for reception of A&E patients) from 140 trusts in England from hospital episode statistics 1 April 2013 to 28 February 2014. | Logistic regression |
Weekend (Saturday and Sunday by date) Versus Weekday (Monday to Friday by date) |
Age Sex Ethnicity Primary diagnosis (SHMIgrouped Clinical Classifications Software category) Elixhauser (comorbidity) conditions Admission method Admission source Deprivation quintile Month Admitting hospital | 30-day mortality (following admission) | Admissions via A&E departments and direct admissions analysed separately |
|
Mohammed 2012122 Retrospective cohort |
Emergency admissions April 2008 - March 2009 from all acute hospitals (n=328) in England via Hospital Episode Statistics Exclusion: admissions discharged alive with a zero day length of stay, age <16 years, maternity care, mental health care other than dementia n=3,105,249 Number of events = 206,683 | Logistic regression |
Weekend (by date) Versus Weekday (by date) |
Age category Complex elderly Male Healthcare resource group with comorbidities/complications Interaction: Age and HRG with comorbidities/complications Admission quarter | Hospital mortality | Assumed to be in hospital mortality because the study was on hospital discharges, no mention of follow up or ONS data |
|
Mohammed 2016121 Retrospective cohort |
All adult (≥16 years) emergency medical and elderly admissions, discharged between 1 January 2014 and 31 December 2014 from 3 general acute hospitals in England. | Linear and logistic regression |
Weekend (Saturday and Sunday by date) Versus Weekday (Monday to Friday by date) |
Index NEWS Age Sex Calendar month | In-hospital mortality | |
|
Noman 2012142 Retrospective cohort |
STEMI patients undergoing PPCI March 2008 - June 2011 at one tertiary cardiac centre in Newcastle from local coronary artery disease database (Dentrite) linked with Office of National Statistics data n=2,571 Event rate = 4.5% | Multiple logistic regression |
Out of hours (weekdays between 18:00 and 08:00 and any time on a Saturday or Sunday) Versus Routine hours (08:00 to 18:00 Monday to Friday) |
Age Sex Previous MI Diabetes mellitus Anterior MI site Baseline haemoglobin and creatinine Admission HR and SBP Cardiogenic shock Onset of symptoms to balloon time Presence of multi-vessel disease Thromolysis in MI flow 3 post-PPCI | Hospital mortality | Procedure time taken as admission time |
|
Palmer 2012147 Retrospective cohort |
Stroke admissions from Hospital Episode Statistics 1 April 2009 - 31 March 2010 n=93,621 Number of events = 8,772 (7 day hospital mortality) | Logistic regression |
Weekend (midnight Friday to Midnight Sunday) Versus Weekday |
Age Sex Socioeconomic deprivation quintile No. of previous admissions Comorbidities (Charlson index with weights derived from all admissions in England) Month of discharge Ethnic group Source of admission Stroke type |
7-day hospital mortality Avoidable adverse events (aspiration pneumonia) Length of stay (discharge to usual place of residence within 56 days) | High risk of detection bias (for mortality outcome) – short follow up |
|
Rathod 2013161 Retrospective cohort |
Consecutive STEMI patients undergoing PPCI in one tertiary heart attack centre in London January 2004 - July 2012 from clinical database, electronic patient record and cardiac surgical database linked with Office of National Statistics data n=3347 Number of events = 138 | Logistic regression |
Out of hours (17:01 to 07:59 Monday to Friday and 17:01 Friday to 07:59 Monday) Versus In hours (08:00 to 17:00 Monday to Friday) |
Age Shock eGFR>60 (epidermal growth factor receptor) EF>40 Procedural success Multi-vessel disease |
30 day mortality Avoidable adverse events (death, recurrent MI, target vessel revascularisa tion) | Procedure time taken as admission time |
|
Ruiz 2015168 Retrospective cohort |
Emergency admissions from an International dataset from the Global Comparators project consisting of hospital administrati ve data 2009-2012 (separate English data analysis) Exclusion: day cases, non-acute care, records with missing/inv alid entries, short-term emergency admissions not ending in death or transfer within 24 hours and with recorded major procedure n=885,864 Number of events = 40,749 | Multilevel mixed-effects logistic regression |
Saturday Sunday Versus Monday |
Age Gender Transfers in from another hospital Year of admission Comorbidity score Diagnosis risk factor Bed numbers Rate of transfers to other hospitals | Hospital 30 day mortality |
Saturday and Sunday analysed separately - included in weekend versus weekday meta-analysis High risk of detection bias – short follow up |
|
Showkathali 2013181 Retrospective cohort |
All patients undergoing PPCI September 2009 - November 2011 at one cardiothora cic centre in Essex from the cardiac service database system n=1471 | Binary logistic regression |
Out of hours (18:00 to 08:00 weeknights and Saturday 08:00 to Monday 08:00) Versus In hours (08:00 to 18:00 weekdays) |
Age >75 years Sex Cardiogenic shock Diabetes Hypertension Previous MI Single vessel PCI Pre-procedure TIMI 0/1 flow Drug eluting stent use Door to balloon time | 30 day mortality | Procedure time taken as admission time |
From: Chapter 41, Cost-effectiveness analyses
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