Demographics, Clinical Characteristics and Impact of Weekend Admissions on Mortality, Length of Stay, and Hospital Charges in Patients with Pulmonary Embolism Having Underling Anti Phospholipid Antibody Syndrome - Using the NIS 2021 Database
Authors: Rajarajan Srinishant , Babu Kalaivani , Chattaraj Asmi , Correa Amit , Ayanambakkam Attanathi Adanma Anji , Roy Arya Mariam , Ramesh Nithya , Ramanan Sruthi P 
Published: December 2024

Background: The influence of weekend admissions on clinical outcomes has garnered significant interest, particularly in conditions requiring urgent care. Anti phospholipid Antibody Syndrome (APLA) is a disorder that increases the risk of thrombosis, leading to conditions such as Pulmonary Embolism (PE). This study aims to assess whether weekend admissions affect mortality, length of stay (LOS), and hospital charges in patients diagnosed with PE having underling APLA.

Methods: We utilised data from the National Inpatient Sample (NIS) - 2021 to identify patients with PE having underling APLA. Patients with APLA and PE were identified using relevant IC10 codes. Survey-weighted analyses were conducted to compare outcomes between weekend and weekday admissions. Logistic and linear regressions were employed to adjust for confounders, including age, gender, race, Charlson Comorbidity Index, insurance type, median household income, hospital bed size, hospital teaching status, and hospital region.

Results: Out of 517,684 PE cases, 1,600 had both APLA and PE. The overall mortality rate among these patients was 5.31%. Significant predictors of mortality in this patient group included age (Odds ratio 1.042, p = 0.0074), gender (female, Odds ratio 0.335, p = 0.0328), Charlson Comorbidity Index (Odds ratio 1.297, p = 0.0073), and insurance status (p = 0.0171). Additionally patients in the West region showing a higher risk of mortality (Odds ratio 1.824, p = 0.018). There was no significant difference in mortality rates between weekend and weekday admissions (Odds ratio 0.769, 95% CI 0.216-2.746, p = 0.6863).

The overall mean LOS was 10.03 days. Significant predictors of LOS included Charlson Comorbidity Index (Coefficient 1.695, p = 0.006), hospital region (Northeast having shorter stays compared to other region, Coefficient -1.662, p = 0.040), and hospital bed size (p = 0.000). There was no significant difference in LOS between weekend and weekday admissions (Coefficient -0.260, p = 0.883).

The mean total hospitalization charges were $176,829.80. Significant predictors of hospital charges included Charlson Comorbidity Index (Coefficient 35,787, p = 0.046) and hospital bed size (p = 0.000).There was no significant difference in charges between weekend and weekday admissions (Weekend admissions incurred mean charges of $144,745.60, while weekday admissions incurred $185,829.00, Coefficient 8,565, p= 0.847).

Conclusion: Weekend admissions do not significantly impact mortality, LOS, or hospital charges for patients with APLA and PE. These findings suggest that healthcare systems effectively manage these patients regardless of the day of admission. Significant predictors of mortality in this patient population included age, gender, Charlson Comorbidity Index, and hospital region, which should be considered in managing these patients. Additionally, Charlson Comorbidity Index and hospital bed size significantly influenced LOS and hospital charges. Future research should explore hospital practices that contribute to consistent outcomes across different admission days and further investigate the significant predictors identified in this study.