The weekend effect in sepsis and septic shock: a 5-year US national study

The "weekend effect" has been observed in many acute conditions; however, limited and conflicting data exist regarding its impact on patients with sepsis. We sought to assess this "weekend effect" in admissions with sepsis in the United States.

For this retrospective cohort study, adult admissions with a primary diagnosis of sepsis or septic shock were identified using ICD-10 codes in the National Inpatient Sample from 2016 through 2020. Outcomes of interest included in-hospital mortality, hospital length of stay, hospitalization costs, and discharge disposition.

A total of 8,405,984 admissions with sepsis or septic shock were identified, of which 2,235,715 (26.6%) were on a weekend. Weekend admissions had slightly lower baseline comorbidity (Elixhauser Index 4.47 ± .01 vs 4.49 ± .01, P < 0.001) but higher rates of respiratory failure, hepatic failure, and neurological failure during admission (all P < 0.05). The crude in-hospital mortality rate was 9.8% vs 9.7% (P = 0.46); however, weekend admissions were associated with lower odds of mortality after adjusting for clinically relevant variables (adjusted odds ratio, 0.97; 95% CI, 0.95-0.98; P < 0.001).

In this analysis, weekend admissions for sepsis or septic shock were not associated with increased in-hospital mortality. The observed lower mortality may reflect evolving care practices, although further investigation is needed.