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Riesgos de mortalidad asociados con hospitalizaciones de urgencia durante fines de semana y días festivos: un

A Sarah Walker¹, Amy Mason¹, T Phuong Quan¹

¹Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK; Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK.

Lancet (London, England)

|May 14, 2017

Resumen

Las hospitalizaciones de fin de semana aumentan el riesgo de mortalidad, principalmente debido a factores a nivel de paciente como la gravedad de la enfermedad identificada a través de pruebas de rutina, no al personal del hospital. Esto pone de relieve la necesidad de mejorar las evaluaciones previas a la admisión.

Área de la Ciencia:

Investigaciones médicas
Salud pública
Investigación en servicios de salud

Sus antecedentes:

El ingreso al hospital durante el fin de semana está relacionado con tasas de mortalidad más altas.
Las razones específicas de este "efecto de fin de semana", teniendo en cuenta la gravedad de la enfermedad y el momento del ingreso, no se comprenden bien.

Objetivo del estudio:

Investigar los factores que contribuyen al aumento de la mortalidad asociada con los ingresos hospitalarios de emergencia durante el fin de semana.
Determinar si los factores a nivel del paciente o la carga de trabajo del hospital explican el efecto del fin de semana.

Principales métodos:

Análisis de más de 500.000 hospitalizaciones de emergencia en cuatro hospitales del Reino Unido (2006-2014).
Resultado primario: mortalidad a los 30 días, analizado mediante modelos de Cox.
Ajustes realizados por factores demográficos, comorbilidades, características de admisión y resultados de pruebas de laboratorio de rutina.

Principales resultados:

Las admisiones de fines de semana y días festivos mostraron una mortalidad de 30 días significativamente mayor en comparación con los días laborables.
Los resultados de las pruebas hematológicas y bioquímicas de rutina explicaron una parte sustancial (33-87%) del exceso de mortalidad durante el fin de semana.
El exceso de mortalidad se concentró en las admisiones del mediodía (1100-1500h) y no estaba relacionado con la carga de trabajo del hospital.

Conclusiones:

Los resultados de las pruebas de rutina explican significativamente el exceso de mortalidad observado en las admisiones de fin de semana.
Las diferencias a nivel de pacientes en el ingreso, en lugar de la reducción de personal hospitalario, parecen impulsar el efecto de fin de semana.
Las investigaciones adicionales sobre los factores no medidos a nivel del paciente pueden explicar el exceso de mortalidad residual, especialmente alrededor del mediodía de las admisiones de fin de semana.

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