Peer Review #2 of "Outcomes of hospitalizations with atrial fibrillation-flutter on a weekday versus weekend: an analysis from a 2014 nationwide inpatient sample (v0.1)" [peer_review]

C Gallagher
2019 unpublished
Background:Patients with atrial fibrillation-flutter (AF) admitted on the weekends were initially reported to have poor outcomes. The primary purpose of this study is to re-evaluate the outcomes for weekend versus weekday AF hospitalization using the 2014 Nationwide Inpatient Sample (NIS). Methods:Included hospitalizations were aged above 18 years. The hospitalizations with AF were identified using the international classification of diseases 9 (ICD-9) codes (427.31, 427.32). In-hospital
more » ... In-hospital mortality, length of stay (LOS), other co-morbidities, cardioversion procedures, and time to cardioversion were recorded. All analysis was performed using SAS 9.4 statistical software (Cary, North Carolina). Results: A total of 453,505 hospitalizations with atrial fibrillation and flutter as primary discharge diagnosis were identified. Among the total hospitalizations with a primary diagnosis of AF, 20.3% were admitted on the weekend. Among the weekend hospitalizations, 0.19% died in hospital compared to 0.74% among those admitted during the week. After adjusting for patient characteristics, hospital characteristics and disease severity, the adjusted odds for in-hospital mortality were not significantly different for weekend vs. weekday hospitalizations (OR=0.91, 95% CI=0.77-1.11; p=0.33). The weekend admissions were associated with significantly lower odds of cardioversion procedures (OR=0.72, 95% CI=0.69-0.76, P < 0.0001), lower cost of hospitalization (USD 8265.8 on weekends vs. USD 8966.5 on the weekdays, P < 0.001), slightly lower rate of anticoagulation (17.09% on the weekends vs. 18.73% on the weekdays. P < 0.0001), and slightly increased time to cardioversion (1.94 days on the weekend vs. 1.73 days on weekdays, P<0.0005). The mean length of hospital stay (LOS) was statistically not different in both groups: (3.49 days ±3.70 (SD)in the weekend group vs. 3.47 days ±3.50 (SD)in the weekday group, P=0.42) Discussion:The weekend AF hospitalizations did not have a clinically significant difference in mortality and LOS compared to those admitted on a weekday. However, the use of cardioversion procedures and cost of hospitalization was significantly lower on the weekends. PeerJ reviewing PDF | Manuscript to be reviewed 1 Outcomes of hospitalizations with atrial fibrillation-flutter on a weekday versus weekend: 2 an analysis from a 2014 nationwide inpatient sample. 4 Dinesh Abstract 25 26 Background: Patients with atrial fibrillation-flutter (AF) admitted on the weekends were 27 initially reported to have poor outcomes. The primary purpose of this study is to re-evaluate the 28 outcomes for weekend versus weekday AF hospitalization using the 2014 Nationwide Inpatient 29 Sample (NIS). 30 Methods: Included hospitalizations were aged above 18 years. The hospitalizations with AF 31 were identified using the international classification of diseases 9 (ICD-9) codes (427.31, 32 427.32). In-hospital mortality, length of stay (LOS), other co-morbidities, cardioversion 33 procedures, and time to cardioversion were recorded. All analysis was performed using SAS 9.4 34 statistical software (Cary, North Carolina). 35 Results: A total of 453,505 hospitalizations with atrial fibrillation and flutter as primary 36 discharge diagnosis were identified. Among the total hospitalizations with a primary diagnosis of 37 AF, 20.3% were admitted on the weekend. Among the weekend hospitalizations, 0.19% died in 38 hospital compared to 0.74% among those admitted during the week. After adjusting for patient 39 characteristics, hospital characteristics and disease severity, the adjusted odds for in-hospital 40 mortality were not significantly different for weekend vs. weekday hospitalizations (OR=0.91, 41 95% CI=0.77-1.11; p=0.33). The weekend admissions were associated with significantly lower 42 odds of cardioversion procedures (OR=0.72, 95% CI=0.69-0.76, P < 0.0001), lower cost of 43 hospitalization (USD 8265.8 on weekends vs. USD 8966.5 on the weekdays, P < 0.001), slightly 44 lower rate of anticoagulation (17.09% on the weekends vs. 18.73% on the weekdays. P < 45 0.0001), and slightly increased time to cardioversion (1.94 days on the weekend vs. 1.73 days on 46 weekdays, P<0.0005). The mean length of hospital stay (LOS) was statistically not different in 47 both groups: (3.49 days ±3.70 (SD)in the weekend group vs. 3.47 days ±3.50 (SD)in the 48 weekday group, P=0.42) 49 Discussion: The weekend AF hospitalizations did not have a clinically significant difference in 50 mortality and LOS compared to those admitted on a weekday. However, the use of cardioversion 51 procedures and cost of hospitalization was significantly lower on the weekends. 52 53 54 55 PeerJ reviewing PDF | Manuscript to be reviewed 102 (https://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp) The number of chronic conditions was 103 obtained from 'NCHRONIC' variable listed in the NIS database. The data element 104 'NCHRONIC' contains the count of unique chronic diagnoses reported on the discharge. The 105 long-term (current) use of anticoagulants was determined using the ICD -9 CM code 'V58.61'. 106 The national estimates for hospitalization were calculated by applying the weights provided by 107 the HCUP-AHRQ in the NIS file. Finally, multivariate logistic regression models were applied 108 to test the adjusted associations between the outcomes of weekend versus weekday admissions. 109 The level of significance (α) was chosen as 5%. 110 111 Results 112 113 We identified a national estimate of 453,505 hospitalizations with AF as the primary 114 diagnosis. Of these, 92,220 were characterized as weekend hospitalizations and 361,285 as 115 weekday hospitalizations. The mean age among weekend and weekday was statistically not 116 different (weekday 70.1 years  13.5 (SD) and weekend 70.2 years  14.2 (SD) with a P-value of 117 0.53 (T-test). The proportion of males was somewhat lower in the weekend group (48.13% on 118 weekends vs. 50.53% on the weekdays, P value < 0.0001). A slightly lower proportion of the 119 white population was hospitalized over the weekends (80.31% on the weekends vs. 82.60% on 120 the weekday), and a higher proportion of the Hispanic population was admitted on the weekends 121 (6.25 on weekends vs. 5.34 on the weekdays, P <0.0001). Hospitalizations with Medicare 122 constituted the majority of overall hospitalizations (67.13%) for AF. AF hospitalizations were 123 relatively higher in the Urban teaching hospitals (59.61%), and the weekday hospitalizations 124 were higher in the urban teaching hospitals vs. the weekend (60.12 on the weekday vs. 57.63% PeerJ reviewing PDF | Manuscript to be reviewed 125 on the weekends, P < 0.0001). The same pattern was observed in the large hospitals which 126 constituted about 50.64% of total AF hospitalizations, and a slightly higher rate of AF 127 hospitalizations in the large hospitals was on the weekdays (51.08% on the weekday vs. 48.93% 128 on the weekends, P < 0.0001). Table 1 summarizes the demographics and baseline characteristics 129 for the weekday and weekend hospitalizations along with the P values (T-test for continuous 130 variables and Chi-square test for the categorical variables). 131 Comparing the in-hospital mortality (primary outcome) in two groups, we have identified 132 that the mortality for weekend hospitalizations did not significantly vary from the weekday 133 hospitalizations (0.19% on the weekends vs. 0.74% on the weekdays, P=0.90). 134 135 Secondary outcomes were the number of inpatient cardioversion procedures, interval to 136 the procedure (time to cardioversion), length of stay, anticoagulation and the cost of 137 hospitalization. These characteristics are listed in Table 2. We noted that the weekend AF 138 hospitalizations underwent fewer cardioversion procedures than those hospitalized on a weekday 139 (2.90% vs. 14.83%, p < 0.0001). The average time to cardioversion was not very different among 140 both groups, though statistically significant (1.94 days on the weekend vs. 1.73 days on a 141 weekday, P=0.0005). The weekend AF admission was associated with a lower cost of 142 hospitalization (USD 8265.8 on weekends vs. USD 8966.5 on the weekdays, P < 0.001). The 143 weekend hospitalizations had a slightly lower rate of anticoagulation (17.09% on the weekends 144 vs. 18.73% on the weekdays. P < 0.0001). 145 146 The univariate (table 3) and the multivariate logistic regression analysis for in-hospital 147 mortality were performed, after adjusting for significant covariates such as age, sex, PeerJ reviewing PDF |
doi:10.7287/peerj.6211v0.1/reviews/2 fatcat:ztr6gg6olng2bccaif2bjb7fse