The impact of day of admission on morbidity and mortality outcomes on patients with febrile neutropenia in the United States: A nationwide analysis

Abstract Purpose There is limited data regarding the impact of the admission day on patients with febrile neutropenia. Past literature has shown no difference in patients with pathologies with structured timelines for management (e.g., non-variceal gastrointestinal bleeding, myocardial infarction). In this study, we explore the national inpatient sample (NIS) to determine how timing day of admission may impact such outcomes. We evaluated clinical outcomes such as all-cause mortality (primary outcome), length of stay, total charges, acute kidney injury, sepsis, and shock to enhance our understanding of its impact. Methods We analyzed data from the 2017-2019 NIS to identify patients admitted with a principal and secondary diagnosis of febrile neutropenia. Patients were stratified based on gender and race. Categorical variables were compared using chi-square tests and continuous variables with independent samples t-testing. To adjust for potential confounding variables, we utilized logistic and linear regression models. Confounders were selected through a univariate screen with a p value cutoff of less than 0.1. Additionally, the Charlson comorbidity index was utilized to account for the presence of comorbid conditions to gauge disease severity. Results In our analysis, we identified a total of 338,730 hospitalizations (weighted) with a diagnosis of febrile neutropenia. There was a statistically significant increase in all-cause mortality (odds ratio [OR]: 1.10, p-value=0.020), sepsis (OR: 1.17, p-value=0.041), and shock (OR: 1.23, p-value<0.001) for patients admitted on the weekend compared to the weekday. There was a statistically significant decrease in length of stay (adjusted coefficient: -1.06, p-value<0.001) in weekend admissions compared to weekday admissions. Conclusions In conclusion, there are several significant differences between weekday and weekend admissions for patients with a diagnosis of febrile neutropenia. Weekend admissions were associated with an increased risk of all-cause mortality, sepsis, and shock. Further prospective studies are required to capture more objective and granular data to outline the reasons behind these findings. However, we postulate that they may be related to understaffing, triaging difficulty, and limited ICU bed availability on the weekend.