Impact of Day of Hospital Admission and Hospital Characteristics on Mortality in Thrombotic Thrombocytopenic Purpura

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening condition where prompt diagnosis and timely therapy are essential for improving patient outcomes. Previous studies have suggested that weekend hospital admissions may be associated with limited resources, leading to worse clinical outcomes. Given ongoing advancements in healthcare infrastructure, we aimed to re-evaluate the impact of weekend admissions and hospital characteristics on TTP mortality. We conducted a retrospective cohort study using the National Inpatient Sample (NIS) database from 2016 to 2019. A chi-squared test was applied to compare demographics (age, sex, racioethnic group), hospital-related factors (bed size, region, location), primary payer type, income quartiles, Mortality in Thrombotic Thrombocytopenic Purpura Score (MITS), time to initiation of therapeutic plasma exchange (TPE) between weekday and weekend admissions. Logistic regression analysis was used to identify predictors of in-hospital mortality while adjusting for covariates. Among 3725 hospitalizations, 68% of patients were female, 43.5% were white, and 20.8% belonged to the 50-59 age group. In-hospital mortality was 6.2%. Patients who died had higher odds of being white (p = 0.03), admitted to small or medium bed-size hospitals (p < 0.01), having higher MITS (p < 0.01), and having longer time to TPE initiation (p < 0.01). Multivariable regression analysis showed no significant association between the day of admission (weekday vs. weekend) and mortality (p = 0.35). While weekend hospital admission did not impact mortality, resource limitations in smaller hospitals may contribute to poor outcomes, as hospital bed size was a significant predictor of mortality. Addressing these disparities through targeted interventions could help optimize patient care and reduce mortality rates in TTP.