ArticlePloS one2020
Clinical complexity and hospital admissions in the December holiday period.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Resilience is associated with frailty and older age in hospitalised patients.BMC geriatrics · 2022Trial
- Systemic and Seasonal Drivers of Hospital Mortality: Revisiting the Early Learning Period Hypothesis.Cureus · 2025Article
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- Urban-rural disparities in the association of nitrogen dioxide exposure with cardiovascular disease risk in China: effect size and economic burden.International journal for equity in health · 2024Article
- Rate and risk factors of in-hospital and early post-discharge mortality in patients admitted to an internal medicine ward.Clinical medicine (London, England) · 2023Article
- Review
- Aging underlies heterogeneity between comorbidity and multimorbidity frameworks.Internal and emergency medicine · 2022Observational
- Radiotherapy interruption due to holidays adversely affects the survival of patients with nasopharyngeal carcinoma: a joint analysis based on large-scale retrospective data and clinical trials.Radiation oncology (London, England) · 2022Article
- Tackling the clinical complexity of breast cancer.Drugs in context · 2022Article
- Factors associated with comorbidity in hospitalized and non-hospitalized inflammatory bowel disease patients: A single-center, preliminary study.Journal of multimorbidity and comorbidityArticle
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13 authors.
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Abstract
backgroundChristmas and New Year's holidays are risk factors for hospitalization, but the causes of this "holiday effect" are uncertain. In particular, clinical complexity (CC) has never been assessed in this setting. We therefore sought to determine whether patients admitted to the hospital during the December holiday period had greater CC compared to those admitted during a contiguous non-holiday period.
methodsThis is a prospective, longitudinal study conducted in an academic ward of internal medicine in 2017-2019. Overall, 227 consecutive adult patients were enrolled, including 106 cases (mean age 79.4±12.8 years, 55 females; 15 December-15 January) and 121 controls (mean age 74.3±16.6 years, 56 females; 16 January-16 February). Demographic characteristics, CC, length of stay, and early mortality rate were assessed. Logistic regression analyses for the evaluation of independent correlates of being a holiday case were computed.
resultsCases displayed greater CC (17.7±5.5 vs 15.2±5.9; p = 0.001), with greater impact of socioeconomic (3.51±1.7 vs 2.9±1.7; p = 0.012) and behavioral (2.36±1.6 vs 1.9±1.8; p = 0.01) CC components. Cases were also significantly frailer according to the Edmonton Frail Scale (8.0±2.8 vs 6.4±3.1; p<0.001), whilst having similar disease burden, as measured by the CIRS comorbidity index. Age (OR 1.02; p = 0.039), low income (OR 1.97, 95% CI 1.10-3.55; p = 0.023), and total CC (OR 1.06; p = 0.014) independently correlated with the cases. Also, cases showed a longer length of stay (median 15.5 vs 11 days; p = 0.0016) and higher in-hospital (12 vs 4 events; p = 0.021) and 30-day (14 vs 6 events; p = 0.035) mortality.
conclusionsPatients hospitalized during the December holiday period had worse health outcomes, and this could be attributable to the grater CC, especially related to socioeconomic (social deprivation, low income) and behavioral factors (inappropriate diet). The evaluation of all CC components could potentially represent a useful tool for a more rational resource allocation over this time of the year.
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