Obel N, Schierbeck J, Pedersen L, Storgaard M, Pedersen C, Sørensen H T, Hansen B
Department of Internal Medicine C, Odense University Hospital and University of Southern Denmark, Odense, Denmark.
Acta Anaesthesiol Scand. 2007 Oct;51(9):1225-30. doi: 10.1111/j.1399-6576.2007.01431.x.
As a result of a shortage of intensive care capacity, patients may be discharged prematurely early during weekends which may lead to an increased mortality and risk of readmission to intensive care units (ICU). We examined whether discharge from the ICU during the first part of the weekend was associated with an increased mortality and readmission to the ICU.
The study was conducted at a university clinic of internal medicine and included all patients admitted for the first time to the ICU, and discharged alive in the period 1 January 2001 to 31 December 2005. Patients were divided in those discharged between 00.00 h Friday and 24.00 h Saturday (weekend group) and those discharged Sunday to Thursday (non-weekend group). The main outcome was time from discharge from the ICU to the combined endpoint death or re-admission to ICU which ever came first. We used Kaplan-Meier analysis and Cox's proportional-hazards regression to compute survival curves and risk ratio estimates.
There were 228 patients in the weekend group and 555 patients in the non-weekend group. Crude and adjusted 28-day risk ratio of the combined endpoint was 1.50 [95% confidence interval (CI): 1.15-1.97] and 1.43 (1.09-1.87) in the weekend group. Although an increased risk of death was observed in the weekend group immediately after discharge from the ICU, the difference in mortality between the two groups had disappeared after 2 years.
Medical patients discharged from the ICU early in the weekends seem to have an increased mortality and risk of readmission to the ICU.
由于重症监护能力短缺，患者可能在周末早期过早出院，这可能导致死亡率增加以及再次入住重症监护病房（ICU）的风险升高。我们研究了周末首日从ICU出院是否与死亡率增加及再次入住ICU有关。
该研究在一所大学内科诊所进行，纳入了2001年1月1日至2005年12月31日期间首次入住ICU且存活出院的所有患者。患者被分为在周五00:00至周六24:00出院的患者（周末组）和在周日至周四出院的患者（非周末组）。主要结局是从ICU出院至死亡或再次入住ICU这两个终点中先出现者的时间。我们使用Kaplan-Meier分析和Cox比例风险回归来计算生存曲线和风险比估计值。
周末组有228例患者，非周末组有555例患者。周末组联合终点的粗28天风险比和校正后风险比分别为1.50[95%置信区间（CI）：1.15 - 1.97]和1.43（1.09 - 1.87）。尽管在从ICU出院后立即观察到周末组死亡风险增加，但两组之间的死亡率差异在2年后消失。
周末早期从ICU出院的内科患者似乎死亡率增加且再次入住ICU的风险升高。
