School of Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA.
Neurosurgery. 2012 Mar;70(3):586-93. doi: 10.1227/NEU.0b013e318232d1ee.
Many studies have found that patients admitted on the weekend have inferior outcomes compared with those admitted on a weekday, which may be due partially to decreased availability of procedures.
To evaluate the impact of weekend admission on the timing of intervention and outcomes after surgery for metastatic spine disease.
Data from the Nationwide Inpatient Sample (2005-2008) were retrospectively extracted. Patients were included if they had metastatic disease and underwent spine surgery; elective hospital admissions were excluded. Multivariate logistic regression analyses were conducted to calculate the odds of undergoing early surgery, in-hospital death, and the development of a complication for patients admitted on the weekend compared with those admitted on a weekday. All analyses were adjusted for differences in age, sex, comorbid disease, primary tumor histology, myelopathy, visceral metastases, and expected primary payer, as well as hospital volume, bed size, and teaching status.
We evaluated 2714 admissions. Weekend admission was associated with a significantly lower adjusted odds of receiving surgery within 1 day (odds ratio, 0.66, 95% confidence interval, 0.54-0.81; P < .001) and within 2 days (odds ratio, 0.68; 95% confidence interval, 0.56-0.83; P < .001) of admission. The adjusted odds of in-hospital death and developing a postoperative complication were not significantly different for those admitted on the weekend.
In this nationwide study examining patients with spinal metastases, those admitted on the weekend were significantly less likely to receive early intervention. Future studies are needed to delineate the reasons for differences in the timing of surgery.
许多研究发现，与在工作日入院的患者相比，周末入院的患者预后较差，这可能部分归因于手术可及性降低。
评估周末入院对转移性脊柱疾病手术患者干预时机和结局的影响。
回顾性提取了来自全国住院患者样本（2005-2008 年）的数据。纳入患有转移性疾病并接受脊柱手术的患者；排除择期住院的患者。采用多变量逻辑回归分析计算周末入院与在工作日入院的患者早期手术、院内死亡和并发症发生的几率。所有分析均根据年龄、性别、合并症、原发肿瘤组织学、脊髓病、内脏转移和预期主要支付方、以及医院容量、床位数和教学地位的差异进行调整。
我们评估了 2714 例入院病例。周末入院与在入院后 1 天内（优势比，0.66；95%置信区间，0.54-0.81；P<0.001）和 2 天内（优势比，0.68；95%置信区间，0.56-0.83；P<0.001）接受手术的调整后几率显著降低。周末入院患者的院内死亡和术后并发症发生率的调整后几率无显著差异。
在这项全国性研究中，研究了患有脊柱转移瘤的患者，周末入院的患者接受早期干预的可能性显著降低。需要进一步研究以阐明手术时机差异的原因。
