Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA 02114, USA.
Aliment Pharmacol Ther. 2013 May;37(9):895-904. doi: 10.1111/apt.12272. Epub 2013 Mar 4.
There is increasing complexity in the management of patients with acute severe exacerbation of inflammatory bowel disease [IBD; Crohn's disease (CD), ulcerative colitis (UC)] with frequent requirement for urgent surgery.
To determine whether a weekend effect exists for IBD care in the United States.
We used data from the Nationwide Inpatient Sample (NIS) 2007, the largest all-payer hospitalisation database in the United States. Discharges with a diagnosis of CD or UC who underwent urgent intestinal surgery within 2 days of hospitalisation were identified using the appropriate ICD-9 codes. The independent effect of admission on a weekend was examined using multivariate logistic regression adjusting for potential confounders.
Our study included 7,112 urgent intestinal surgeries in IBD patients, 21% of which occurred following weekend admissions. There was no difference in disease severity between weekend and weekday admissions. Post-operative complications were more common following weekend than weekday hospitalisations in UC [odds ratio (OR) 1.71, 95% confidence interval (CI) 1.01-2.90]. The most common post-operative complication was post-operative infections (Weekend 30% vs. weekday 20%, P = 0.04). The most striking difference between weekend and weekday hospitalisations was noted for needing repeat laparotomy (OR 11.5), mechanical wound complications (OR 10.03) and pulmonary complications (OR 2.22). In contrast, occurrence of any post-operative complication in CD was similar between weekday and weekend admissions.
Patients with UC hospitalised on a weekend undergoing urgent surgery within 2 days have an increased risk for post-operative complications, in particular mechanical wound complications, need for repeat laparotomy and post-operative infections.
患有急性重度炎症性肠病（IBD；克罗恩病[CD]、溃疡性结肠炎[UC]）的患者的管理日益复杂，经常需要紧急手术。
确定美国 IBD 护理是否存在周末效应。
我们使用了美国最大的全支付住院数据库——全国住院患者样本（NIS）2007 中的数据。使用适当的 ICD-9 代码确定在住院后 2 天内接受紧急肠道手术且诊断为 CD 或 UC 的患者。使用多元逻辑回归调整潜在混杂因素，检查入院时间对周末的独立影响。
我们的研究包括 7112 例 IBD 患者的紧急肠道手术，其中 21%是在周末入院后进行的。周末和工作日入院的患者疾病严重程度没有差异。与工作日住院相比，UC 患者周末住院后的术后并发症更常见[比值比（OR）1.71，95%置信区间（CI）1.01-2.90]。最常见的术后并发症是术后感染（周末 30%，工作日 20%，P=0.04）。周末和工作日住院之间最显著的差异是需要再次剖腹手术（OR 11.5）、机械性伤口并发症（OR 10.03）和肺部并发症（OR 2.22）。相比之下，CD 患者在工作日和周末入院的术后任何并发症的发生率相似。
在住院后 2 天内接受紧急手术的 UC 患者，如果在周末入院，术后并发症的风险增加，特别是机械性伤口并发症、需要再次剖腹手术和术后感染的风险增加。
