Yarbrough Chester K, Bommarito Kerry M, Gamble Paul G, Hawasli Ammar H, Dorward Ian G, Olsen Margaret A, Ray Wilson Z
Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA -
Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
J Neurosurg Sci. 2018 Apr;62(2):107-115. doi: 10.23736/S0390-5616.16.03617-1. Epub 2016 Mar 3.
Recent studies in surgical and non-surgical specialties have suggested that patients admitted on the weekend may have worse outcomes. In particular, patients with stroke and acute cardiovascular events have shown worse outcomes with weekend treatment. It is unclear whether this extends to patients with spinal cord injury (SCI). This study was designed to evaluate factors for readmission after index hospitalization for spinal cord injury.
This cohort was constructed from the State Inpatient Databases of California, New York, and Florida. For this study 14,396 patients with SCI were identified. The primary outcome measure evaluated was 30-day readmission. Secondary measures include in-hospital complications. Univariate and multivariate analysis were utilized to evaluate covariates. c2, Fisher's exact, and linear, logistic, and modified Poisson regression methods were utilized for statistical analysis. Propensity score methods were used with matched pairs analysis performed by the McNemar's Test.
Weekend admission was not associated with increased 30- day readmission rates in multivariate analysis. Race and discharge to a facility (RR 1.60 [1.43-1.79]) or home with home care (RR 1.23 [1.07-1.42]), were statistically significant risk factors for readmission. Payor status did not affect rates of readmission. In propensity score matched pairs analysis, weekend admission was not associated with increased odds of 30-day readmission (OR 1.04 [0.89-1.21]). Patients admitted to high volume centers had significantly lower risk of readmission when compared with patients admitted to low volume centers.
Our results suggest that the weekend effect, described previously in other patient populations, may not play as important a role in patients with SCI.
近期外科及非外科专业的研究表明，周末入院的患者可能预后较差。特别是，中风和急性心血管事件患者在周末接受治疗时预后更差。目前尚不清楚这是否也适用于脊髓损伤（SCI）患者。本研究旨在评估脊髓损伤患者首次住院后再入院的相关因素。
该队列由加利福尼亚州、纽约州和佛罗里达州的住院患者数据库构建而成。本研究共纳入14396例脊髓损伤患者。评估的主要结局指标为30天再入院率。次要指标包括住院期间的并发症。采用单因素和多因素分析评估协变量。采用卡方检验、Fisher精确检验以及线性、逻辑和修正泊松回归方法进行统计分析。采用倾向评分方法，并通过McNemar检验进行配对分析。
多因素分析显示，周末入院与30天再入院率增加无关。种族以及转至医疗机构（相对风险1.60 [1.43 - 1.79]）或回家并接受家庭护理（相对风险1.23 [1.07 - 1.42]）是再入院的统计学显著危险因素。支付者状态不影响再入院率。在倾向评分配对分析中，周末入院与30天再入院几率增加无关（比值比1.04 [0.89 - 1.21]）。与入住低容量中心的患者相比，入住高容量中心的患者再入院风险显著更低。
我们的结果表明，先前在其他患者群体中描述的周末效应，在脊髓损伤患者中可能并不起重要作用。
