Hsieh Cheng-Yang, Lin Huey-Juan, Chen Chih-Hung, Li Chung-Yi, Chiu Meng-Jun, Sung Sheng-Feng
Department of Neurology, Tainan Sin Lau Hospital Department of Neurology, Chi Mei Medical Center Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Department of Public Health, College of Medicine, National Cheng Kung University, Tainan Department of Public Health, China Medical University, Taichung Department of Public Health, College of Medicine, Tainan Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan.
Medicine (Baltimore). 2016 Jun;95(25):e4046. doi: 10.1097/MD.0000000000004046.
Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index.This was an observational study using a representative sample of the National Health Insurance claims data linked to the National Death Registry. We identified patients hospitalized for ischemic stroke, and examined the effect of weekend admission on 30-day mortality with vs without adjustment for stroke severity by using multilevel logistic regression analysis adjusting for patient-, physician-, and hospital-related factors. We analyzed 46,007 ischemic stroke admissions, in which weekend admissions accounted for 23.0%. Patients admitted on weekends had significantly higher 30-day mortality (4.9% vs 4.0%, P < 0.001) and stroke severity index (7.8 vs 7.4, P < 0.001) than those admitted on weekdays. In multivariate analysis without adjustment for stroke severity, weekend admission was associated with increased 30-day mortality (odds ratio (OR), 1.20; 95% confidence interval [CI], 1.08-1.34). This association became null after adjustment for stroke severity (OR, 1.07; 95% CI, 0.95-1.20).The "weekend effect" on stroke mortality might be attributed to higher stroke severity in weekend patients. While claims data are useful for examining stroke outcomes, adequate adjustment for stroke severity is warranted.
以往关于卒中后周末入院是否与死亡率增加相关的研究结果并不一致，部分原因在于病例组合的差异。基于索赔的研究通常缺乏关于疾病严重程度的足够信息，因此病例组合调整不足。在本研究中，我们通过使用基于索赔的卒中严重程度指数来研究周末入院对缺血性卒中患者30天死亡率的影响。
这是一项观察性研究，使用了与国家死亡登记处相关联的国民健康保险索赔数据的代表性样本。我们确定了因缺血性卒中住院的患者，并通过多水平逻辑回归分析，在调整患者、医生和医院相关因素的情况下，研究了周末入院对30天死亡率的影响，同时比较了调整和未调整卒中严重程度的情况。我们分析了46007例缺血性卒中入院病例，其中周末入院病例占23.0%。与工作日入院的患者相比，周末入院的患者30天死亡率（4.9%对4.0%，P<0.001）和卒中严重程度指数（7.8对7.4，P<0.001）显著更高。在未调整卒中严重程度的多变量分析中，周末入院与30天死亡率增加相关（优势比（OR），1.20；95%置信区间[CI]，1.08 - 1.34）。在调整卒中严重程度后，这种关联消失（OR，1.07；95%CI，0.95 - 1.20）。
卒中死亡率的“周末效应”可能归因于周末入院患者更高的卒中严重程度。虽然索赔数据有助于研究卒中结局，但对卒中严重程度进行充分调整是必要的。
