Williams Anwen, Powell Arfon G M T, Spernaes Izabela, Basu Pallavi, Edwards Stephen, Edwards Paul
Nevill Hall Hospital, Brecon Road, Abergavenny, NP7 7EG, United Kingdom.
Division of Cancer and Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XW, United Kingdom.
Surgeon. 2019 Feb;17(1):15-18. doi: 10.1016/j.surge.2018.04.007. Epub 2018 May 31.
The influence of patient demographics and mode of admission on the 'weekend effect' remains unclear. This study examins the relationship between day of admission, patient demographics, mode of presentation and survival.
Hospital admissions over a three-year period were studied. Patients with an inpatient stay less than 24 h and those who were discharged from the emergency department were excluded. In-hospital mortality was correlated with day of admission, age, gender and mode of presentation in a binary logistical regression analysis.
There were 448,827 admissions, of which 350,648 (85.7%) occurred during a weekday. 256,777 (62.7%) were emergency presentations, which was closely related to a weekend admission (92.3% vs 57.8%, p < 0.001). There were 8099 deaths of which 6336 (78.2%) related to a weekday admission and 1736 (21.4%) related a weekend admission. Mortality for elective admissions was 78 (0.05%) compared to 8021 (3.12%), p < 0.001 in emergency admissions. Univariable regression analysis revealed a weekend admission (Odds Ratio (OR) 1.68 (95% confidence interval (CI) 1.60-1.78, p < 0.001) and emergency presentation (OR 63.02 (95%CI 50.42-78.77), p < 0.011) were associated with weekend mortality. On multivariable analysis the OR for weekend admission reduced to 1.07 (95%CI 1.01-1.13), p = 0.013 and the OR for emergency presentation increased to 76.68 (95%CI 61.40-96.00), p < 0.001.
This study highlights that higher weekend mortality rates are a consequence of a lower proportion of elective admissions. Extending the working week to seven days might reduce weekend mortality without reducing the total number of deaths.
患者人口统计学特征及入院方式对“周末效应”的影响尚不清楚。本研究探讨入院日期、患者人口统计学特征、就诊方式与生存率之间的关系。
对三年期间的医院入院情况进行研究。排除住院时间少于24小时的患者以及从急诊科出院的患者。在二元逻辑回归分析中，将院内死亡率与入院日期、年龄、性别及就诊方式进行关联分析。
共有448,827例入院患者，其中350,648例（85.7%）在工作日入院。256,777例（62.7%）为急诊就诊，这与周末入院密切相关（92.3%对57.8%，p<0.001）。共有8099例死亡，其中6336例（78.2%）与工作日入院相关，1736例（21.4%）与周末入院相关。择期入院的死亡率为78例（0.05%），而急诊入院的死亡率为8021例（3.12%），p<0.001。单变量回归分析显示，周末入院（比值比（OR）1.68（95%置信区间（CI）1.60 - 1.78，p<0.001））和急诊就诊（OR 63.02（95%CI 50.42 - 78.77），p<0.011）与周末死亡率相关。多变量分析中，周末入院的OR降至1.07（95%CI 1.01 - 1.13），p = 0.013，急诊就诊的OR升至76.68（95%CI 61.40 - 96.00），p<0.001。
本研究强调周末死亡率较高是择期入院比例较低的结果。将工作周延长至七天可能会降低周末死亡率，而不会减少死亡总数。
