Honeyford Kate, Cecil Elizabeth, Lo Michelle, Bottle Alex, Aylin Paul
Department of Primary Care and Public Health, Dr Foster Unit at Imperial College, 3 Dorset Rise, London, EC4Y 8EN, UK.
Department of Family Medicine and Primary Healthcare, Hospital Authority, Hong Kong, Hong Kong.
BMC Health Serv Res. 2018 Nov 20;18(1):870. doi: 10.1186/s12913-018-3688-3.
The concept of a weekend effect, poorer outcomes for patients admitted to hospitals at the weekend is not new, but is the focus of debate in England. Many studies have been published which consider outcomes for patients on admitted at the weekend. This systematic review and meta-analysis aims to estimate the effect of weekend admission on mortality in UK hospitals.
This is a systematic review and meta-analysis of published studies on the weekend effect in UK hospitals. We used EMBASE, MEDLINE, HMIC, Cochrane, Web of Science and Scopus to search for relevant papers. We included systematic reviews, randomised controlled trials and observational studies) on patients admitted to hospital in the UK and published after 2001. Our outcome was death; studies reporting mortality were included. Reviewers identified studies, extracted data and assessed the quality of the evidence, independently and in duplicate. Discrepancy in assessment was considered by a third reviewer. All meta-analyses were performed using a random-effects meta-regression to incorporate the heterogeneity into the weighting.
Forty five articles were included in the qualitative synthesis. 53% of the articles concluded that outcomes for patients either undergoing surgery or admitted at the weekend were worse. We included 39 in the meta-analysis which contributed 50 separate analyses. We found an overall effect of 1.07 [odds ratio (OR)] (95%CI:1.03-1.12), suggesting that patients admitted at the weekend had higher odds of mortality than those admitted during the week. Sub-group analyses suggest that the weekend effect remained when measures of case mix severity were included in the models (OR:1.06 95%CI:1.02-1.10), but that the weekend effect was not significant when clinical registry data was used (OR:1.03 95%CI: 0.98-1.09). Heterogeneity was high, which may affect generalisability.
Despite high levels of heterogeneity, we found evidence of a weekend effect in the UK, even after accounting for severity of disease. Further work is required to examine other potential explanations for the "weekend effect" such as staffing levels and other organisational factors.
PROSPERO International Prospective Register of Systematic Reviews -registration number: CRD42016041225 .
周末效应的概念，即周末入院患者预后较差，并非新鲜事物，但却是英国争论的焦点。已有许多研究发表，探讨了周末入院患者的预后情况。本系统评价和荟萃分析旨在评估英国医院周末入院对死亡率的影响。
这是一项对已发表的关于英国医院周末效应研究的系统评价和荟萃分析。我们使用EMBASE、MEDLINE、HMIC、Cochrane、科学网和Scopus检索相关论文。我们纳入了2001年后发表的关于英国住院患者的系统评价、随机对照试验和观察性研究。我们的结局指标是死亡；纳入报告死亡率的研究。评审员独立且重复地识别研究、提取数据并评估证据质量。评估差异由第三位评审员审议。所有荟萃分析均采用随机效应荟萃回归，将异质性纳入权重计算。
45篇文章纳入定性综合分析。53%的文章得出结论，周末接受手术或入院的患者预后较差。我们纳入39项进行荟萃分析，这些研究贡献了50项独立分析。我们发现总体效应为1.07 [比值比（OR）]（95%置信区间：1.03 - 1.12），表明周末入院患者的死亡几率高于一周内入院患者。亚组分析表明，当模型中纳入病例组合严重程度测量指标时，周末效应仍然存在（OR：1.06，95%置信区间：1.02 - 1.10），但使用临床登记数据时，周末效应不显著（OR：1.03，95%置信区间：0.98 - 1.09）。异质性较高，这可能影响结果的普遍性。
尽管异质性程度较高，但我们发现英国存在周末效应的证据，即使在考虑疾病严重程度之后。需要进一步开展工作，以研究“周末效应”的其他潜在解释，如人员配备水平和其他组织因素。
国际系统评价前瞻性注册库PROSPERO - 注册号：CRD42016041225 。
