Department of Neurosurgery, Leeds General Infirmary, Leeds, UK.
School of Medicine, University of Leeds, Leeds, UK.
Br J Neurosurg. 2022 Feb;36(1):26-30. doi: 10.1080/02688697.2020.1853674. Epub 2020 Dec 7.
In this article, we have studied what the impact of the 2016 contract has been on the weekend mortality rate in a single UK Neurosurgery centre for emergency admissions.
All adult neurosurgery admissions and mortality data from Leeds General Infirmary in 2016 and 2018 was included. Weekday was defined as between 00:01 am Monday and 23:59 Friday. Weekend was defined as anything outside this timeframe. In the first part of the analysis, we excluded all public holiday admissions and compared mortality risks between weekday and weekend admissions. A Cox proportional hazard model was used to examine the time to in-hospital death or censorship. From the model, we compared the hazard ratio of weekend-vs.-weekday admissions for 7-day, 30-day and overall mortalities as well as compared the hazard of mortality on each day of the week to Wednesday admission. In the second part of the analysis, we compared mortality risks of weekday admissions versus public holiday admissions. Finally, to further evaluate whether there was any change in service standard from 2016 to 2018, we assessed the odds ratio of mortality between admission in 2018 and 2016 on weekends and weekdays excluding public holidays.
At 95% confidence interval, no significant difference in hazard ratio was found between admissions on different days in the week when compared to Wednesday in 2016 and 2018. There is a higher weekday admission 7-day mortality hazard ratio in 2018 compared to 2016 but overall there is no statistically significant difference in mortality hazard ratio between the two years. There is, however, a statistically significant difference in hazard ratio when comparing public holiday mortality in 2018 to weekday mortality.
There was no weekend effect in our unit in 2016 or in 2018, however there is a public holiday effect in 2018.
本文研究了 2016 年合同对英国一家神经外科中心急诊入院周末死亡率的影响。
纳入了利兹综合医院 2016 年和 2018 年所有成人神经外科入院和死亡数据。工作日定义为周一 00:01 至周五 23:59。周末定义为除此时间段之外的任何时间。在分析的第一部分，我们排除了所有公共假日入院的病例，并比较了工作日和周末入院的死亡率风险。采用 Cox 比例风险模型来检查住院期间死亡或删失的时间。从模型中，我们比较了周末与工作日入院的 7 天、30 天和总体死亡率的风险比，以及比较了每周各天与周三入院的死亡率风险。在分析的第二部分，我们比较了工作日与公共假日入院的死亡率风险。最后，为了进一步评估 2016 年至 2018 年服务标准是否有任何变化，我们评估了 2018 年和 2016 年周末和非公共假日工作日入院的死亡率比值比。
在 95%置信区间内，与 2016 年和 2018 年周三相比，一周中不同天的入院时风险比没有显著差异。2018 年与 2016 年相比，工作日入院 7 天死亡率的风险比更高，但两年间死亡率风险比没有统计学上的显著差异。然而，比较 2018 年公共假日死亡率与工作日死亡率时，风险比有统计学上的显著差异。
在我们的单位，2016 年或 2018 年均未出现周末效应，但 2018 年存在公共假日效应。
