编辑精选 - 周末入院对破裂性腹主动脉瘤结局影响的系统评价和荟萃分析：呼吁提供公平的七天血管服务。
Editor's Choice - Systematic Review and Meta-Analysis of the Effect of Weekend Admission on Outcomes for Ruptured Abdominal Aortic Aneurysms: A Call for an Equitable Seven Day Vascular Service.
机构信息
Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK.
Department of Medicine, Tameside Hospital, Tameside and Glossop NHS Foundation Trust, Manchester, UK.
出版信息
Eur J Vasc Endovasc Surg. 2021 May;61(5):767-778. doi: 10.1016/j.ejvs.2020.12.022. Epub 2021 Feb 22.
OBJECTIVE
"The weekend effect" of higher patient mortality when presenting at a weekend compared with a weekday has been established for several conditions. The aim of this study was to investigate whether a weekend effect exists for the emergency condition of ruptured abdominal aortic aneurysm.
DATA SOURCES
A review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number CRD42020157484). MEDLINE, EMBASE and CINAHL were searched using the Healthcare Databases Advanced Search interface developed by NICE.
REVIEW METHODS
The prognostic factor of interest was weekend admission. The primary outcome of interest was all cause peri-operative mortality, with a secondary outcome of hospital length of stay. A random effects meta-analysis was performed, and the results were reported as summary odds ratio (OR) and 95% confidence interval (CI).
RESULTS
Twelve observational cohort studies published between 2001 and 2019 comprising 14 patient cohorts with a total of 95 856 patients were eligible for quantitative synthesis. Patients presenting on a weekend had a significantly higher risk of unadjusted in hospital mortality (OR 1.20, 95% CI 1.10 - 1.31, p < .001). Both the unadjusted 30 day mortality risk (OR 1.16, 95% CI 0.98 - 1.39, p = .090) and unadjusted 90 day mortality risk (OR 1.12, 95% CI 0.90 - 1.40, p = .30) were higher for those presenting at a weekend, but neither reached statistical significance. There was a significantly greater risk of combined unadjusted in hospital, 30 and 90 day mortality for those presenting at a weekend (OR 1.17, 95% CI 1.09 - 1.27, p < .001). Hospital length of stay was not statistically different between groups.
CONCLUSION
There is an association between weekend admission and higher mortality in patients presenting with ruptured abdominal aortic aneurysm.
目的
与工作日相比，患者在周末就诊时死亡率更高的“周末效应”已在多种情况下得到证实。本研究旨在探讨“周末效应”是否存在于腹主动脉瘤破裂这一急诊情况中。
资料来源
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南（PROSPERO 注册号 CRD42020157484）进行文献回顾。使用 NICE 开发的医疗保健数据库高级搜索界面在 MEDLINE、EMBASE 和 CINAHL 中进行检索。
研究方法
感兴趣的预后因素为周末入院。主要结局为全因围手术期死亡率，次要结局为住院时间。进行了随机效应荟萃分析，并以汇总优势比（OR）和 95%置信区间（CI）报告结果。
结果
2001 年至 2019 年期间发表的 12 项观察性队列研究，包括 14 项患者队列研究，共有 95856 名患者符合定量综合分析的条件。周末就诊的患者未校正住院死亡率显著升高（OR 1.20，95%CI 1.10-1.31，p<0.001）。周末就诊的患者未校正 30 天死亡率风险（OR 1.16，95%CI 0.98-1.39，p=0.090）和未校正 90 天死亡率风险（OR 1.12，95%CI 0.90-1.40，p=0.30）均较高，但均未达到统计学意义。周末就诊的患者联合未校正住院、30 天和 90 天死亡率的风险显著增加（OR 1.17，95%CI 1.09-1.27，p<0.001）。两组患者的住院时间无统计学差异。
结论
在因腹主动脉瘤破裂就诊的患者中，周末就诊与死亡率升高相关。
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