日本节假日收治急性主动脉夹层对院内死亡率的影响：一项全国性研究。

Effect of holiday admission for acute aortic dissection on in-hospital mortality in Japan: A nationwide study.

机构信息

Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-Ko, Tokyo, Japan.

Centre for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan.

出版信息

PLoS One. 2021 Nov 18;16(11):e0260152. doi: 10.1371/journal.pone.0260152. eCollection 2021.

DOI:10.1371/journal.pone.0260152

PMID:34793535

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8601417/

Abstract

BACKGROUND

Patients admitted on weekends have higher mortality than those admitted on weekdays. However, whether the "weekend effect" results in a higher mortality after admission for acute aortic dissection (AAD),-classified according to Stanford types-remains unclear. This study aimed to examine the association between admission day and in-hospital mortality in AAD Type A and B.

METHODS

We used data from the Japanese registry of all Cardiac and Vascular Diseases Diagnostic Procedure Combination, a nationwide claim-based database with data from 953 certified hospitals, and enrolled in-patients with AAD admitted between April 1, 2012, and March 31, 2016. Based on the admission day, we stratified patients into groups (Weekdays, Saturdays, and Sundays/holidays). The influence of the admission day on in-hospital mortality was assessed via multi-level logistic regression analysis. We also performed a Stanford type-based stratified analysis.

RESULTS

Among the included 25,641 patients, in-hospital mortality was 16.0%. The prevalence of patients admitted with AAD was relatively higher on weekdays. After adjustment for covariates, patients admitted on a Sunday/holiday showed an increased risk of in-hospital mortality (odds ratio [OR] 1.20; 95% confidence interval [CI] 1.07-1.33, p<0.001) than patients admitted on weekdays. Among patients admitted on a Sunday/holiday, only the subgroup of Stanford Type A showed a significantly increased risk of in-hospital mortality. (Stanford Type A, non-surgery vs. surgery groups: 95% CI 1.06-1.48 vs. 1.17-1.68, p<0.001 for both groups, OR 1.25 vs. 1.41, respectively, Stanford Type B, non-surgery vs. surgery groups: 95% CI 0.64-1.09 vs. 0.40-2.10; p = 0.182 vs. 0.846; OR 0.84 vs. 0.92).

CONCLUSIONS

In conclusion, patients with AAD Type A admitted on a Sunday/holiday may have an increased in-hospital mortality risk.

摘要

背景

与工作日相比，周末入院的患者死亡率更高。然而，根据斯坦福分型，急性主动脉夹层（AAD）患者的“周末效应”是否会导致更高的住院死亡率仍不清楚。本研究旨在探讨 AAD A 型和 B 型患者入院日与住院期间死亡率之间的关系。

方法

我们使用了日本心血管疾病诊断程序组合全国索赔数据库的数据，该数据库包含来自 953 家认证医院的数据，纳入了 2012 年 4 月 1 日至 2016 年 3 月 31 日期间因 AAD 入院的住院患者。根据入院日，我们将患者分为工作日、周六和周日/节假日组。通过多水平逻辑回归分析评估入院日对住院期间死亡率的影响。我们还进行了基于斯坦福分型的分层分析。

结果

在纳入的 25641 名患者中，住院期间死亡率为 16.0%。工作日入院的 AAD 患者比例相对较高。在校正了混杂因素后，与工作日入院的患者相比，周日/节假日入院的患者住院期间死亡风险增加（优势比[OR] 1.20；95%置信区间[CI] 1.07-1.33，p<0.001）。在周日/节假日入院的患者中，仅 A 型斯坦福的亚组显示住院期间死亡风险显著增加。（斯坦福 A 型，非手术组与手术组：95%CI 1.06-1.48 与 1.17-1.68，两组均<0.001，OR 1.25 与 1.41，斯坦福 B 型，非手术组与手术组：95%CI 0.64-1.09 与 0.40-2.10；p=0.182 与 0.846；OR 0.84 与 0.92）。