Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand.
World Neurosurg. 2022 Oct;166:e872-e891. doi: 10.1016/j.wneu.2022.07.127. Epub 2022 Aug 7.
This meta-analysis assessed the impact of off-hour hospitalization (weekends, and evenings or nighttime on weekdays) on mortality and morbidity in patients with nontraumatic subarachnoid hemorrhage (SAH).
Electronic databases were systematically searched for studies comparing outcomes between patients with nontraumatic SAH hospitalized during off-hour and on-hour periods (daytime on weekdays). The primary outcome was mortality (in-hospital and at different follow-up periods after hospitalization). Secondary outcomes included delays in treatment, and complications. Sensitivity analysis including only studies in which adjusted multivariate analyses were performed for any of the outcomes, and meta-regression controlling for clinically important patient factors, were also performed.
Sixteen studies were included. There was no significant difference in in-hospital mortality (adjusted odds ratio, 1.03; 95% confidence interval [CI], 0.97-1.09; P = 0.30) and at all follow-up periods (7/14 days and 1/3/6 months) after hospitalization between SAH patients who were admitted during off-hour compared with on-hour periods, despite adjusted multivariate meta-analysis being performed. However, patients who were admitted during off-hour periods experienced greater delays from their initial scan to treatment (mean difference, 42.7, 25.2-60.1 hours; P < 0.0001) and had higher rates of pneumonia (odds ratio, 1.65, 1.12-2.44; P = 0.011).
This meta-analysis has not shown an increased risk of mortality in the short-term and long-term among patients with nontraumatic SAH who were hospitalized during off-hour compared with on-hour periods, despite adjusting for potentially confounding patient factors. The delays to treatment and higher observed rates of pneumonia highlight areas in which hospital services and resources should be targeted during these off-hour periods in patients presenting with nontraumatic SAH.
本荟萃分析评估了非创伤性蛛网膜下腔出血（SAH）患者周末、平日傍晚或夜间住院与死亡率和发病率的关系。
系统检索电子数据库，比较非创伤性 SAH 患者在周末和非周末（平日白天）住院期间的结局。主要结局是死亡率（住院期间和住院后不同随访期）。次要结局包括治疗延迟和并发症。还进行了仅纳入对任何结局进行调整多变量分析的研究的敏感性分析，以及控制临床重要患者因素的荟萃回归分析。
纳入 16 项研究。尽管进行了调整多变量荟萃分析，但与非周末相比，周末和非周末期间住院的 SAH 患者住院期间（调整后优势比，1.03；95%置信区间 [CI]，0.97-1.09；P = 0.30）和所有随访期（7/14 天和 1/3/6 个月）的院内死亡率并无显著差异。然而，周末和非周末期间住院的患者从初始扫描到治疗的时间延迟更长（平均差异，42.7，25.2-60.1 小时；P < 0.0001），肺炎发生率更高（比值比，1.65，1.12-2.44；P = 0.011）。
尽管调整了潜在混杂患者因素，但本荟萃分析并未显示非创伤性 SAH 患者在周末住院与非周末住院相比，在短期和长期内的死亡率风险增加。治疗延迟和更高的肺炎发生率突显了在这些非工作时间，医院服务和资源应针对非创伤性 SAH 患者的这些方面进行优化。
