Ren Renee, Dominy Calista, Bueno Brian, Pasik Sara, Markowitz Jonathan, Yeshoua Brandon, Cho Brian, Arvind Varun, Valliani Aly A, Kim Jun, Cho Samuel
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Neurospine. 2023 Mar;20(1):290-300. doi: 10.14245/ns.2244816.408. Epub 2023 Mar 31.
The "weekend effect" occurs when patients cared for during weekends versus weekdays experience worse outcomes. But reasons for this effect are unclear, especially amongst patients undergoing elective cervical spinal fusion (ECSF). Our aim was to analyze whether index weekend admission affects 30- and 90-day readmission rates post-ECSF.
All ECSF patients > 18 years were retrospectively identified from the 2016-2018 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD), using unique patient linkage codes and International Classification of Diseases, Tenth Revision codes. Patient demographics, comorbidities, and outcomes were analyzed. Univariate logistic regression analyzed primary outcomes of 30- and 90-day readmission rates in weekday or weekend groups. Multivariate regression determined the impact of complications on readmission rates.
Compared to the weekday group (n = 125,590), the weekend group (n = 1,026) held a higher percentage of Medicare/Medicaid insurance, incurred higher costs, had longer length of stay, and fewer routine home discharge (all p < 0.001). There was no difference in comorbidity burden between weekend versus weekday admissions, as measured by the Elixhauser Comorbidity Index (p = 0.527). Weekend admissions had higher 30-day (4.30% vs. 7.60%, p < 0.001) and 90-day (7.80% vs. 16.10%, p < 0.001) readmission rates, even after adjusting for sex, age, insurance status, and comorbidities. All-cause complication rates were higher for weekend admissions (8.62% vs. 12.7%, p < 0.001), specifically deep vein thrombosis, infection, neurological conditions, and pulmonary embolism.
Index weekend admission increases 30- and 90-day readmission rates after ECSF. In patients undergoing ECSF on weekends, postoperative care for patients at risk for specific complications will allow for improved outcomes and health care utilization.
“周末效应”是指与工作日接受治疗的患者相比，周末接受治疗的患者预后更差。但这种效应的原因尚不清楚，尤其是在接受择期颈椎融合术（ECSF）的患者中。我们的目的是分析初次周末入院是否会影响ECSF术后30天和90天的再入院率。
使用独特的患者链接代码和国际疾病分类第十版代码，从2016 - 2018年医疗成本和利用项目全国再入院数据库（NRD）中回顾性识别所有年龄大于18岁的ECSF患者。分析患者的人口统计学、合并症和预后情况。单因素逻辑回归分析工作日或周末组30天和90天再入院率的主要结局。多因素回归确定并发症对再入院率的影响。
与工作日组（n = 125,590）相比，周末组（n = 1,026）中医疗保险/医疗补助保险的比例更高，费用更高，住院时间更长，常规家庭出院的患者更少（所有p < 0.001）。根据埃利克斯豪泽合并症指数衡量，周末入院与工作日入院之间的合并症负担没有差异（p = 0.527）。即使在调整了性别、年龄、保险状况和合并症之后，周末入院的30天（4.30%对7.60%，p < 0.001）和90天（7.80%对16.10%，p < 0.001）再入院率仍然更高。周末入院的全因并发症发生率更高（8.62%对12.7%，p < 0.001），特别是深静脉血栓形成、感染、神经系统疾病和肺栓塞。
初次周末入院会增加ECSF术后30天和90天的再入院率。对于在周末接受ECSF的患者，对有特定并发症风险的患者进行术后护理将改善预后和医疗资源利用情况。
