Rai Karan, Douglas Ivor S, Mehta Anuj B
Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA.
J Intensive Care Med. 2023 Dec;38(12):1136-1142. doi: 10.1177/08850666231185315. Epub 2023 Jun 26.
Increased mortality in patients admitted to hospitals on weekends is a well-described phenomenon labeled the "weekend effect." Studies evaluating the weekend effect in intensive care units (ICUs) have arrived at conflicting results. Identifying a weekend effect for critically-ill patients may inform clinical care pathways and resource allocation.
Determine the association of initiation of mechanical ventilation (MV) upon admission on a weekend versus weekday with hospital mortality.
We conducted a retrospective cohort study of non-surgical adult patients using the California Patient Discharge Database from 2018 to 2019. We identified MV initiated on the day of admission and diagnoses using discharge billing codes. The primary exposure was admission and initiation of MV on a weekend versus weekday and the primary outcome was hospital mortality. Hierarchical logistic regression was used to determine the association between hospital mortality and MV initiation timing, adjusting for case-mix.
Among 90 288 admissions in 2018 and 2019 meeting inclusion criteria, 24 771 (27.5%) had MV initiated on weekends, while 65 517 (72.6%) had MV initiated on weekdays. Patient demographics and comorbidities were similar between groups. Chronic alcohol and substance use disorders, and acute intoxications and traumas were more prevalent among patients with MV initiated on weekends. No difference in hospital mortality was observed with initiation of MV on weekends versus weekdays (23.1% vs 22.8%, ARD = 0.3%, aOR = 1.02, 95% CI 0.98, 1.07).
Contrary to prior studies, no increased mortality was observed among newly admitted patients initiated on MV on weekends compared to weekdays. While weekend effects may exist in other settings, newly admitted patients likely have MV initiated in the emergency department or ICU, which tend to have more consistent staffing levels. Further research is needed to determine if care patterns in these units could be used as a model for units where weekend effects continue to impact outcomes.
周末入院患者死亡率增加是一种已被充分描述的现象，称为“周末效应”。评估重症监护病房（ICU）中周末效应的研究得出了相互矛盾的结果。确定重症患者的周末效应可能会为临床护理路径和资源分配提供信息。
确定周末与工作日入院时开始机械通气（MV）与医院死亡率之间的关联。
我们使用2018年至2019年的加利福尼亚患者出院数据库对非手术成年患者进行了一项回顾性队列研究。我们使用出院计费代码确定入院当天开始的MV和诊断。主要暴露因素是周末与工作日入院并开始MV，主要结局是医院死亡率。采用分层逻辑回归来确定医院死亡率与MV开始时间之间的关联，并对病例组合进行调整。
在2018年和2019年符合纳入标准的90288例入院患者中，24771例（27.5%）在周末开始MV，而65517例（72.6%）在工作日开始MV。两组患者的人口统计学和合并症相似。慢性酒精和物质使用障碍以及急性中毒和创伤在周末开始MV的患者中更为普遍。周末与工作日开始MV的患者在医院死亡率方面没有差异（23.1%对22.8%，绝对风险差=0.3%，调整后比值比=1.02，95%置信区间0.98，1.07）。
与先前的研究相反，与工作日相比，周末开始MV的新入院患者未观察到死亡率增加。虽然在其他环境中可能存在周末效应，但新入院患者可能在急诊科或ICU开始MV，而这些科室的人员配备水平往往更稳定。需要进一步研究以确定这些科室的护理模式是否可以作为周末效应继续影响结局的科室的模型。
