周末急性缺血性脑卒中患者的收治模式和结局。
Patterns and outcomes of weekend admission for acute ischemic stroke.
机构信息
Department of Neurology, Mount Sinai Downtown, New York, NY, United States.
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.
出版信息
J Stroke Cerebrovasc Dis. 2023 Sep;32(9):107250. doi: 10.1016/j.jstrokecerebrovasdis.2023.107250. Epub 2023 Jul 11.
BACKGROUND AND OBJECTIVES
The "weekend effect" describes worse care delivery during off-hours or weekends and has been demonstrated in multiple sub-specialties. Off-hours care for acute ischemic stroke (AIS) has been associated with poorer outcomes. However, there is less data about the "weekend effect" on endovascular thrombectomy (ET) outcomes.
METHODS
We used Medicare 100% sample datasets and included all AIS admissions from 2018-2019, using validated International Classification of Diseases, 10th Revision, Clinical Modification codes to identify AIS and comorbidities. Medicare provides the date of admission for all hospitalizations, and the day of the week was determined and assigned to weekend (Saturday or Sunday) or weekday (Monday through Friday). We defined 3 major outcomes: inpatient mortality, discharge home (vs. other destination), and 30-day mortality.
RESULTS
Among 471427 AIS admissions,13.0% and 12.9% of all AIS admissions occurred on a Saturday and Sunday, respectively, less than the expected 14.3% occurring on any given day (p-value <0.0001). AIS admissions on a weekend were less likely to receive IV thrombolysis (13.6% on Saturday and 12.9% on Sunday) and ET (13.1% on Saturday and 13.2% on Sunday), p-value <0.0001. Among all AIS admissions, weekend admission was associated with worse outcomes, including higher odds of inpatient mortality (adjusted OR 1.04 [95% CI 1.01-1.08, p<0.0001]), lower odds of discharge home (0.94 [0.93-0.96, p<0.0001]), and higher odds of 30-day mortality (1.06 [1.04-1.08, p<0.0001]). However, among AIS patients treated with ET, there was no association of weekend admission with outcomes.
CONCLUSIONS
In this national and contemporary dataset, we observed that the proportion of thrombolysis and ET cases was less over the weekend, and outcomes (inpatient mortality, 30-day mortality and odds of discharge home) were worse overall. We did not observe this association among AIS patients undergoing ET on a weekend vs. weekday.
背景与目的
“周末效应”描述了在非工作时间或周末医疗服务质量下降的现象，这种现象已经在多个亚专科领域得到证实。非工作时间对急性缺血性脑卒中（AIS）的治疗与较差的治疗效果相关。然而，关于血管内取栓术（EVT）治疗 AIS 的“周末效应”的数据则较少。
方法
我们使用了 Medicare100%抽样数据集，纳入了 2018 年至 2019 年所有 AIS 住院患者，使用验证后的国际疾病分类第 10 版临床修订版（ICD-10-CM）代码来识别 AIS 和合并症。Medicare 提供了所有住院患者的入院日期，根据入院日期判断周末（周六或周日）或工作日（周一至周五）。我们定义了 3 个主要结局：住院期间死亡率、出院回家（vs. 其他目的地）和 30 天死亡率。
结果
在 471427 例 AIS 患者中，周六和周日分别有 13.0%和 12.9%的患者接受了治疗，低于任何一天（p<0.0001）预计的 14.3%的就诊比例。周末收治的 AIS 患者接受静脉溶栓治疗（周六为 13.6%，周日为 12.9%）和 EVT（周六为 13.1%，周日为 13.2%）的可能性较低，p<0.0001。在所有 AIS 患者中，周末入院与较差的预后相关，包括更高的住院期间死亡率（校正比值比 1.04[95%CI1.01-1.08，p<0.0001]）、出院回家的可能性更低（0.94[0.93-0.96，p<0.0001]）和 30 天死亡率更高（1.06[1.04-1.08，p<0.0001]）。然而，在接受 EVT 治疗的 AIS 患者中，周末入院与结局之间没有关联。
结论
在这个全国性和当代的数据集中，我们观察到周末溶栓和 EVT 治疗的比例较低，总体预后（住院期间死亡率、30 天死亡率和出院回家的可能性）更差。在周末接受 EVT 治疗的 AIS 患者中，我们没有观察到这种关联。
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