Liu Peter Pin-Sung, Chang Jui-Chih, Hsu Jin-Yi, Huang Huei-Kai, Loh Ching-Hui, Yeh Jih-I
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
Center for Healthy Longevity, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Korean Circ J. 2024 Mar;54(3):126-137. doi: 10.4070/kcj.2023.0266. Epub 2024 Jan 18.
The impact of off-hours admission (such as weekends, nighttime, and non-working hours) vs. regular hours (weekdays and daytime working hours) on the mortality risk of patients undergoing surgery for type A aortic dissection (TAAD) repair is still uncertain. To address this uncertainty, we undertook a comprehensive systematic review and meta-analysis. We aimed to assess the potential link between off-hours admission and the risk of mortality in patients undergoing TAAD repair surgery.
We conducted a thorough search of the PubMed, Embase, and Cochrane Library databases, covering the period from their inception to May 20, 2023. Our inclusion criteria encompassed all studies that examined the potential relationship between off-hour admission and mortality in individuals who had undergone surgery for TAAD repair. The odds ratios (ORs) were extracted and combined utilizing a random effects model for our synthesis.
Nine studies with 16,501 patients undergoing TAAD repair surgery were included in the meta-analysis. Overall, patients who underwent surgery during the weekend had higher in-hospital mortality (pooled OR, 1.41; 95% confidence interval [CI], 1.14-1.75; p=0.002) than those treated on weekdays. However, the mortality risks among patients who underwent TAAD surgery during nighttime and non-working hours were not significantly elevated compared to daytime and working hours admission.
Weekend surgery for TAAD was associated with a higher in-hospital mortality risk than weekday surgery. However, further studies are warranted to identify and develop strategies to improve the quality of round-the-clock care for patients with TAAD.
非工作时间入院（如周末、夜间和非工作时间）与正常时间（工作日和白天工作时间）相比，对接受A型主动脉夹层（TAAD）修复手术患者的死亡风险的影响仍不确定。为了解决这一不确定性，我们进行了一项全面的系统评价和荟萃分析。我们旨在评估非工作时间入院与TAAD修复手术患者死亡风险之间的潜在联系。
我们对PubMed、Embase和Cochrane图书馆数据库进行了全面检索，涵盖从建库至2023年5月20日的时间段。我们的纳入标准包括所有研究TAAD修复手术患者非工作时间入院与死亡率之间潜在关系的研究。提取比值比（OR）并使用随机效应模型进行合并以进行综合分析。
荟萃分析纳入了9项研究，共16501例接受TAAD修复手术的患者。总体而言，在周末接受手术的患者院内死亡率（合并OR，1.41；95%置信区间[CI]，1.14 - 1.75；p = 0.002）高于在工作日接受治疗的患者。然而，与白天和工作时间入院相比，夜间和非工作时间接受TAAD手术的患者死亡风险并未显著升高。
TAAD的周末手术与比工作日手术更高的院内死亡风险相关。然而，有必要进一步开展研究以确定并制定策略来提高TAAD患者全天候护理的质量。
