Li Renxi, Lee SeungEun, Rienas William, Sarin Shawn
The George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
The George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
Clin Res Hepatol Gastroenterol. 2024 Aug;48(7):102396. doi: 10.1016/j.clinre.2024.102396. Epub 2024 Jun 12.
Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to alleviate portal hypertension in patients with decompensated liver cirrhosis. The weekend effect refers to a higher risk of adverse outcomes associated with procedures performed on weekends compared to weekdays. The goal of this study is to determine whether a weekend effect is evident in TIPS procedures.
The study identified patients who underwent TIPS procedures in the NIS database from 2015 to 2020. Patients who were admitted on the weekday or weekends were classified into two cohorts. Preoperative variables, including demographics, comorbidities, primary payer status, and hospital characteristics, were noted. Multivariable analysis was used to assess outcomes.
Compared to patients admitted on the weekdays, weekend patients had higher in-hospital mortality (12.87 % vs. 7.96 %, aOR = 1.62, 95 CI 1.32-1.00, p < 0.01), hepatic encephalopathy (33.24 % vs. 26.18 %, aOR = 1.41, 95 CI 1.23-1.63, p < 0.01), acute kidney injury (39.03 % vs. 28.36 %, aOR = 1.68, 95 CI 1.46-1.93, p < 0.01), and transfer out (15.91 % vs. 12.76 %, aOR=1.33, 95 CI 1.11-1.60, p < 0.01). It was also found that weekend patients had longer wait from admission to operation (3.83 ± 0.15 days vs 2.82 ± 0.07 days, p < 0.01), longer LOS (11.22 ± 0.33 days vs 8.38 ± 0.15 days, p < 0.01), and higher total hospital charge (219,973 ± 7,352 dollars vs 172,663 ± 3,183 dollars, p < 0.01).
Our research unveiled a significant relationship between weekend admission and a higher risk of mortality and morbidity post-TIPS procedure. Eliminating delays in treatment associated with the weekend effect may mitigate this gap to deliver consistent and high-quality care to all patients.
经颈静脉肝内门体分流术（TIPS）是一种用于缓解失代偿期肝硬化患者门静脉高压的手术。周末效应是指与工作日进行的手术相比，周末进行手术的不良结局风险更高。本研究的目的是确定TIPS手术中是否存在明显的周末效应。
该研究在国家住院患者样本（NIS）数据库中识别出2015年至2020年期间接受TIPS手术的患者。在工作日或周末入院的患者被分为两个队列。记录术前变量，包括人口统计学、合并症、主要支付者状态和医院特征。采用多变量分析评估结局。
与工作日入院的患者相比，周末入院的患者院内死亡率更高（12.87%对7.96%，校正比值比[aOR]=1.62，95%置信区间[CI]1.32 - 1.00，p<0.01）、肝性脑病发生率更高（33.24%对26.18%，aOR = 1.41，95%CI 1.23 - 1.63，p<0.01）、急性肾损伤发生率更高（39.03%对28.36%，aOR = 1.68，95%CI 1.46 - 1.93，p<0.01）以及转出率更高（15.91%对12.76%，aOR = 1.33，95%CI 1.11 - 1.60，p<0.01）。还发现周末入院的患者从入院到手术的等待时间更长（3.83±0.15天对2.82±0.07天，p<0.01）、住院时间更长（11.22±0.33天对8.38±0.15天，p<0.01）以及总住院费用更高（219,973±7,352美元对172,663±3,183美元，p<0.01）。
我们的研究揭示了周末入院与TIPS手术后更高的死亡和发病风险之间存在显著关系。消除与周末效应相关的治疗延迟可能会缩小这一差距，为所有患者提供一致且高质量的护理。
