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工作日与周末因需首次植入心内装置的心脏传导阻滞入院治疗的结局对比

Outcomes of Weekday Versus Weekend Admissions for Heart Block Requiring De Novo Intracardiac Device Implantation.

作者信息

Mohamed Abdel-Rhman, Pena Clarissa, Kadiver Sohrab, Abdelrahman Ahmad, Mousa Omar, Elzanaty Ahmad, Grubb Blair

机构信息

Internal Medicine, The University of Toledo Medical Center, Toledo, USA.

Internal Medicine, Tanta University Faculty of Medicine, Tanta, EGY.

出版信息

Cureus. 2024 Jul 9;16(7):e64141. doi: 10.7759/cureus.64141. eCollection 2024 Jul.

Abstract

Even with comparable healthcare structure and staffing, patients presenting on weekends often face poorer outcomes, including longer wait times in the emergency department, extended hospital stays, and delays in major procedures. This discrepancy prompts questions about whether life-saving cardiac procedures, such as permanent pacemaker (PPM) implantation for atrioventricular block, also experience similar delays and differences in outcomes. We researched over 200,000 patients from the National Inpatient Sample (NIS) database to help study whether patients admitted on the weekend truly had worse outcomes than patients admitted on the weekday. Using the International Classification of Diseases, Tenth Revision (ICD-10) using STATA software (StataCorp LLC, College Station, TX), we found that 79.6% of patients were admitted on weekdays. Among these weekday admissions, 56.2% were males, with an average age of 75.8 years. Weekend admissions included 54.4% male patients, with an average age of 76.4 years. Key variables influencing outcomes were renal failure history, non-ST elevation myocardial infarction, diabetes mellitus, and percutaneous coronary intervention. Of the total patients, 1,315 died during hospitalization, with no significant difference in mortality between weekday and weekend admissions. However, weekend admissions had a higher rate of cardiac arrest, a greater likelihood of delayed pacer implantation, and longer hospital stays. Weekend admissions were linked to delays in PPM placement, longer hospital stays, and higher hospitalization costs. Mortality rates did not increase for patients admitted on weekends. Further research is needed to explore this issue in greater depth and to identify the specific factors contributing to the discrepancy between weekend and weekday admissions, which resulted in worse outcomes for weekend patients.

摘要

即使在医疗结构和人员配备相当的情况下,周末就诊的患者往往面临更差的治疗结果,包括在急诊科等待时间更长、住院时间延长以及重大手术延迟。这种差异引发了关于诸如房室传导阻滞的永久性起搏器(PPM)植入等挽救生命的心脏手术是否也会经历类似延迟和结果差异的问题。我们研究了来自国家住院样本(NIS)数据库的20多万名患者,以帮助研究周末入院的患者是否真的比工作日入院的患者治疗结果更差。使用国际疾病分类第十版(ICD - 10)并借助STATA软件(StataCorp有限责任公司,德克萨斯州大学站),我们发现79.6%的患者在工作日入院。在这些工作日入院的患者中,56.2%为男性,平均年龄为75.8岁。周末入院的患者中男性占54.4%,平均年龄为76.4岁。影响治疗结果的关键变量包括肾衰竭病史、非ST段抬高型心肌梗死、糖尿病和经皮冠状动脉介入治疗。在所有患者中,1315人在住院期间死亡,工作日和周末入院患者的死亡率没有显著差异。然而,周末入院患者心脏骤停发生率更高,起搏器植入延迟的可能性更大,住院时间更长。周末入院与PPM植入延迟、住院时间延长和住院费用增加有关。周末入院患者的死亡率并未上升。需要进一步研究以更深入地探讨这个问题,并确定导致周末和工作日入院差异的具体因素,这些因素导致周末入院患者治疗结果更差。

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本文引用的文献

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