Dergham Ali, Witherspoon Luke, Nashed Joseph Y, Skinner Thomas, Power Liam, Mahoney John, Blew Brian, Warren Jeffrey T
From the Division of Urology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, Ont. (Dergham, Witherspoon, Mahoney, Blew, Warren); the Department of Urology, Queen's University, Kingston, Ont. (Nashed, Skinner); the Department of Urology, Dalhousie University, Halifax, N.S. (Power).
From the Division of Urology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, Ont. (Dergham, Witherspoon, Mahoney, Blew, Warren); the Department of Urology, Queen's University, Kingston, Ont. (Nashed, Skinner); the Department of Urology, Dalhousie University, Halifax, N.S. (Power)
Can J Surg. 2024 Dec 18;67(6):E406-E415. doi: 10.1503/cjs.013422. Print 2024 Nov-Dec.
The effect of weekend admission and surgery on patient morbidity and mortality has been studied in many settings and has been shown to lead to worse outcomes. Several studies have sought to determine whether there is a weekend effect in kidney transplantation specifically, but a clear effect on outcomes and graft survival has not been established.
We analyzed data from all deceased-donor organ procurements and cadaveric kidney transplants occurring during the 5-year period between Apr. 1, 2013, and Dec. 31, 2017, included in the database of the Trillium Gift of Life Network, Ontario's organ and tissue donation agency.
A total of 1116 deceased donor nephrectomies (DNs) and 1858 recipient procedures were performed in Ontario during the study period. The overall rate of after-hours DNs on weekdays was significantly greater than during working hours (23.1/30 d v. 15.4/30 d, < 0.001). Donations after neurological determination of death were more frequent during weekday working hours (22.8/30 d) than after hours on weekdays (17.3/30 d, < 0.001) or weekends (16.3/30 d, < 0.001), whereas donations after cardiac death were significantly more frequent after hours on weekdays than during working hours (10.3/30 d v. 7.7/30 d, = 0.021). On weekdays, mean warm ischemia time (WIT) was significantly longer after hours than during working hours (40.75 ± 12.26 min v. 38.52 ± 11.92 min, = 0.017). Similarly, mean WIT was longer after hours than during working hours on weekends (40.23 ± 12.48 min v. 38.59 ± 11.91 min, = 0.015).
Kidney transplantations occurred more frequently after hours and were associated with increased WIT. Further study is needed across multiple Canadian centres to better understand the temporal patterns of kidney transplantation and implications for patients, providers, and health care systems.
周末入院及手术对患者发病率和死亡率的影响已在多种环境中进行了研究，结果显示会导致更差的预后。多项研究试图确定肾移植中是否存在特定的周末效应，但尚未明确其对预后和移植物存活的影响。
我们分析了安大略省器官与组织捐赠机构翠菊生命礼物网络数据库中2013年4月1日至2017年12月31日这5年期间所有已故捐赠者器官获取及尸体肾移植的数据。
在研究期间，安大略省共进行了1116例已故捐赠者肾切除术（DNs）和1858例受者手术。工作日非工作时间的DNs总体发生率显著高于工作时间（23.1/30天对15.4/30天，<0.001）。经神经学判定死亡后的捐赠在工作日工作时间（22.8/30天）比工作日非工作时间（17.3/30天，<0.001）或周末（16.3/30天，<0.001）更频繁，而心脏死亡后的捐赠在工作日非工作时间比工作时间显著更频繁（10.3/30天对7.7/30天，=0.021）。在工作日，非工作时间的平均热缺血时间（WIT）显著长于工作时间（40.75±12.26分钟对38.52±11.92分钟，=0.017）。同样，周末非工作时间的平均WIT也长于工作时间（40.23±12.48分钟对38.59±11.91分钟，=0.015）。
肾移植在非工作时间更频繁发生，且与WIT增加有关。需要在多个加拿大中心进行进一步研究，以更好地了解肾移植的时间模式及其对患者、提供者和医疗保健系统的影响。
