The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis.
The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis.
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DOI：
10.1186/s12913-018-3688-3
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发表时间：
2018-11-20
影响因子：
2.8
通讯作者：
Aylin P
中科院分区：
文献类型：
--
作者：
Honeyford K;Cecil E;Lo M;Bottle A;Aylin P
周末效应的概念，即周末入院患者的预后更差并不是什么新鲜事，但在英国是争论的焦点。已经发表了许多研究，这些研究考虑了周末入院患者的结果。这项系统回顾和荟萃分析旨在评估周末入院对英国医院死亡率的影响。这是对已发表的关于英国医院周末效应的研究的系统回顾和荟萃分析。应用EMBASE、MEDLINE、HMIC、Cochrane、Web of Science、Scope us等数据库检索相关文献。我们对2001年后在英国住院的患者进行了系统评价、随机对照试验和观察性研究。我们的结果是死亡；报告死亡率的研究包括在内。审查员独立地和一式两份地确定研究、提取数据并评估证据的质量。第三位审查员考虑了评估中的差异。所有的荟萃分析均采用随机效应荟萃回归方法，将异质性纳入加权。定性综合共纳入45篇文献。53%的文章得出结论认为，无论是接受手术的患者还是周末入院的患者结果都更差。我们在Meta分析中纳入了39个，共贡献了57个独立的分析。我们发现了1.07[优势比(OR)]的影响(95%CI：1.03-1.12)，这表明周末入院的患者比一周内入院的患者有更高的死亡率。亚组分析表明，当模型中包括病例组合严重程度的测量时，周末效应仍然存在(OR：1.06，95%CI：1.02-1.10)，但当使用临床登记数据时，周末效应并不显著(OR：1.03，95%CI：0.98-1.09)。异质性很高，这可能会影响通用性。尽管存在高度的异质性，但我们发现了英国存在周末效应的证据，即使在考虑了疾病的严重程度后也是如此。还需要进一步的工作来研究“周末效应”的其他潜在解释，如人员配备水平和其他组织因素。PROSPERO国际前瞻性系统评价登记簿-注册号：CRD42016041225。本文的在线版本(10.1186/s129130183688-3)包含补充材料，可供授权用户使用。
The concept of a weekend effect, poorer outcomes for patients admitted to hospitals at the weekend is not new, but is the focus of debate in England. Many studies have been published which consider outcomes for patients on admitted at the weekend. This systematic review and meta-analysis aims to estimate the effect of weekend admission on mortality in UK hospitals. This is a systematic review and meta-analysis of published studies on the weekend effect in UK hospitals. We used EMBASE, MEDLINE, HMIC, Cochrane, Web of Science and Scopus to search for relevant papers. We included systematic reviews, randomised controlled trials and observational studies) on patients admitted to hospital in the UK and published after 2001. Our outcome was death; studies reporting mortality were included. Reviewers identified studies, extracted data and assessed the quality of the evidence, independently and in duplicate. Discrepancy in assessment was considered by a third reviewer. All meta-analyses were performed using a random-effects meta-regression to incorporate the heterogeneity into the weighting. Forty five articles were included in the qualitative synthesis. 53% of the articles concluded that outcomes for patients either undergoing surgery or admitted at the weekend were worse. We included 39 in the meta-analysis which contributed 57 separate analyses. We found an effect of 1.07 [odds ratio (OR)] (95%CI:1.03–1.12), suggesting that patients admitted at the weekend had higher odds of mortality than those admitted during the week. Sub-group analyses suggest that the weekend effect remained when measures of case mix severity were included in the models (OR:1.06 95%CI:1.02–1.10), but that the weekend effect was not significant when clinical registry data was used (OR:1.03 95%CI: 0.98–1.09). Heterogeneity was high, which may affect generalisability. Despite high levels of heterogeneity, we found evidence of a weekend effect in the UK, even after accounting for severity of disease. Further work is required to examine other potential explanations for the “weekend effect” such as staffing levels and other organisational factors. PROSPERO International Prospective Register of Systematic Reviews -registration number: CRD42016041225. The online version of this article (10.1186/s12913-018-3688-3) contains supplementary material, which is available to authorized users.
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影响因子：
10.8
作者：
Harris M;Macinko J;Jimenez G;Mullachery P
通讯作者：
Mullachery P
影响因子：
2.9
作者：
Handel AE;Patel SV;Skingsley A;Bramley K;Sobieski R;Ramagopalan SV
通讯作者：
Ramagopalan SV
影响因子：
2.9
作者：
Furnivall, Daniel;Bottle, Alex;Aylin, Paul
通讯作者：
Aylin, Paul
DOI：
10.4997/jrcpe.2010.205
发表时间：
2010-01-01
影响因子：
1.4
作者：
Maggs, F.;Mallet, M.
通讯作者：
Mallet, M.
影响因子：
2.7
作者：
Haddock, Rosemary;Deighan, Christopher;Thomson, Peter C.
通讯作者：
Thomson, Peter C.