Investigating the "Weekend Effect" on Outcomes of Patients Undergoing Endovascular Mechanical Thrombectomy for Ischemic Stroke.
Investigating the "Weekend Effect" on Outcomes of Patients Undergoing Endovascular Mechanical Thrombectomy for Ischemic Stroke.
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DOI：
10.1016/j.jstrokecerebrovasdis.2021.106013
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
de Havenon A
中科院分区：
文献类型：
--
作者：
Grandhi R;Ravindra VM;Ney JP;Zaidat O;Taussky P;de Havenon A
随着越来越多的证据表明其对大血管闭塞（LVO）缺血性卒中患者的疗效，血管内血栓切除术（EVT）的使用有所增加。“周末效应”，即在周末/下班时间就诊的患者比在正常工作时间就诊的患者的临床结局更差，是急性缺血性卒中（AIS）研究的一个关键领域。我们的目的是评估接受EVT的患者是否存在“周末效应”。这项对2016-2018年全国住院患者样本数据的回顾性、横断面分析包括有记录的缺血性卒中诊断（ICD-10代码I63、I64和H34.1）、EVT程序代码和美国国立卫生研究院卒中量表（NIHSS）评分的≥18岁患者;暴露变量为周末与工作日治疗。主要结局是院内死亡;次要结局是有利的出院、延长的住院时间（LOS）和费用。构建逻辑回归模型以确定结局的预测因素。我们确定了6，052例接受EVT的AIS患者（平均年龄68.7±14.8岁; 50.8%为女性; 70.8%为白色;中位数（IQR）入院NIHSS 16）。560例患者（11.1%）发生了院内死亡的主要结局; 1,039例患者（20.6%）发生了有利出院的次要结局。平均LOS为7.8±8.6天。基于入院时间的结果或成本没有显著差异。在混合效应模型中，我们发现周末与工作日入院对院内死亡、有利出院或延长LOS没有影响。这些结果表明，“周末效应”不会影响因LVO接受EVT的患者的结局或成本。
With growing evidence of its efficacy for patients with large-vessel occlusion (LVO) ischemic stroke, the use of endovascular thrombectomy (EVT) has increased. The “weekend effect,” whereby patients presenting during weekends/off hours have worse clinical outcomes than those presenting during normal working hours, is a critical area of study in acute ischemic stroke (AIS). Our objective was to evaluate whether a “weekend effect” exists in patients undergoing EVT. This retrospective, cross-sectional analysis of the 2016–2018 Nationwide Inpatient Sample data included patients ≥18 years with documented diagnosis of ischemic stroke (ICD-10 codes I63, I64, and H34.1), procedural code for EVT, and National Institutes of Health Stroke Scale (NIHSS) score; the exposure variable was weekend vs. weekday treatment. The primary outcome was in-hospital death; secondary outcomes were favorable discharge, extended hospital stay (LOS), and cost. Logistic regression models were constructed to determine predictors for outcomes. We identified 6,052 AIS patients who received EVT (mean age 68.7±14.8 years; 50.8% female; 70.8% White; median (IQR) admission NIHSS 16). The primary outcome of in-hospital death occurred in 560 (11.1%); the secondary outcome of favorable discharge occurred in 1,039 (20.6%). The mean LOS was 7.8±8.6 days. There were no significant differences in the outcomes or cost based on admission timing. In the mixed-effects models, we found no effect of weekend vs. weekday admission on in-hospital death, favorable discharge, or extended LOS. These results demonstrate that the “weekend effect” does not impact outcomes or cost for patients who undergo EVT for LVO.
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DOI：
10.1016/j.jstrokecerebrovasdis.2014.06.006
发表时间：
2014-11-01
影响因子：
2.5
作者：
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通讯作者：
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影响因子：
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作者：
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3.4
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影响因子：
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作者：
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.105246
发表时间：
2020-11-01
影响因子：
2.5
作者：
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