Clinical Outcomes after Thrombectomy for Acute Ischemic Stroke on Weekends versus Weekdays
Clinical Outcomes after Thrombectomy for Acute Ischemic Stroke on Weekends versus Weekdays
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DOI：
10.1016/j.jstrokecerebrovasdis.2014.06.006
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发表时间：
2014-11-01
影响因子：
2.5
通讯作者：
Nahab, Fadi
中科院分区：
文献类型：
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作者：
Saad, Ali;Adil, Malik Muhammad;Nahab, Fadi
背景：本研究的目的是确定急性缺血性卒中（AIS）患者在周末和工作日行血栓切除术的临床结果是否不同。方法：从2005 - 2011年全国住院患者样本中选取初步诊断为AIS并行取栓术的患者，按周末或工作日就诊进行分层。进行Logistic回归分析，以确定教学医院和非教学医院出院时中度至重度残疾的相关因素。结果：在研究期间12,055例接受血栓切除术的AIS患者中，2862例（23.7%）在周末入院。在多因素logistic回归分析中，与非教学医院出院时中度或重度残疾相关的因素为周末入院（优势比[or]， 1.6； 95%可信区间[CI]， 1.0-2.8; P = 0.04）、高血压诊断（or, 1.9; 95% CI, 1.0-3.6; P = 0.05）、医疗保险或医疗补助状况（or, 2.1; 95% CI, 1.14.3; P = 0.02）；在教学医院中，与出院时中度或重度残疾相关的因素有：年龄0 ~ 70岁（or, 1.5; 95% CI, 1.1 ~ 2.2; P = 0.02）、肺炎（or, 4.7; 95% CI, 2.2 ~ 10.2; P < 0.0001）、脓毒症（or, 8.2; 95% CI, 1.2 ~ 54.8; P = 0.03）、颅内出血（or, 3.3; 95% CI, 1.8 ~ 6.1; P = 0.0001）以及在西北医院地区的治疗（or, 1.7; 95% CI, 1.2 ~ 2.4; P = 0.03）。结论：周末入住非教学医院的AIS取栓患者出院时出现中度至重度残疾的可能性高于工作日入住的患者。教学医院未见周末对出院临床结果的影响。
Background: The objective of this study was to determine whether clinical outcomes differed in acute ischemic stroke (AIS) patients who underwent thrombectomy on weekends versus weekdays. Methods: Patients with a primary diagnosis of AIS who underwent thrombectomy were identified from the Nationwide Inpatient Sample from 2005 to 2011 and stratified according to weekend or weekday admission. Logistic regression analysis was performed to identify factors associated with moderate-to-severe disability at hospital discharge in teaching and nonteaching hospitals. Results: Of 12,055 patients with AIS who underwent thrombectomy during the study period, 2862 (23.7%) were admitted on a weekend. In a multivariate logistic regression analysis, factors associated with moderate or severe disability at discharge in nonteaching hospitals were weekend admission (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.0-2.8; P = .04), diagnosis of hypertension (OR, 1.9; 95% CI, 1.0-3.6; P = .05), and Medicare or Medicaid insurance status (OR, 2.1; 95% CI 1.14.3; P = .02); factors associated with moderate or severe disability at discharge in teaching hospitals were age >70 years (OR, 1.5; 95% CI, 1.1-2.2; P = .02), pneumonia (OR, 4.7; 95% CI, 2.2-10.2; P < .0001), sepsis (OR, 8.2; 95% CI, 1.2-54.8; P = .03), intracranial hemorrhage (OR, 3.3; 95% CI, 1.8-6.1; P = .0001), and treatment in a Northwest hospital region (OR, 1.7; 95% CI, 1.2-2.4; P = .03). Conclusions: AIS patients undergoing thrombectomy who were admitted to nonteaching hospitals on weekends were more likely to be discharged with moderate-to-severe disability than those admitted on weekdays. No weekend effect on discharge clinical outcome was seen in teaching hospitals.