Association between weekend admissions and mortality after aneurysmal subarachnoid hemorrhage: the “weekend effect” revisited

View More View Less
  • 1 Faculty of Medicine, University of Toronto, Ontario;
  • | 2 Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia;
  • | 3 Division of Neurosurgery, University of Calgary, Alberta;
  • | 4 Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Ontario;
  • | 5 Division of Neurosurgery, St. Michael’s Hospital;
  • | 6 Labatt Family Centre of Excellence in Brain Injury and Trauma Research;
  • | 7 Keenan Research Centre for Biomedical Science and the Li Ka Shing Knowledge Institute of St. Michael’s Hospital; and
  • | 8 Departments of Physiology and Surgery, University of Toronto, Ontario, Canada
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Higher mortality has been reported with weekend or after-hours patient admission across a wide range of surgical and medical specialties, a phenomenon termed the “weekend effect.” The authors evaluated whether weekend admission contributed to death and long-term neurological outcome in patients following aneurysmal subarachnoid hemorrhage.

METHODS

A post hoc analysis of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) study was conducted. Univariable and stepwise multivariable logistic regression analyses were performed to assess the associations between weekend admission and mortality and long-term neurological outcome.

RESULTS

Of 413 subjects included in the CONSCIOUS-1 study, 140 patients had been admitted during the weekend. A significant interaction was identified between weekend admission and neurological grade on presentation, suggesting that the outcomes of patients who had initially presented with a poor grade were disproportionately influenced by the weekend admission. On stepwise multivariable logistic regression in the subgroup of patients who had presented with a poor neurological grade (29 of 100 patients), admission on the weekend was found to be independently associated with death (OR 6.59, 95% CI 1.62–26.88, p = 0.009). Weekend admission was not associated with long-term neurological outcome.

CONCLUSIONS

Weekend admission was an independent risk factor for death within 12 weeks following aneurysmal subarachnoid hemorrhage in patients presenting with a poor neurological grade. Further work is required to identify and mitigate any mediating factors.

ABBREVIATIONS

aSAH = aneurysmal subarachnoid hemorrhage; CONSCIOUS-1 = Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage; eGOS = extended Glasgow Outcome Scale; WFNS = World Federation of Neurosurgical Societies.

Illustration from Duan et al. (pp 1174–1181).

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence George M. Ibrahim: Hospital for Sick Children, University of Toronto, ON, Canada. george.ibrahim@sickkids.ca.

INCLUDE WHEN CITING Published online March 29, 2019; DOI: 10.3171/2019.1.JNS183185.

M.M. and O.G.S.A. contributed equally to this work and share first authorship.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Ambler GK, Mariam NBG, Sadat U, Coughlin PA, Loftus IM, Boyle JR: Weekend effect in non-elective abdominal aortic aneurysm repair. BJS Open 1:158164, 2017

    • Search Google Scholar
    • Export Citation
  • 2

    Andaluz N, Zuccarello M: Recent trends in the treatment of cerebral aneurysms: analysis of a nationwide inpatient database. J Neurosurg 108:11631169, 2008

    • Search Google Scholar
    • Export Citation
  • 3

    Ayling OGS, Ibrahim GM, Alotaibi NM, Gooderham PA, Macdonald RL: Anemia after aneurysmal subarachnoid hemorrhage is associated with poor outcome and death. Stroke 49:18591865, 2018

    • Search Google Scholar
    • Export Citation
  • 4

    Ayling OGS, Ibrahim GM, Alotaibi NM, Gooderham PA, Macdonald RL: Dissociation of early and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage. Stroke 47:29452951, 2016

    • Search Google Scholar
    • Export Citation
  • 5

    Cavallazzi R, Marik PE, Hirani A, Pachinburavan M, Vasu TS, Leiby BE: Association between time of admission to the ICU and mortality: a systematic review and metaanalysis. Chest 138:6875, 2010

    • Search Google Scholar
    • Export Citation
  • 6

    Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. : Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43:17111737, 2012

    • Search Google Scholar
    • Export Citation
  • 7

    Crowley RW, Yeoh HK, Stukenborg GJ, Ionescu AA, Kassell NF, Dumont AS: Influence of weekend versus weekday hospital admission on mortality following subarachnoid hemorrhage. Clinical article. J Neurosurg 111:6066, 2009

    • Search Google Scholar
    • Export Citation
  • 8

    Deshmukh H, Hinkley M, Dulhanty L, Patel HC, Galea JP: Effect of weekend admission on in-hospital mortality and functional outcomes for patients with acute subarachnoid haemorrhage (SAH). Acta Neurochir (Wien) 158:829835, 2016

    • Search Google Scholar
    • Export Citation
  • 9

    Freemantle N, Ray D, McNulty D, Rosser D, Bennett S, Keogh BE, et al. : Increased mortality associated with weekend hospital admission: a case for expanded seven day services? BMJ 351:h4596, 2015

    • Search Google Scholar
    • Export Citation
  • 10

    Graeb DA, Robertson WD, Lapointe JS, Nugent RA, Harrison PB: Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis. Radiology 143:9196, 1982

    • Search Google Scholar
    • Export Citation
  • 11

    Gupta A, Agarwal R, Ananthakrishnan AN: “Weekend Effect” in patients with upper gastrointestinal hemorrhage: a systematic review and meta-analysis. Am J Gastroenterol 113:1321, 2018

    • Search Google Scholar
    • Export Citation
  • 12

    Han L, Meacock R, Anselmi L, Kristensen SR, Sutton M, Doran T, et al. : Variations in mortality across the week following emergency admission to hospital: linked retrospective observational analyses of hospital episode data in England, 2004/5 to 2013/14. Southampton, UK: NIHR Journals Library, 2017. Health Serv Deliv Res (https://www.ncbi.nlm.nih.gov/books/NBK464621/) [Accessed January 28, 2019]

    • Search Google Scholar
    • Export Citation
  • 13

    Hijdra A, Brouwers PJ, Vermeulen M, van Gijn J: Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke 21:11561161, 1990

    • Search Google Scholar
    • Export Citation
  • 14

    Hoshijima H, Takeuchi R, Mihara T, Kuratani N, Mizuta K, Wajima Z, et al. : Weekend versus weekday admission and short-term mortality: a meta-analysis of 88 cohort studies including 56,934,649 participants. Medicine (Baltimore) 96:e6685, 2017

    • Search Google Scholar
    • Export Citation
  • 15

    Ibrahim GM, Fallah A, Macdonald RL: Clinical, laboratory, and radiographic predictors of the occurrence of seizures following aneurysmal subarachnoid hemorrhage. J Neurosurg 119:347352, 2013

    • Search Google Scholar
    • Export Citation
  • 16

    Jaja BNR, Saposnik G, Lingsma HF, Macdonald E, Thorpe KE, Mamdani M, et al. : Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study. BMJ 360:j5745, 2018

    • Search Google Scholar
    • Export Citation
  • 17

    Macdonald RL, Kassell NF, Mayer S, Ruefenacht D, Schmiedek P, Weidauer S, et al. : Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke 39:30153021, 2008

    • Search Google Scholar
    • Export Citation
  • 18

    Macdonald RL, Schweizer TA: Spontaneous subarachnoid haemorrhage. Lancet 389:655666, 2017

  • 19

    McKinney JS, Deng Y, Kasner SE, Kostis JB: Comprehensive stroke centers overcome the weekend versus weekday gap in stroke treatment and mortality. Stroke 42:24032409, 2011

    • Search Google Scholar
    • Export Citation
  • 20

    Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. : International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809817, 2005

    • Search Google Scholar
    • Export Citation
  • 21

    Naidech AM, Janjua N, Kreiter KT, Ostapkovich ND, Fitzsimmons BF, Parra A, et al. : Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage. Arch Neurol 62:410416, 2005

    • Search Google Scholar
    • Export Citation
  • 22

    Nguyen E, Tsoi A, Lee K, Farasat S, Coleman CI: Association between weekend admission for intracerebral and subarachnoid hemorrhage and in-hospital mortality. Int J Cardiol 212:2628, 2016

    • Search Google Scholar
    • Export Citation
  • 23

    Pandey AS, Wilkinson DA, Gemmete JJ, Chaudhary N, Thompson BG, Burke JF: Impact of weekend presentation on short-term outcomes and choice of clipping vs coiling in subarachnoid hemorrhage. Neurosurgery 81:8791, 2017

    • Search Google Scholar
    • Export Citation
  • 24

    Pauls LA, Johnson-Paben R, McGready J, Murphy JD, Pronovost PJ, Wu CL: The weekend effect in hospitalized patients: a meta-analysis. J Hosp Med 12:760766, 2017

    • Search Google Scholar
    • Export Citation
  • 25

    Rinkel GJ, Algra A: Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol 10:349356, 2011

  • 26

    Schilling PL, Campbell DA Jr, Englesbe MJ, Davis MM: A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza. Med Care 48:224232, 2010

    • Search Google Scholar
    • Export Citation
  • 27

    Shih YN, Chen YT, Shih CJ, Ou SM, Hsu YT, Chen RC, et al. : Association of weekend effect with early mortality in severe sepsis patients over time. J Infect 74:345351, 2017

    • Search Google Scholar
    • Export Citation
  • 28

    Sorita A, Ahmed A, Starr SR, Thompson KM, Reed DA, Dabrh AMA, et al. : Off-hour presentation and outcomes in patients with acute ischemic stroke: a systematic review and meta-analysis. Eur J Intern Med 25:394400, 2014

    • Search Google Scholar
    • Export Citation
  • 29

    Sorita A, Ahmed A, Starr SR, Thompson KM, Reed DA, Prokop L, et al. : Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis. BMJ 348:f7393, 2014

    • Search Google Scholar
    • Export Citation
  • 30

    Taufique Z, May T, Meyers E, Falo C, Mayer SA, Agarwal S, et al. : Predictors of poor quality of life 1 year after subarachnoid hemorrhage. Neurosurgery 78:256264, 2016

    • Search Google Scholar
    • Export Citation
  • 31

    Teasdale GM, Drake CG, Hunt W, Kassell N, Sano K, Pertuiset B, et al. : A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry 51:1457, 1988

    • Search Google Scholar
    • Export Citation
  • 32

    van Gijn J, Kerr RS, Rinkel GJ: Subarachnoid haemorrhage. Lancet 369:306318, 2007

  • 33

    Wartenberg KE, Mayer SA: Medical complications after subarachnoid hemorrhage. Neurosurg Clin N Am 21:325338, 2010

  • 34

    Wilson JT, Pettigrew LE, Teasdale GM: Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma 15:573585, 1998

    • Search Google Scholar
    • Export Citation
  • 35

    Witiw CD, Ibrahim GM, Fallah A, Macdonald RL: Early predictors of prolonged stay in a critical care unit following aneurysmal subarachnoid hemorrhage. Neurocrit Care 18:291297, 2013

    • Search Google Scholar
    • Export Citation
  • 36

    Zapf MAC, Kothari AN, Markossian T, Gupta GN, Blackwell RH, Wai PY, et al. : The “weekend effect” in urgent general operative procedures. Surgery 158:508514, 2015

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 654 385 22
Full Text Views 197 136 2
PDF Downloads 117 39 5
EPUB Downloads 0 0 0