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.
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.
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.
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.
ABBREVIATIONSaSAH = 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.
ConnollyESJrRabinsteinAACarhuapomaJRDerdeynCPDionJHigashidaRT: Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke43:1711–17372012
DeshmukhHHinkleyMDulhantyLPatelHCGaleaJP: Effect of weekend admission on in-hospital mortality and functional outcomes for patients with acute subarachnoid haemorrhage (SAH). Acta Neurochir (Wien)158:829–8352016
HanLMeacockRAnselmiLKristensenSRSuttonMDoranT: 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 Library2017. Health Serv Deliv Res (https://www.ncbi.nlm.nih.gov/books/NBK464621/) [Accessed January 28 2019]
HoshijimaHTakeuchiRMiharaTKurataniNMizutaKWajimaZ: Weekend versus weekday admission and short-term mortality: a meta-analysis of 88 cohort studies including 56,934,649 participants. Medicine (Baltimore)96:e66852017
JajaBNRSaposnikGLingsmaHFMacdonaldEThorpeKEMamdaniM: Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study. BMJ360:j57452018
MolyneuxAJKerrRSYuLMClarkeMSneadeMYarnoldJA: 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. Lancet366:809–8172005
SchillingPLCampbellDAJrEnglesbeMJDavisMM: A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza. Med Care48:224–2322010
TeasdaleGMDrakeCGHuntWKassellNSanoKPertuisetB: A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry51:14571988