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

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

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    Interaction between WFNS grade and weekend admission with respect to mortality. Patients who initially presented on the weekend with a poor WFNS grade (IV–V) had significantly higher mortality at 12 weeks than those admitted during the week or those who presented with WFNS grades I–III. Figure is available in color online only.

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