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The weekend effect revisited: evidence from the Upper Austrian stroke registry

  • Silvia Angerer
  • Klaus Buttinger
  • Harald StummerEmail author
Original Paper
First Online:

Abstract

Empirical evidence on the so-called ‘weekend-effect’ on stroke mortality is mixed with some studies reporting significantly higher mortality for weekend admissions and others finding no difference. The aim of this paper is to enhance the evidence on the weekend-effect on stroke mortality using a rich stroke registry data set from Upper Austria and to discuss underlying reasons for the heterogeneity in results. Using logistic regressions and ordinary least squares regressions with hospital and year-fixed effects, the outcomes of weekend versus weekday admissions are compared for patients admitted to 16 hospitals in Upper Austria with transient ischemic attack (TIA), cerebral infarction or hemorrhage between 2007 and 2015. The primary outcomes include in-hospital mortality, 30-day and 90-day all-cause mortality as well as the length of hospital stay. In addition, we analyze differences in process-quality indicators between weekdays and weekends. Our results show that on weekends there are on average 25% fewer admissions than on weekdays with significantly higher in-hospital mortality. Adjusting for case-mix, the association between weekend admissions and mortality becomes null suggesting that the higher mortality on weekends is explained by heterogeneities in admissions rather than health-care quality.

Keywords

Weekend Stroke Mortality 

JEL Classification

I11 I18 
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Notes

Acknowledgements

The authors would like to thank the Upper Austrian Regional Health Insurance (OÖ GKK), especially Mr. Eckschlager and Mr. Schableger for providing the data and the helpful discussions.

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

Supplementary material

10198_2019_1035_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 24 KB)

References

  1. 1.
    Roth, G.A., et al.: Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J. Am. Coll. Cardiol. 70(1), 1–25 (2017).  https://doi.org/10.1016/j.jacc.2017.04.052 CrossRefGoogle Scholar
  2. 2.
    Krishnamurthi, R.V., et al.: Stroke prevalence, mortality and disability-adjusted life years in adults aged 20–64 years in 1990–2013: data from the global burden of disease 2013 study. Neuroepidemiology. 45(3), 190–202 (2015).  https://doi.org/10.1159/000441098 CrossRefGoogle Scholar
  3. 3.
    Feigin, V.L., et al.: Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 383(9913), 245–254 (2014)CrossRefGoogle Scholar
  4. 4.
    Davenport, R., Dennis, M.: Neurological emergencies: acute stroke. J. Neurol. Neurosurg. Psychiatry. 68(3), 277 (2000)CrossRefGoogle Scholar
  5. 5.
    Lemesle, M., Milan, C., Faivre, J., Moreau, T., Giroud, M., Dumas, R.: Incidence trends of ischemic stroke and transient ischemic attacks in a well-defined French population from 1985 through 1994. Stroke. 30(2), 371–377 (1999)CrossRefGoogle Scholar
  6. 6.
    Wieberdink, R.G., Ikram, M.A., Hofman, A., Koudstaal, P.J., Breteler, M.M.: Trends in stroke incidence rates and stroke risk factors in Rotterdam, the Netherlands from 1990 to 2008. Eur. J. Epidemiol. 27(4), 287–295 (2012).  https://doi.org/10.1007/s10654-012-9673-y CrossRefGoogle Scholar
  7. 7.
    Feigin, V.L., Lawes, C.M., Bennett, D.A., Barker-Collo, S.L., Parag, V.: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet. Neurol. 8(4), 355–369 (2009).  https://doi.org/10.1016/s1474-4422(09)70025-0 CrossRefGoogle Scholar
  8. 8.
    Buttinger, K., Stummer, H.: Integrierte Schlaganfallversorgung in Oberösterreich. HeilberufeScience. 3(2), 86–92 (2012).  https://doi.org/10.1007/s16024-011-0075-y CrossRefGoogle Scholar
  9. 9.
    Sacco, R.L., et al.: An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 44(7), 2064–2089 (2013).  https://doi.org/10.1161/STR.0b013e318296aeca CrossRefGoogle Scholar
  10. 10.
    Sorensen, A.G., Ay, H.: Transient ischemic attack: definition, diagnosis, and risk stratification. Neuroimaging. Clin. N. Am. 21(2), 303–313 (2011).  https://doi.org/10.1016/j.nic.2011.01.013x).CrossRefGoogle Scholar
  11. 11.
    Gomez, C.R.: Time is brain: the stroke theory of relativity. J. Stroke. Cerebrovasc. Dis. 27(8), 2214–2227 (2018).  https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.04.001 CrossRefGoogle Scholar
  12. 12.
    Powers, W.J., et al.: 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 49(3), e46–e99 (2018).  https://doi.org/10.1161/STR.0000000000000158 CrossRefGoogle Scholar
  13. 13.
    Saposnik, G., Baibergenova, A., Bayer, N., Hachinski, V.: Weekends: a dangerous time for having a. stroke? Stroke. 38(4), 1211–1215 (2007).  https://doi.org/10.1161/01.STR.0000259622.78616.ea CrossRefGoogle Scholar
  14. 14.
    Reeves, M.J., Smith, E., Fonarow, G., Hernandez, A., Pan, W., Schwamm, L.H.: Off-hour admission and in-hospital stroke case fatality in the get with the guidelines-stroke program. Stroke. 40(2), 569–576 (2009).  https://doi.org/10.1161/strokeaha.108.519355 CrossRefGoogle Scholar
  15. 15.
    Tung, Y., Chang, G., Chen, Y.: Associations of physician volume and weekend admissions with ischemic stroke outcome in Taiwan: a nationwide population-based study. Med. Care. 47, 1018–1025 (2009)CrossRefGoogle Scholar
  16. 16.
    Fang, J., Saposnik, G., Silver, F.L., Kapral, M.K.: Association between weekend hospital presentation and stroke fatality. Neurology. 75(18), 1589–1596 (2010).  https://doi.org/10.1212/WNL.0b013e3181fb84bc CrossRefGoogle Scholar
  17. 17.
    McKinney, J.S., Deng, Y., Kasner, S.E., Kostis, J.B.: Comprehensive stroke centers overcome the weekend versus weekday gap in stroke treatment and mortality. Stroke. 42(9), 2403–2409 (2011).  https://doi.org/10.1161/strokeaha.110.612317 CrossRefGoogle Scholar
  18. 18.
    Ogbu, U.C., Westert, G.P., Slobbe, L.C., Stronks, K., Arah, O.A.: A multifaceted look at time of admission and its impact on case-fatality among a cohort of ischaemic stroke patients. J. Neurol. Neurosurg. Psychiatry. 82(1), 8–13 (2011).  https://doi.org/10.1136/jnnp.2009.202176 CrossRefGoogle Scholar
  19. 19.
    Palmer, W.L., Bottle, A., Davie, C., Vincent, C.A., Aylin, P.: Dying for the weekend: a retrospective cohort study on the association between day of hospital presentation and the quality and safety of stroke care. Arch. Neurol. 69(10), 1296–1302 (2012).  https://doi.org/10.1001/archneurol.2012.1030 CrossRefGoogle Scholar
  20. 20.
    Bray, B.D., et al.: Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study. PLoS. Med. 11(8), e1001705 (2014).  https://doi.org/10.1371/journal.pmed.1001705 CrossRefGoogle Scholar
  21. 21.
    Roberts, S.E., Thorne, K., Akbari, A., Samuel, D.G., Williams, J.G.: Mortality following stroke, the weekend effect and related factors: record linkage study. PLoS. One. 10(6), e0131836 (2015).  https://doi.org/10.1371/journal.pone.0131836 CrossRefGoogle Scholar
  22. 22.
    Shi, L., Zhang, D., Chen, L., Truong, K.D.: “Weekend EFFECT” or “Saturday Effect”? An analysis of hospital mortality for patients with ischemic stroke in South Carolina. Circulation. 134(19), 1510–1512 (2016).  https://doi.org/10.1161/circulationaha.116.024535 CrossRefGoogle Scholar
  23. 23.
    Turner, M., Barber, M., Dodds, H., Dennis, M., Langhorne, P., Macleod, M.-J.: Stroke patients admitted within normal working hours are more likely to achieve process standards and to have better outcomes. J. Neurol. Neurosurg. Psychiatry. 87(2), 138 (2016)Google Scholar
  24. 24.
    Janszky, I., Ahnve, S., Ljung, R.: Weekend versus weekday admission and stroke outcome in Sweden from 1968 to 2005. Stroke. 38(9), e95 (2007).  https://doi.org/10.1161/strokeaha.107.491449 CrossRefGoogle Scholar
  25. 25.
    Niewada, M., Jezierska-Ostapczuk, A., Skowronska, M., Sarzynska-Dlugosz, I., Czlonkowska, A.: Weekend versus weekday admissions in polish stroke centres—could admission day affect prognosis in polish ischaemic stroke patients? Neurologia. I. Neurochirurgia. Polska. 46(1), 15–21 (2012)CrossRefGoogle Scholar
  26. 26.
    Cho, K.H., Park, E.C., Nam, C.M., Choi, Y., Shin, J., Lee, S.G.: Effect of weekend admission on in-hospital mortality in patients with ischemic stroke: an analysis of korean nationwide claims data from 2002 to 2013. J. Stroke. Cerebrovasc. Dis. 25(2), 419–427 (2016).  https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.014 CrossRefGoogle Scholar
  27. 27.
    Adil, M.M., Vidal, G., Beslow, L.A.: Weekend effect in children with stroke in the nationwide inpatient sample. Stroke. 47(6), 1436–1443 (2016).  https://doi.org/10.1161/strokeaha.116.013453 CrossRefGoogle Scholar
  28. 28.
    Patel, A.A.., et al.: A nationwide analysis of outcomes of weekend admissions for intracerebral hemorrhage shows disparities based on hospital teaching status. Neurohospitalist. 6(2), 51–58 (2016).  https://doi.org/10.1177/1941874415601164 CrossRefGoogle Scholar
  29. 29.
    Kostis, W.J., Demissie, K., Marcella, S.W., Shao, Y.H., Wilson, A.C., Moreyra, A.E.: Weekend versus weekday admission and mortality from myocardial infarction. N. Engl. J. Med. 356(11), 1099–1109 (2007).  https://doi.org/10.1056/NEJMoa063355 CrossRefGoogle Scholar
  30. 30.
    Aujesky, D., Jimenez, D., Mor, M.K., Geng, M., Fine, M.J., Ibrahim, S.A.: Weekend versus weekday admission and mortality after acute pulmonary embolism. Circulation. 119(7), 962–968 (2009).  https://doi.org/10.1161/circulationaha.108.824292 CrossRefGoogle Scholar
  31. 31.
    Freemantle, N., et al.: Weekend hospitalization and additional risk of death: an analysis of inpatient data. J. R. Soc. Med. 105(2), 74–84 (2012).  https://doi.org/10.1258/jrsm.2012.120009 CrossRefGoogle Scholar
  32. 32.
    Nanchal, R., et al.: Pulmonary embolism: the weekend effect. Chest. 142(3), 690–696 (2012).  https://doi.org/10.1378/chest.11-2663 CrossRefGoogle Scholar
  33. 33.
    Aylin, P., Alexandrescu, R., Jen, M.H., Mayer, E.K., Bottle, A.: Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics. BMJ. 346, f2424 (2013).  https://doi.org/10.1136/bmj.f2424 CrossRefGoogle Scholar
  34. 34.
    Gallerani, M., et al.: Outcomes of weekend versus weekday admission for acute aortic dissection or rupture: a retrospective study on the Italian National Hospital Database. Int. J. Cardiol. 168(3), 3117–3119 (2013).  https://doi.org/10.1016/j.ijcard.2013.04.065 CrossRefGoogle Scholar
  35. 35.
    Freemantle, N., et al.: Increased mortality associated with weekend hospital admission: a case for expanded seven day services? : Br. Med. J. 351, h4596 (2015).  https://doi.org/10.1136/bmj.h4596 CrossRefGoogle Scholar
  36. 36.
    Robinson, E.J., et al.: Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study. BMJ Qual. Saf. 25, 832–841 (2015)CrossRefGoogle Scholar
  37. 37.
    Khoshchehreh, M., Groves, E.M., Tehrani, D., Amin, A., Patel, P.M., Malik, S.: Changes in mortality on weekend versus weekday admissions for Acute Coronary Syndrome in the United States over the past decade. Int. J. Cardiol. 210, 164–172 (2016).  https://doi.org/10.1016/j.ijcard.2016.02.087 CrossRefGoogle Scholar
  38. 38.
    Han, L., Sutton, M., Clough, S., et al.: Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital. BMJ. Qual. Saf. 27, 445–454 (2018)CrossRefGoogle Scholar
  39. 39.
    Shaheen, A.A., Kaplan, G.G., Myers, R.P.: Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin. Gastroenterol. Hepatol. 7(3), 303–310 (2009).  https://doi.org/10.1016/j.cgh.2008.08.033 CrossRefGoogle Scholar
  40. 40.
    Mohammed, M.A., Sidhu, K.S., Rudge, G., Stevens, A.J.: Weekend admission to hospital has a higher risk of death in the elective setting than in the emergency setting: a retrospective database study of national health service hospitals in England. BMC. Health. Serv. Res. 12, 87 (2012).  https://doi.org/10.1186/1472-6963-12-87 CrossRefGoogle Scholar
  41. 41.
    Albright, K.C., et al.: Can comprehensive stroke centers erase the ‘weekend effect’? Cerebrovasc. Dis. 27(2), 107–113 (2009).  https://doi.org/10.1159/000177916 CrossRefGoogle Scholar
  42. 42.
    Turin, T.C., et al.: Case fatality of stroke and day of the week: is the weekend effect an artifact? Takashima stroke registry, Japan (1988–2003). Cerebrovasc. Dis. 26(6), 606–611 (2008).  https://doi.org/10.1159/000165114. (Basel. Switzerland) CrossRefGoogle Scholar
  43. 43.
    Jauss, M., Oertel, W., Allendoerfer, J., Misselwitz, B., Hamer, H.: Bias in request for medical care and impact on outcome during office and non-office hours in stroke patients. Eur. J. Neurol. 16(10), 1165–1167 (2009).  https://doi.org/10.1111/j.1468-1331.2009.02656.x CrossRefGoogle Scholar
  44. 44.
    O’Brien, E.C., Rose, K.M., Shahar, E., Rosamond, W.D.: Stroke mortality, clinical presentation and day of arrival: The Atherosclerosis Risk in Communities (ARIC) Study. Stroke. Res. Treat. 2011, 383012 (2011).  https://doi.org/10.4061/2011/383012 Google Scholar
  45. 45.
    Albright, K.C., et al.: Comprehensive Stroke Centers and the “Weekend Effect”: The SPOTRIAS Experience. Cerebrovasc. Dis. 34(5–6), 424–429 (2012).  https://doi.org/10.1159/000345077. (Basel. Switzerland) CrossRefGoogle Scholar
  46. 46.
    Kim, S.C., et al.: Weekend admission in patients with acute ischemic stroke is not associated with poor functional outcome than weekday admission. J. Clin. Neurol. 8(4), 265–270 (2012).  https://doi.org/10.3988/jcn.2012.8.4.265. (Seoul, Korea) CrossRefGoogle Scholar
  47. 47.
    Hsieh, C.Y., Lin, H.J., Chen, C.H., Li, C.Y., Chiu, M.J., Sung, S.F.: “Weekend effect” on stroke mortality revisited: application of a claims-based stroke severity index in a population-based cohort study. Medicine. 95(25), e4046 (2016).  https://doi.org/10.1097/md.0000000000004046
  48. 48.
    Campbell, J.T.Petal: The effect of out of hours presentation with acute stroke on processes of care and outcomes: analysis of data from the Stroke Improvement National Audit Programme (SINAP). PLoS. One. 9(2), e87946 (2014).  https://doi.org/10.1371/journal.pone.0087946 CrossRefGoogle Scholar
  49. 49.
    Kristiansen, N.S., Mainz, J., Norgard, B.M., Bartels, P.D., Andersen, G., Johnsen, S.P.: Off-hours admission and acute stroke care quality: a nationwide study of performance measures and case-fatality. Stroke. 45(12), 3663–3669 (2014).  https://doi.org/10.1161/strokeaha.114.005535 CrossRefGoogle Scholar
  50. 50.
    Jiang, F., Zhang, J.H., Qin, X.: “Weekend effects” in patients with intracerebral hemorrhage. Acta Neurochirurgica. Supplement. 111, 333–336 (2011).  https://doi.org/10.1007/978-3-7091-0693-8_55 CrossRefGoogle Scholar
  51. 51.
    Inoue, T., Fushimi, K.: Weekend versus weekday admission and in-hospital mortality from ischemic stroke in Japan. J. Stroke. Cerebrovasc. Dis. 24(12), 2787–2792 (2015).  https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.08.010 CrossRefGoogle Scholar
  52. 52.
    Barer, D.: Do studies of the weekend effect really allow for differences in illness severity? An analysis of 14 years of stroke admissions. Age. Ageing. 46(1), 138–142 (2016).  https://doi.org/10.1093/ageing/afw173 Google Scholar
  53. 53.
    Asuzu, D., et al.: On- versus off-hour patient cohorts at a primary stroke center: onset-to-treatment duration and clinical outcomes after iv thrombolysis. J. Stroke. Cerebrovasc. Dis. 25(2), 447–451 (2016).  https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.017 CrossRefGoogle Scholar
  54. 54.
    Kamitani, S., et al.: Consciousness level and off-hour admission affect discharge outcome of acute stroke patients: a J-ASPECT study. J. Am. Heart. Assoc. 3(5), e001059 (2014).  https://doi.org/10.1161/jaha.114.001059 CrossRefGoogle Scholar
  55. 55.
    Rost, N.S., et al.: Stroke severity is a crucial predictor of outcome: an international prospective validation study. J. Am. Heart. Assoc. Cardiovasc.Cerebrovasc. Dis. 5(1), e002433 (2016).  https://doi.org/10.1161/JAHA.115.002433 Google Scholar
  56. 56.
    Statisik Austria: Bevölkerung zu Jahresbeginn seit 1982 nach Bundesländern und Staatsangehörigkeit. https://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/bevoelkerung/bevoelkerungsstand_und_veraenderung/bevoelkerung_zu_jahres-_quartalsanfang/108123.html (2018). Accessed October 5, 2018
  57. 57.
    Kobel, C., Thuilliez, J., Bellanger, M., Pfeiffer, K.-P.: DRG systems and similar patient classification systems in Europe. In: Reinhard, A.G.W.Q.M.W. (ed.) Diagnosis-related groups in Europe: moving towards transparency, efficiency and quality in hospitals. European observatory on health systems and policies series, pp. 37–58. Mc Graw Hill Open University Press, New York, (2011)Google Scholar
  58. 58.
    Askim, T., Bernhardt, J., Churilov, L., Indredavik, B.: The Scandinavian stroke scale is equally as good as The National Institutes of Health Stroke Scale in identifying 3-month outcome. J. Rehabilit. Med. 48(10), 909–912 (2016).  https://doi.org/10.2340/16501977-2155 CrossRefGoogle Scholar
  59. 59.
    Lasserson, D.S., Chandratheva, A., Giles, M.F., Mant, D., Rothwell, P.M.: Influence of general practice opening hours on delay in seeking medical attention after transient ischaemic attack (TIA) and minor stroke: prospective population based study. BMJ. 337 (2008).  https://doi.org/10.1136/bmj.a1569
  60. 60.
    Sebastian, H.: Die Rolle der AllgemeinmedizinerInnen als erste Anlaufstelle im österreichischen Gesundheitssystem. In: vol. Doktor der gesamten Heilkunde (Dr. med. univ.). Wien, Medizinische Universität Wien (2014)Google Scholar
  61. 61.
    Rothwell, P.M., et al.: Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 370(9596), 1432–1442 (2007).  https://doi.org/10.1016/s0140-6736(07)61448-2 CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.UMIT, University for Health Sciences, Medical Informatics and Technology, Institute for Management and Economics in Healthcare6060 Hall in TirolAustria
  2. 2.Salzkammergut KlinikumGmundenAustria
  3. 3.University Seeburg Castle, Institut für Gesundheitsmanagement und InnovationSeekirchen am WallerseeAustria

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