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Re-evaluating the Weekend Effect on SAH: A Nationwide Analysis of the Association Between Mortality and Weekend Admission

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Abstract

Objective

Multiple studies have shown worse outcomes in patients admitted for medical and surgical conditions on the weekend. However, past literature analyzing this “weekend effect” on subarachnoid hemorrhage (SAH) found no significant increase in mortality. This study utilizes more recent data to re-evaluate the association between weekend admission and mortality of patients hospitalized for SAH.

Methods

This retrospective cohort study queried the SAH patients in the Nationwide Inpatient Sample (NIS) database who were discharged from 2006 through 2014 during the weekend.

Results

Of the 54,703 admissions for SAH identified during the study period, 14,821 (27.1%) occurred over the weekend. Patients admitted over the weekend had a mean age of 59.2 years and were most likely to be female (59.6%), to be white (62.9%), located in the south region of the USA (40.1%), and be admitted to a teaching hospital (74.4%). When compared directly to weekday admissions, patients admitted over the weekend had higher odds of in-hospital mortality (odds ratio 1.07; confidence interval 95%, 1.02–1.12). There was no significant difference shown in the rate patients get surgical clipping versus endovascular coiling (p = 0.28) or the amount of time between admission to procedure for clipping (p = 0.473) or coiling (p = 0.255) on the weekend versus a weekday.

Conclusion

Based on our findings, the likelihood of the in-hospital mortality was higher for patients admitted over the weekend. However, the characteristics of the study, primarily observational, prevent us arriving at an accurate conclusion about why this occurs; hence, we believe it is an important starting point to consider for future research.

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Abbreviations

CT:

Computed tomography

HCUP:

Healthcare Cost and Utilization Project

ICD-9 CM:

International Classification of Diseases, Ninth Edition, Clinical Modification

NIS:

Nationwide Inpatient Sample

SAH:

Subarachnoid hemorrhage

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Funding

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Authors and Affiliations

  1. School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    William C. Johnson, Nicolas A. Morton-Gonzaba & John V. Lacci

  2. Neurocritical Care Unit, Sanatorio Pasteur, Intensive Care Unit, Hospital San Juan Bautista, Catamarca, Argentina

    Daniel Godoy

  3. Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Alireza Mirahmadizadeh

  4. Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7843, San Antonio, TX, 78229, USA

    Ali Seifi

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  1. William C. Johnson
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Contributions

WCJ, NM-G, and DG contributed to the literature review and writing of the paper. Statistical analysis and writing the paper were carried out by JL. AM, who is an epidemiologist, edited the final draft and helped in the method rewriting. AS was the principal investigator, who designed the project and edited the paper.

Corresponding author

Correspondence to Ali Seifi.

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Conflict of interest

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

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Johnson, W.C., Morton-Gonzaba, N.A., Lacci, J.V. et al. Re-evaluating the Weekend Effect on SAH: A Nationwide Analysis of the Association Between Mortality and Weekend Admission. Neurocrit Care 30, 293–300 (2019). https://doi.org/10.1007/s12028-018-0609-6

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  • DOI: https://doi.org/10.1007/s12028-018-0609-6

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