Abstract
Background:
We sought to check current stutus of weekend effect (differences in acute ischemic stroke (AIS) outcomes between patients admitted at the weekend versus weekday) which is the basis of many change in health policy to deal with disparities.
Objective:
To evaluate the influence of admission on a perticular day of the week (DOW) on outcomes in AIS pts.
Methods:
We reviewed the HCUP's Nationwide Inpatient Sample (NIS) database from 2008 - 11 for all emergency room (ER) admissions for AIS using ICD 9-CM code. NIS represents 20% of all US hospital. Pts aged < 18 years were excluded. After adjusting for age, gender, median income level, primary payer, hospital region, teaching status, and bed size, a Survey Logistic and Linear regression models were used to compare weekend versus weekday stroke admissions in terms of: incidence of IV thrombolytic (IVT) use, in-hospital mortality and discharge disposition. Length of stay (LOS) was calculated only in pts who survived. Cost to charge ratio files were merged with NIS to calculate cost of care. The cost of care was adjusted for inflation with reference to 2011. Chi-square was utilized for univariate analysis for categorical variable.
Results:
A total 390,401 (weighted: 1,933,243) ER admissions were studied, of which 99,968 (weighted: 494,863) were admitted on weekends. The average age of the cohort was 71 years, 53.4 % females, and 60.8% were whites. In univariate analysis, admission on weekend was associated with higher mortality (7.28% vs. 7.13%, p<0.001), higher utilization of IVT (4.10% vs. 3.72%, p<0.001) and higher discharge to long term facility (44.7% vs. 42.9%, p<0.001). After adjusting for confounders, weekend admission was associated with higher utilization of IVT (OR/days/cost, 95% CI, P-value) (OR 1.10, 1.06 - 1.14; p<0.001); increased discharge to long term facility (OR 1.08, 1.06 - 1.10; p<0.001) and have statistically shorter LOS (-0.08 days, -0.14 - -0.02; p = 0.007). There was no difference in in-hospital mortality (OR: 1.02, 0.99 - 1.05; p = 0.17) or cost of care (142$, - 5 - 288; p=0.06) for weekend admission.
Conclusion:
Admission on a weekend is a predictor of higher utilization of IVT and discharge to a long-term facility , but there was no difference in in-hospital mortality or cost of care.