Clinical outcomes after thrombectomy for acute ischemic stroke on weekends versus weekdays

J Stroke Cerebrovasc Dis. Nov-Dec 2014;23(10):2708-2713. doi: 10.1016/j.jstrokecerebrovasdis.2014.06.006. Epub 2014 Oct 24.

Abstract

Background: The objective of this study was to determine whether clinical outcomes differed in acute ischemic stroke (AIS) patients who underwent thrombectomy on weekends versus weekdays.

Methods: Patients with a primary diagnosis of AIS who underwent thrombectomy were identified from the Nationwide Inpatient Sample from 2005 to 2011 and stratified according to weekend or weekday admission. Logistic regression analysis was performed to identify factors associated with moderate-to-severe disability at hospital discharge in teaching and nonteaching hospitals.

Results: Of 12,055 patients with AIS who underwent thrombectomy during the study period, 2862 (23.7%) were admitted on a weekend. In a multivariate logistic regression analysis, factors associated with moderate or severe disability at discharge in nonteaching hospitals were weekend admission (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.0-2.8; P = .04), diagnosis of hypertension (OR, 1.9; 95% CI, 1.0-3.6; P = .05), and Medicare or Medicaid insurance status (OR, 2.1; 95% CI 1.1-4.3; P = .02); factors associated with moderate or severe disability at discharge in teaching hospitals were age >70 years (OR, 1.5; 95% CI, 1.1-2.2; P = .02), pneumonia (OR, 4.7; 95% CI, 2.2-10.2; P < .0001), sepsis (OR, 8.2; 95% CI, 1.2-54.8; P = .03), intracranial hemorrhage (OR, 3.3; 95% CI, 1.8-6.1; P = .0001), and treatment in a Northwest hospital region (OR, 1.7; 95% CI, 1.2-2.4; P = .03).

Conclusions: AIS patients undergoing thrombectomy who were admitted to nonteaching hospitals on weekends were more likely to be discharged with moderate-to-severe disability than those admitted on weekdays. No weekend effect on discharge clinical outcome was seen in teaching hospitals.

Keywords: All cerebrovascular disease/stroke; endovascular therapy; harm/risk analysis; infarction; thrombectomy; weekend effect.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging / pathology
  • Brain Ischemia / surgery*
  • Comorbidity
  • Disabled Persons / statistics & numerical data*
  • Female
  • Hospitalization
  • Humans
  • Intracranial Hemorrhages / epidemiology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Discharge / statistics & numerical data
  • Pneumonia / epidemiology
  • Prognosis
  • Regression Analysis
  • Sepsis / epidemiology
  • Severity of Illness Index
  • Stroke / surgery*
  • Thrombectomy / adverse effects*
  • Time*
  • Treatment Outcome