Background

Recent interest in the ‘weekend effect’ has been expanded to cardiovascular intensive care units, yet the impact of off-hours admission on mortality and cardiovascular ICU (CICU) length of stay remains uncertain.

Objectives

We examine the association between CICU admission day and time with mortality. Additionally, length-of-stay was also evaluated in relation to admission time.

Methods

A single-center, retrospective cohort study was conducted including 10,638 adult patients admitted to a CICU in a tertiary-care academic medical center from July 1, 2012 to June 30, 2019. ICU mortality and length-of-stay were assessed by admission day and time adjusting for comorbid conditions and other clinical variables. We used logistic regression models to evaluate the factors associated with mortality and a generalized linear model (GLM) with log link function and gamma distribution was used to evaluate the factors associated with ICU length of stay.

Results

Compared to weekday-day admissions, we observed an increased mortality for weekend-day for all admissions (6.5 vs 9.6%, Adjusted OR: 1.32 (1.03–1.72)), and for medical CICU admissions (7.6 vs 9.9%, Adjusted OR: 1.35 (1.02–1.79)). Additionally, compared to weekday-day, weekday-night admission was associated with 7% longer ICU length of stay in surgical ICU patients, 7% shorter length of stay in medical ICU patients.

Conclusion

Admission to this open-model CICU during weekend hours (Saturday 08:00-Sunday 17:59) versus nights or weekdays is associated with increased mortality. ICU staffing care models should not significantly change based on the day of the week.

中文翻译：

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基于入院日期和时间的心血管重症监护病房死亡率检查

背景

最近对“周末效应”的兴趣已扩大到心血管重症监护病房，但非工作时间入院对死亡率和心血管 ICU (CICU) 住院时间的影响仍不确定。

目标

我们检查了 CICU 入院日期和时间与死亡率之间的关系。此外，还根据入院时间评估了逗留时间。

方法

进行了一项单中心、回顾性队列研究，包括 2012 年 7 月 1 日至 2019 年 6 月 30 日期间在一家三级医疗学术医疗中心入住 CICU 的 10,638 名成年患者。按入院日评估 ICU 死亡率和住院时间并根据合并症和其他临床变量进行时间调整。我们使用逻辑回归模型来评估与死亡率相关的因素，并使用具有对数链接函数和伽马分布的广义线性模型 (GLM) 来评估与 ICU 住院时间相关的因素。

结果

与平日入院相比，我们观察到所有入院（6.5 对 9.6%，调整后的 OR：1.32（1.03-1.72））和医疗 CICU 入院（7.6 对 9.9%，调整后的 OR： 1.35 (1.02–1.79))。此外，与工作日相比，工作日夜间入院与外科 ICU 患者的 ICU 住院时间延长 7%，内科 ICU 患者的住院时间缩短 7% 相关。

结论

在周末时间（周六 08:00-周日 17:59）与晚上或工作日相比，进入这个开放式 CICU 与死亡率增加有关。ICU 人员配备护理模式不应根据一周中的哪一天而发生显着变化。