Objectives: With growing evidence of its efficacy for patients with large-vessel occlusion (LVO) ischemic stroke, the use of endovascular thrombectomy (EVT) has increased. The “weekend effect,” whereby patients presenting during weekends/off hours have worse clinical outcomes than those presenting during normal working hours, is a critical area of study in acute ischemic stroke (AIS). Our objective was to evaluate whether a “weekend effect” exists in patients undergoing EVT.

Methods

This retrospective, cross-sectional analysis of the 2016–2018 Nationwide Inpatient Sample data included patients ≥18 years with documented diagnosis of ischemic stroke (ICD-10 codes I63, I64, and H34.1), procedural code for EVT, and National Institutes of Health Stroke Scale (NIHSS) score; the exposure variable was weekend vs. weekday treatment. The primary outcome was in-hospital death; secondary outcomes were favorable discharge, extended hospital stay (LOS), and cost. Logistic regression models were constructed to determine predictors for outcomes.

Results

We identified 6052 AIS patients who received EVT (mean age 68.7±14.8 years; 50.8% female; 70.8% White; median (IQR) admission NIHSS 16 (10-21). The primary outcome of in-hospital death occurred in 560 (11.1%); the secondary outcome of favorable discharge occurred in 1039 (20.6%). The mean LOS was 7.8±8.6 days. There were no significant differences in the outcomes or cost based on admission timing. In the mixed-effects models, we found no effect of weekend vs. weekday admission on in-hospital death, favorable discharge, or extended LOS.

Conclusion

These results demonstrate that the “weekend effect” does not impact outcomes or cost for patients who undergo EVT for LVO.

中文翻译：

---

调查接受缺血性卒中血管内机械血栓切除术患者结局的“周末效应”

目的：随着越来越多的证据表明其对大血管闭塞 (LVO) 缺血性卒中患者的疗效，血管内血栓切除术 (EVT) 的使用有所增加。“周末效应”，即在周末/非工作时间就诊的患者比在正常工作时间就诊的患者临床结果更差，是急性缺血性卒中 (AIS) 研究的一个关键领域。我们的目标是评估接受 EVT 的患者是否存在“周末效应”。

方法

这项对 2016-2018 年全国住院患者样本数据的回顾性横断面分析包括年龄≥18 岁且有记录诊断为缺血性卒中（ICD-10 代码 I63、I64 和 H34.1）、EVT 程序代码和国家研究所的患者健康中风量表（NIHSS）评分；暴露变量是周末与工作日治疗。主要结局是院内死亡；次要结果是良好的出院、延长的住院时间 (LOS) 和成本。构建逻辑回归模型以确定结果的预测因子。

结果

我们确定了 6052 名接受 EVT 的 AIS 患者（平均年龄 68.7±14.8 岁；50.8% 女性；70.8% 白人；中位 (IQR) 入院 NIHSS 16 (10-21)。院内死亡的主要结局发生在 560 (11.1 %）；次要结局为 1039 人（20.6%）。平均 LOS 为 7.8±8.6 天。根据入院时间的不同，结局或费用无显着差异。在混合效应模型中，我们发现周末与工作日入院对住院死亡、良好出院或延长 LOS 没有影响。

结论

这些结果表明，“周末效应”不会影响接受 EVT 治疗 LVO 的患者的结果或成本。