Did the introduction of comprehensive stroke centers impact the "weekend effect" on mortality for patients with intracranial hemorrhage in the United States?

ABSTRACT

OBJECTIVES: Over the last two decades, various studies have evaluated the impact of weekend admission to the hospital on inpatient mortality. Our study sought to identify whether or not the "weekend effect" was true for patients with Intracranial Hemorrhage (ICH) admitted to United States hospitals and whether or not the introduction of comprehensive stroke centers (CSCs) made an impact on the "weekend effect" for ICH. PATIENTS AND METHODS: Searched the Nationwide Inpatient Sample for the ICH discharges between 2006 and 2014. Multivariate regression analysis was performed to evaluate the factors that impacted in-hospital mortality. Additional subgroup analysis was performed based on two time periods, before CSCs (2006-2009) and afterward (2010-2014). RESULTS: 146,587 discharges with ICH were reported by the NIS with 37,471 (25.6%) weekend admissions. The weekday admission cohort was 50.6% male with a mean age of 67.1 years. There was a total of 35,362 deaths among ICH admissions. The in-hospital mortality rate was significantly higher for weekend admissions compared to that of weekday admissions (25.2% vs. 23.8%, p < 0.001). Multivariate analysis of mortality for the 2006-2009 subgroup demonstrated a statistically significant higher odds of death with weekend admission (OR = 1.15, 95% CI [1.10, 1.20], p = 0) but not for the 2010-2014 subgroup (OR = 1.03, 95% CI [0.99, 1.07], p = 0.09). CONCLUSION: Our study showed that in-hospital mortality was found to be increased for patients with ICH admitted on a weekend; however, this association was lost after the initiation of CSCs. Further prospective studies are warranted to gain a better understanding regarding this association.