Original ArticleWeekend versus Weekday Admission in Spinal Cord Injury and Its Effect on Timing of Surgical Intervention
Introduction
Weekend admissions received special attention in 2001 after publication of a study showing an increase in mortality for patients admitted with serious conditions such as ruptured abdominal aortic aneurysms, acute epiglottitis, and pulmonary embolism.1 Bell et al1 suggested relative staff shortages and less experienced workers as a possible explanation for these findings. In addition, others have suggested that weekend admissions may result in less likelihood of invasive procedures and possible delayed intervention.2
In the neurosurgical literature, Pandey et al3 reported no significant differences in mortality, discharge destination, or intervention (clip vs. coil) for patients with subarachnoid hemorrhage. On the other hand, Turner et al4 found that patients with stroke admitted during weekends were “less likely to be managed according to current guidelines” including fewer early admissions to stroke units, fewer same-day swallow screens, and lower likelihood of receiving thrombolysis. Similarly, other studies have found worse outcomes for patients undergoing spinal surgery who were admitted on the weekend.5, 6, 7
Acute spinal cord injury (SCI) resulting in significant loss of motor and sensory function is a devastating condition, but there are limited data on the impact of weekend admission on its management and outcomes.5 Thus the purpose of the present study is to investigate the effect of weekend admission on the timing of intervention and short-term outcome (including morbidity and mortality) in patients with acute SCI.
Section snippets
Study Design and Data Source
The present study was deemed exempt from review by the local institutional review board (2016-6862). This is a retrospective cohort study using the U.S. National Inpatient Sample (NIS) database from 2012 to 2014. This database is the largest inpatient database in the country, capturing over 7 million admissions each year from nonfederal participating hospitals; it represents a 20% sample of discharges from participating institutions. Patient diagnoses and procedures up to 2014 are captured in
Results
A total of 9390 patients met our inclusion criteria and were included in this study. The mean age for all patients was 55 years (SD 18 years) and 73.2% were male. From the total group, 34.1% of patients were admitted during the weekend and 65.9% during a weekday, with general characteristics shown and compared in Table 1. In terms of general demographics, average age was found to be significantly lower (53 vs. 55 years) in the weekend group (P = 0.004) and a higher proportion of patients in the
Discussion
Surgical treatment of SCI focuses on decompression of the neural elements with or without stabilization or realignment on a case-to-case basis. Although the Surgical Timing in Acute Spinal Cord Injury Study showed that surgery within 24 hours resulted in improved neurologic outcome at 6 months compared with delayed intervention,8 a recent systematic review by Wilson et al9 showed that on the basis of current evidence from 6 clinical investigations, the efficacy of early intervention is variable
Conclusion
In this study, presentation with acute SCI on a weekend did not impact the timing of surgical intervention, rate of perioperative complications, or mortality rate. These findings are reassuring and suggest that operative treatment of SCI is not compromised during weekends. Patients with complete (ASIA A) injuries were more likely to receive early intervention compared with patients with incomplete lesions. The impact of weekend admission on long-term outcome, however, is yet to be determined.
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Is there a weekend effect in spine surgery?: A systematic review and meta-analysis of postoperative outcomes
2023, Medicine (United States)Systematic Nursing Interventions Combined with Continuity of Care in Patients with a Spinal Fracture Complicated with a Spinal Cord Injury and Its Effect on Recovery and Satisfaction
2022, Evidence-based Complementary and Alternative Medicine
Conflict of interest statement: No funds were received in support of this work. Reza Yassari has a consulting agreement with Stryker. The other authors have no conflicts of interest.