Abstract
Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index. This was an observational study using a representative sample of the National Health Insurance claims data linked to the National Death Registry. We identified patients hospitalized for ischemic stroke, and examined the effect of weekend admission on 30-day mortality with vs without adjustment for stroke severity by using multilevel logistic regression analysis adjusting for patient-, physician-, and hospital-related factors. We analyzed 46,007 ischemic stroke admissions, in which weekend admissions accounted for 23.0%. Patients admitted on weekends had significantly higher 30-day mortality (4.9% vs 4.0%, P<0.001) and stroke severity index (7.8 vs 7.4, P<0.001) than those admitted on weekdays. In multivariate analysis without adjustment for stroke severity, weekend admission was associated with increased 30-day mortality (odds ratio (OR), 1.20; 95% confidence interval [CI], 1.08-1.34). This association became null after adjustment for stroke severity (OR, 1.07; 95% CI, 0.95-1.20). The "weekend effect" on stroke mortality might be attributed to higher stroke severity in weekend patients. While claims data are useful for examining stroke outcomes, adequate adjustment for stroke severity is warranted.
| Original language | English |
|---|---|
| Article number | e4046 |
| Journal | Medicine (United States) |
| Volume | 95 |
| Issue number | 25 |
| DOIs | |
| Publication status | Published - 2016 Jun 1 |
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All Science Journal Classification (ASJC) codes
- Medicine(all)
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"Weekend effect" on stroke mortality revisited. / Hsieh, Cheng Yang; Lin, Huey Juan; Chen, Chih Hung; Li, Chung Yi; Chiu, Meng Jun; Sung, Sheng Feng.
In: Medicine (United States), Vol. 95, No. 25, e4046, 01.06.2016.Research output: Contribution to journal › Article
TY - JOUR
T1 - "Weekend effect" on stroke mortality revisited
AU - Hsieh, Cheng Yang
AU - Lin, Huey Juan
AU - Chen, Chih Hung
AU - Li, Chung Yi
AU - Chiu, Meng Jun
AU - Sung, Sheng Feng
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index. This was an observational study using a representative sample of the National Health Insurance claims data linked to the National Death Registry. We identified patients hospitalized for ischemic stroke, and examined the effect of weekend admission on 30-day mortality with vs without adjustment for stroke severity by using multilevel logistic regression analysis adjusting for patient-, physician-, and hospital-related factors. We analyzed 46,007 ischemic stroke admissions, in which weekend admissions accounted for 23.0%. Patients admitted on weekends had significantly higher 30-day mortality (4.9% vs 4.0%, P<0.001) and stroke severity index (7.8 vs 7.4, P<0.001) than those admitted on weekdays. In multivariate analysis without adjustment for stroke severity, weekend admission was associated with increased 30-day mortality (odds ratio (OR), 1.20; 95% confidence interval [CI], 1.08-1.34). This association became null after adjustment for stroke severity (OR, 1.07; 95% CI, 0.95-1.20). The "weekend effect" on stroke mortality might be attributed to higher stroke severity in weekend patients. While claims data are useful for examining stroke outcomes, adequate adjustment for stroke severity is warranted.
AB - Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index. This was an observational study using a representative sample of the National Health Insurance claims data linked to the National Death Registry. We identified patients hospitalized for ischemic stroke, and examined the effect of weekend admission on 30-day mortality with vs without adjustment for stroke severity by using multilevel logistic regression analysis adjusting for patient-, physician-, and hospital-related factors. We analyzed 46,007 ischemic stroke admissions, in which weekend admissions accounted for 23.0%. Patients admitted on weekends had significantly higher 30-day mortality (4.9% vs 4.0%, P<0.001) and stroke severity index (7.8 vs 7.4, P<0.001) than those admitted on weekdays. In multivariate analysis without adjustment for stroke severity, weekend admission was associated with increased 30-day mortality (odds ratio (OR), 1.20; 95% confidence interval [CI], 1.08-1.34). This association became null after adjustment for stroke severity (OR, 1.07; 95% CI, 0.95-1.20). The "weekend effect" on stroke mortality might be attributed to higher stroke severity in weekend patients. While claims data are useful for examining stroke outcomes, adequate adjustment for stroke severity is warranted.
UR - http://www.scopus.com/inward/record.url?scp=85013729557&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85013729557&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000004046
DO - 10.1097/MD.0000000000004046
M3 - Article
C2 - 27336904
AN - SCOPUS:85013729557
VL - 95
JO - Medicine (United States)
JF - Medicine (United States)
SN - 0025-7974
IS - 25
M1 - e4046
ER -