Abstract
BackgroundAneurysmal subarachnoid haemorrhage (aSAH) is an acute cerebrovascular event with high socioeconomic impact as it tends to affect younger patients. The recent NCEPOD study looking into management of aSAH has recommended that neurovascular units in the United Kingdom should aim to secure cerebral aneurysms within 48 h and that delays because of weekend admissions can increase the mortality and morbidity attributed to aSAH.MethodWe used data from a prospective audit of aSAH patients admitted between January 2009 and December 2011. The baseline demographic and clinical features of the weekend and weekday groups were compared using the chi-squared test and T-test. Cox proportional hazards models (Proc Phreg in SAS) were used to calculate the adjusted overall hazard of in-hospital death associated with admission on weekend, adjusting for age, sex, baseline WFNS grade, type of treatment received and time from scan to treatment. Sliding dichotomy analysis was used to estimate the difference in outcomes after SAH at 3 months in weekend and weekday admissions.ResultsThose admitted on weekends had a significantly higher scan to treatment time (83.05 ± 83.4 h vs 40.4 ± 53.4 h, P < 0.0001) and admission to treatment (71.59 ± 79.8 h vs 27.5 ± 44.3 h, P < 0.0001) time. After adjustments for adjusted for relevant covariates weekend admission was statistically significantly associated with excess in-hospital mortality (HR = 2.1, CL [1.13–4.0], P = 0.01). After adjustments for all the baseline covariates, the sliding dichotomy analysis did not show effects of weekend admission on long-term outcomes on the good, intermediate and worst prognostic bands.ConclusionsThis study provides important data showing excess in-hospital mortality of patients with SAH on weekend admissions served by the United Kingdom’s National Health Service.; However, there were no effects of weekend admission on long-term outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00701-016-2746-z) contains supplementary material, which is available to authorized users.
Highlights
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Aneurysmal subarachnoid haemorrhage is an acute cerebrovascular event with an incidence of 9 per 100,000 person years [7]
This study provides important data showing excess in-hospital mortality of patients with SAH on weekend admissions served by the United Kingdom’s National Health Service.; there were no effects of weekend admission on long-term outcomes
Patients presenting after 3 days of ictus were not offered aneurysm treatment due to the heightened risk of spasm, better medical management of delayed cerebral ischaemia (DCI), as well as a wider repertoire of intervention to counteract vasospasm during endovascular procedures, has meant that attempts at endovascular treatment of aneurysms beyond the 3day golden period is becoming more accepted practice
Summary
Electronic supplementary material The online version of this article (doi:10.1007/s00701-016-2746-z) contains supplementary material, which is available to authorized users.Aneurysmal subarachnoid haemorrhage (aSAH) is an acute cerebrovascular event with an incidence of 9 per 100,000 person years [7]. Patients presenting after 3 days of ictus were not offered aneurysm treatment due to the heightened risk of spasm, better medical management of DCI, as well as a wider repertoire of intervention (medical and surgical) to counteract vasospasm during endovascular procedures, has meant that attempts at endovascular treatment of aneurysms beyond the 3day golden period is becoming more accepted practice. This is of particular significance in an era that has seen a move towards centralisation of specialist neurovascular centres and inevitable longer transit times to centres for definitive neurovascular care. Sliding dichotomy analysis was used to estimate the difference in outcomes after SAH at 3 months in weekend and weekday admissions
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