Abstract
BackgroundThe “weekend effect” describes the assumption that weekend and/or on-call duty admission of emergency patients is associated with increased morbidity and mortality rates. For aneurysmal subarachnoid hemorrhage, we investigated, whether presentation out of regular working hours and microsurgical clipping at nighttime correlates with worse patient outcome.MethodsThis is a retrospective review of consecutive patients that underwent microsurgical clipping of an acutely ruptured aneurysm at our institution between 2010 and 2019. Patients admitted during (1) regular working hours (Monday–Friday, 08:00–17:59) and (2) on-call duty and microsurgical clipping performed during (a) daytime (Monday–Sunday, 08:00–17:59) and (b) nighttime were compared regarding the following outcome parameters: operation time, treatment-related complications, vasospasm, functional outcome, and angiographic results.ResultsAmong 157 enrolled patients, 104 patients (66.2%) were admitted during on-call duty and 48 operations (30.6%) were performed at nighttime. Admission out of regular hours did not affect cerebral infarction (p = 0.545), mortality (p = 0.343), functional outcome (p = 0.178), and aneurysm occlusion (p = 0.689). Microsurgical clipping at nighttime carried higher odds of unfavorable outcome at discharge (OR: 2.3, 95%CI: 1.0–5.1, p = 0.039); however, there were no significant differences regarding the remaining outcome parameters. After multivariable adjustment, clipping at nighttime did not remain as independent prognosticator of short-term outcome (OR: 2.1, 95%CI: 0.7–6.2, p = 0.169).ConclusionsAdmission out of regular working hours and clipping at nighttime were not independently associated with poor outcome. The adherence to standardized treatment protocols might mitigate the “weekend effect.”
Highlights
Aneurysmal subarachnoid hemorrhage is a severe neurological condition caused by spontaneous rupture of intracranial aneurysms
Microsurgical clipping represents a well-established, safe and effective technique for aneurysm occlusion, in particular for complex aneurysms, which are challenging to treat by endovascular means [11,12,13]
When patients are admitted during the weekend or during nighttime, the question arises, whether microsurgical clipping should be performed during on-call duty or postponed to the working day
Summary
Aneurysmal subarachnoid hemorrhage (aSAH) is a severe neurological condition caused by spontaneous rupture of intracranial aneurysms. Acta Neurochir (2021) 163:783–791 morbidity and mortality when compared to admissions during the routine daytime shift [3] This phenomenon was denoted as the “weekend effect” [20]. The objective of this study was to evaluate, whether admission of patients with aSAH out of regular working hours and/or microsurgical clipping performed at night is associated with a worse patient outcome. For this purpose, the following outcome parameters were defined: operation time, cerebral infarction, in-hospital mortality, functional outcome and angiographic results. We investigated, whether presentation out of regular working hours and microsurgical clipping at nighttime correlates with worse patient outcome
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