Abstract
BackgroundAcute aortic dissection is a life-threatening condition associated with high mortality rate. Findings from previous studies addressing the “weekend effect” on the mortality rate from an acute aortic dissection mortality have been inconsistent. Furthermore, the effect of admission for acute aortic dissection during the holiday season has not been previously investigated.ObjectiveOur aim was to evaluate the effect of admission for acute aortic dissection during holiday season or weekends on the risk of mortality.MethodsWe conducted a retrospective analysis of nationwide cohort data from the Taiwan’s National Health Insurance Research Database. We collected data on all adult patients hospitalized for acute aortic dissection between 2001 and 2017 in Taiwan and classified them into the following three groups based on day of admission: holiday season (at least 4 consecutive days; n = 280), weekend (n = 1 041), and weekday (n = 3 109). The following three outcomes were evaluated: in-hospital mortality, 7-day mortality, and 180-day mortality.ResultsA multivariable logistic regression was used to adjust for possible cofounders on the measured outcomes. Compared to weekday admissions for acute aortic dissection, weekend admissions resulted in a 29% increase in the risk of in-hospital death (aOR = 1.29; 95% CI, 1.05–1.59; P = 0.0153), with a 25% increase in the 7-day (aOR = 1.25; 95% CI, 1.001–1.563; P = 0.0492) and 20% increase in the 180-day mortality risk (aOR = 1.20; 95% CI, 1.01–1.42; P = 0.0395). Of note, admission over the holiday season did not result in a higher mortality risk than for weekday admissions; this finding, however, might reflect insufficient statistical power on subgroup analysis.ConclusionPatients admitted for acute aortic dissection during the weekends are at higher risk of mortality compared to those admitted on weekdays. Our finding likely reflects inadequate staffing and team experience of weekend staff and can guide healthcare policy makers to improve patient outcomes.
Highlights
Acute aortic dissection is a life-threatening condition associated with high mortality rate
Patients admitted for acute aortic dissection during the weekends are at higher risk of mortality compared to those admitted on weekdays
In the real world, shortage of staff [2] and lack of staff with subspecialty training [3] during weekends results in a higher risk of mortality for patients admitted with acute aortic dissection, a phenomenon known as the “weekend effect” [4, 5]
Summary
Acute aortic dissection is a life-threatening condition associated with high mortality rate. Despite recent advances in diagnostic and treatment strategies, in-hospital mortality rate was as high as 22% and 14% for patients with acute type A and type B aortic dissection, respectively, according to a recent analysis from the International Registry of Acute Aortic Dissection [1]. A recent analysis from a Nordic Aortic Dissection Database, observed no significant relationship between weekend admissions and mortality risk from an acute aortic dissection [6]. The effect of admission for acute aortic dissection during the holiday season has not been previously investigated
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