Is There a “Weekend Effect” on In-Hospital Outcomes of Type a Aortic Dissection Repair? A Population-Based Analysis of National Inpatient Sample From 2015-2020

Abstract

Background

“Weekend effect” in type A aortic dissection (TAAD) repair has been identified in several countries where weekend admission is associated with higher mortality rates. However, in the US, findings have been mixed regarding the “weekend effect” on TAAD outcomes. This study aimed to conduct a comprehensive, population-based analysis of the association between weekend admission and the in-hospital outcomes of TAAD repair using a large-scale national registry.

Methods

Patients who underwent TAAD repair were identified in National Inpatient Sample from Q4 2015–2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients admitted on the weekend vs weekday, where demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status were adjusted.

Results

There were 1007 and 3275 patients who underwent TAAD repair under weekend and weekday admission, respectively. Patients admitted on the weekend were more likely to get transferred in from a different acute care hospital and have renal malperfusion. After multivariable analysis, patients admitted on the weekend and weekday had comparable times from admission to operation (0.88 ± 2.64 vs 0.92 ± 2.99 days, P = 0.64) and in-hospital mortality (15.99% vs 14.84%, aOR = 1.119, 95 CI = 0.914-1.37, P = 0.28). All other in-hospital outcomes, hospital length of stay, and total hospital charge were similar between the 2 cohorts.

Conclusion

Patients admitted on weekends and weekdays had comparable times from admission to operation, as well as similar in-hospital mortality and morbidities. These findings suggest the effectiveness of weekend emergency care protocols for TAAD patients and the lack of a “weekend effect” on TAAD repair in the United States.