Abstract：
OBJECTIVE: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to alleviate portal hypertension in patients with decompensated liver cirrhosis. The weekend effect refers to a higher risk of adverse outcomes associated with procedures performed on weekends compared to weekdays. The goal of this study is to determine whether a weekend effect is evident in TIPS procedures.
METHODS: The study identified patients who underwent TIPS procedures in the NIS database from 2015 to 2020. Patients who were admitted on the weekday or weekends were classified into two cohorts. Preoperative variables, including demographics, comorbidities, primary payer status, and hospital characteristics, were noted. Multivariable analysis was used to assess outcomes.
RESULTS: Compared to patients admitted on the weekdays, weekend patients had higher in-hospital mortality (12.87 % vs. 7.96 %, aOR = 1.62, 95 CI 1.32-1.00, p < 0.01), hepatic encephalopathy (33.24 % vs. 26.18 %, aOR = 1.41, 95 CI 1.23-1.63, p < 0.01), acute kidney injury (39.03 % vs. 28.36 %, aOR = 1.68, 95 CI 1.46-1.93, p < 0.01), and transfer out (15.91 % vs. 12.76 %, aOR=1.33, 95 CI 1.11-1.60, p < 0.01). It was also found that weekend patients had longer wait from admission to operation (3.83 ± 0.15 days vs 2.82 ± 0.07 days, p < 0.01), longer LOS (11.22 ± 0.33 days vs 8.38 ± 0.15 days, p < 0.01), and higher total hospital charge (219,973 ± 7,352 dollars vs 172,663 ± 3,183 dollars, p < 0.01).
CONCLUSIONS: Our research unveiled a significant relationship between weekend admission and a higher risk of mortality and morbidity post-TIPS procedure. Eliminating delays in treatment associated with the weekend effect may mitigate this gap to deliver consistent and high-quality care to all patients.
METHODS: The study identified patients who underwent TIPS procedures in the NIS database from 2015 to 2020. Patients who were admitted on the weekday or weekends were classified into two cohorts. Preoperative variables, including demographics, comorbidities, primary payer status, and hospital characteristics, were noted. Multivariable analysis was used to assess outcomes.
RESULTS: Compared to patients admitted on the weekdays, weekend patients had higher in-hospital mortality (12.87 % vs. 7.96 %, aOR = 1.62, 95 CI 1.32-1.00, p < 0.01), hepatic encephalopathy (33.24 % vs. 26.18 %, aOR = 1.41, 95 CI 1.23-1.63, p < 0.01), acute kidney injury (39.03 % vs. 28.36 %, aOR = 1.68, 95 CI 1.46-1.93, p < 0.01), and transfer out (15.91 % vs. 12.76 %, aOR=1.33, 95 CI 1.11-1.60, p < 0.01). It was also found that weekend patients had longer wait from admission to operation (3.83 ± 0.15 days vs 2.82 ± 0.07 days, p < 0.01), longer LOS (11.22 ± 0.33 days vs 8.38 ± 0.15 days, p < 0.01), and higher total hospital charge (219,973 ± 7,352 dollars vs 172,663 ± 3,183 dollars, p < 0.01).
CONCLUSIONS: Our research unveiled a significant relationship between weekend admission and a higher risk of mortality and morbidity post-TIPS procedure. Eliminating delays in treatment associated with the weekend effect may mitigate this gap to deliver consistent and high-quality care to all patients.
摘要：
目的：经颈静脉肝内门体分流术（TIPS）是一种用于缓解失代偿期肝硬化患者门脉高压的手术。与工作日相比，周末效应是指与周末进行的手术相关的不良后果的风险更高。这项研究的目的是确定周末效应在TIPS程序中是否明显。
方法：该研究确定了2015年至2020年在NIS数据库中接受TIPS手术的患者。在工作日或周末入院的患者被分为两组。术前变量,包括人口统计，合并症,主要付款人身份，和医院的特点，被注意到。多变量分析用于评估结果。
结果：与平日入院的患者相比，周末患者住院死亡率较高(12.87%vs.7.96%,OR=1.62,95CI1.32-1.00,p<0.01),肝性脑病（33.24%vs.26.18%,OR=1.41，95CI1.23-1.63，p<0.01)，急性肾损伤（39.03%vs.28.36%,OR=1.68，95CI1.46-1.93，p<0.01)，并转出(15.91%与12.76%,OR=1.33，95CI1.11-1.60，p<0.01）。还发现周末患者从入院到手术的等待时间更长（3.83±0.15天vs2.82±0.07天，p<0.01),LOS更长(11.22±0.33天vs8.38±0.15天，p<0.01),和更高的总住院费用(219,973±7,352美元vs172,663±3,183美元，p<0.01)。
结论：我们的研究揭示了周末入院与TIPS手术后更高的死亡率和发病率之间的显著关系。消除与周末效应相关的治疗延迟可能会减轻这种差距，从而为所有患者提供一致和高质量的护理。
方法：该研究确定了2015年至2020年在NIS数据库中接受TIPS手术的患者。在工作日或周末入院的患者被分为两组。术前变量,包括人口统计，合并症,主要付款人身份，和医院的特点，被注意到。多变量分析用于评估结果。
结果：与平日入院的患者相比，周末患者住院死亡率较高(12.87%vs.7.96%,OR=1.62,95CI1.32-1.00,p<0.01),肝性脑病（33.24%vs.26.18%,OR=1.41，95CI1.23-1.63，p<0.01)，急性肾损伤（39.03%vs.28.36%,OR=1.68，95CI1.46-1.93，p<0.01)，并转出(15.91%与12.76%,OR=1.33，95CI1.11-1.60，p<0.01）。还发现周末患者从入院到手术的等待时间更长（3.83±0.15天vs2.82±0.07天，p<0.01),LOS更长(11.22±0.33天vs8.38±0.15天，p<0.01),和更高的总住院费用(219,973±7,352美元vs172,663±3,183美元，p<0.01)。
结论：我们的研究揭示了周末入院与TIPS手术后更高的死亡率和发病率之间的显著关系。消除与周末效应相关的治疗延迟可能会减轻这种差距，从而为所有患者提供一致和高质量的护理。
