背景:在一些周末入院的手术患者中,已证明周末效果以围手术期结果较差为特征,而不是平日。这项研究旨在检查周末对StanfordB型主动脉夹层(TBAD)的开放手术修复或胸血管内动脉瘤修复(TEVAR)的影响。
方法:在2015-2020年第四季度的国家/国家住院患者样本中确定了接受TBAD修复的患者。分别检查开放手术和TEVAR。进行了多变量分析,比较了患者在工作日和周末入院时的住院围手术期结果。调整后的术前变量包括性别,年龄,种族,社会经济地位,医院特色,临床症状,合并症,和选修/非选修录取。此外,逗留时间,从入院到手术的天数,和医院总费用进行了比较。
结果:在接受开放性TBAD修复的患者中,1321人在工作日被录取,340人在周末被录取。在接受TEVAR治疗TBAD的患者中,2018年在工作日录取,440个在周末录取。工作日和周末的开放式修复结果没有差异。在TEVAR,周末入院与更高的术后肾衰竭相关(1.14%vs.20%,aOR=4.11,P=.04)和浅表伤口并发症(2.73%vs1.49%,aOR=2.2,P=.03)但下呼吸道并发症(5.80%vs3.64%,OR=.47,P=.01)。此外,在TEVAR,周末入院与从入院到手术的时间更长相关(3.92±.27vs2.35±.09天,P<.01)。
结论:肾灌注不良是TBAD修复的常见指征。周末入院并接受TEVAR的TBAD患者术后肾衰竭较高,这可能是由于延迟诊断和治疗。
BACKGROUND: Weekend effect characterized by worse perioperative outcomes has been demonstrated in some surgery patients admitted on weekends, as opposed to weekdays. This study aimed to examine weekend effect on open surgical repair or thoracic endovascular aneurysm repair (TEVAR) for Stanford Type B Aortic Dissection (TBAD).
METHODS: Patients who underwent TBAD repair were identified in National/Nationwisde Inpatient Sample from Q4 2015-2020. Open surgery and TEVAR were examined separately. Multivariable analyses were performed comparing in-hospital perioperative outcomes of patients under weekday and weekend admission. Adjusted preoperative variables included sex, age, race, socioeconomic status, hospital characteristics, clinical symptoms, comorbidities, and elective/non-elective admission. Also, length of stay, days from admission to operation, and total hospital charge were compared.
RESULTS: Among patients who underwent open TBAD repair, 1321 were admitted on weekdays and 340 on weekends. Among patients who underwent TEVAR for TBAD, 2018 were admitted on weekdays and 440 wereadmitted on weekends. There was no difference in open repair outcomes between those admitted on weekdays vs weekends. In TEVAR, weekend admission was associated with higher post-procedural kidney failure (1.14% vs .20%, aOR = 4.11, P = .04) and superficial wound complications (2.73% vs 1.49%, aOR = 2.2, P = .03) but lower respiratory complications (5.80% vs 3.64%, aOR = .47, P = .01). Also, in TEVAR, weekend admission was associated with longer time from admission to operation (3.92 ± .27 vs 2.35 ± .09 days, P < .01).
CONCLUSIONS: Renal malperfusion was a common indication for TBAD repair. TBAD patients admitted over the weekend and underwent TEVAR had higher post-procedural kidney failure, which may be due to delayed diagnosis and treatment.