目的:与平日干预相比,周末手术干预的结果与更高的死亡率和并发症发生率相关。虽然先前的研究报告了颈动脉内膜切除术(CEA)的“周末效应”,经颈动脉血运重建术(TCAR)和经股颈动脉支架术(TFCAS)的这种关联尚不清楚.我们调查了所有三种颈动脉血运重建方法的周末效果。
方法:我们查询了接受CEA的患者的血管质量倡议(VQI),TCAR,和TFCAS在2016-2022年之间。卡方和逻辑回归模型分析了结果,包括院内卒中,死亡,MI,和周末30天的死亡率与工作日干预。利用后向逐步回归来识别显著的混杂变量,并最终包括在每个最终的逻辑回归模型中。结果的Logistic回归以症状状态为基础。次要多变量分析比较了周末与周末三种血运重建方法之间的结果。工作日干预。
结果:分析了155,962个程序,包括103,790个CEA,31,666TCAR和20,506TFCAS。其中,1988年CEA,246TCAR和820TFCAS接受了周末干预。Logistic回归显示TCAR无显著差异,CEA[OR:1.31,(1.04-1.65)]和TFCAS[OR:1.46,(1.09-1.96)]周末手术发生院内卒中/死亡/MI的几率增加。无症状TCAR患者30天死亡率的几率几乎是其三倍[OR:2.85,(1.06-7.68),P=0.038]。同样,无症状CEA的住院死亡几率几乎增加了两倍[OR:2.89,(1.30-6.43),P=0.009]和无症状TFCAS[OR:2.78,(1.34-5.76),P=0.006]名患者。次要分析表明,CEA和TCAR在所有结果中没有显着差异。与CEA和TCAR相比,TFCAS与卒中和死亡几率增加相关。
结论:在这项观察性队列研究中,我们发现周末颈动脉血运重建与并发症和死亡率增加相关.此外,在CEA和TFCAS手术组中,周末无症状患者的表现更差.在三种血运重建方法中,TFCAS与围手术期中风和死亡率的最高几率相关。因此,我们的研究结果表明,周末应该避免使用TFCAS程序,赞成CEA或TCAR。在CEA不良候选患者中,TCAR为周末手术提供最低的发病率和死亡率。
OBJECTIVE: Outcomes for weekend surgical interventions are associated with higher rates of mortality and complications compared to weekday interventions. While prior investigations have reported the \'weekend effect\' for carotid endarterectomy (CEA), this association remains unclear for Transcarotid Artery Revascularization (TCAR) and Transfemoral Carotid Artery Stenting (TFCAS). We investigated the weekend effect for all three carotid revascularization methods.
METHODS: We queried the Vascular Quality Initiative (VQI) for patients undergoing CEA, TCAR, and TFCAS between 2016-2022. Chi-square and logistic regression modeling analyzed outcomes including in-hospital stroke, death, MI, and 30-day mortality by weekend vs. weekday intervention. Backward stepwise regression was utilized to identify significant confounding variables and were ultimately included in each final logistic regression model. Logistic regression of outcomes was substratified by symptomatic status. Secondary multivariable analysis compared outcomes between the three revascularization methods by weekend vs. weekday interventions.
RESULTS: 155,962 procedures were analyzed including 103,790 CEA, 31,666 TCAR and 20,506 TFCAS. Of these, 1988 CEA, 246 TCAR and 820 TFCAS received weekend interventions. Logistic regression demonstrated no significant differences for TCAR, and increased odds of in-hospital stroke/death/MI for CEA [OR:1.31,(1.04-1.65)] and TFCAS [OR:1.46,(1.09-1.96)] weekend procedures. Asymptomatic TCAR patients had nearly triple the odds of 30-day mortality [OR:2.85,(1.06-7.68), P=0.038]. Similarly, odds of in-hospital death were nearly tripled for asymptomatic CEA [OR:2.89,(1.30-6.43), P=0.009] and asymptomatic TFCAS [OR:2.78,(1.34-5.76), P=0.006] patients. Secondary analysis demonstrated that CEA and TCAR had no significant differences for all outcomes. TFCAS was associated with increased odds of stroke and death compared to CEA and TCAR.
CONCLUSIONS: In this observational cohort study, we found that weekend carotid revascularization is associated with increased odds of complications and mortality. Furthermore, asymptomatic weekend patients perform worse in the CEA and TFCAS procedural groups. Among the three revascularization methods, TFCAS is associated with the highest odds of perioperative stroke and mortality. As such, our findings suggest that TFCAS procedures should be avoided over the weekend, in favor of CEA or TCAR. In patients who are poor candidates for CEA, TCAR offers the lowest morbidity and mortality for weekend procedures.